Dimensions and Role-Specific Mediators of Surrogate Trust in the ICU.

PubMed

Hutchison, Paul J; McLaughlin, Katie; Corbridge, Tom; Michelson, Kelly N; Emanuel, Linda; Sporn, Peter H S; Crowley-Matoka, Megan

2016-12-01

In the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient's prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU. Prospective qualitative study. Medical ICU of a major urban university hospital. Surrogate decision makers of intubated, mechanically ventilated patients in the medical ICU. Semistructured interviews focused on surrogates' general experiences in the ICU and on their trust in the clinicians caring for the patient. Interviews were audio-recorded, transcribed verbatim, and coded by two reviewers. Constant comparison was used to identify themes pertaining to trust. Thirty surrogate interviews revealed five dimensions of trust in ICU clinicians: technical competence, communication, honesty, benevolence, and interpersonal skills. Most surrogates emphasized the role of nurses in trust formation, frequently citing their technical competence. Trust in physicians was most commonly related to honesty and the quality of their communication with surrogates. Interventions to improve trust in the ICU should be role-specific, since surrogate expectations are different for physicians and nurses with regard to behaviors relevant to trust. Further research is needed to confirm our findings and explore the impact of trust modification on clinician-family conflict.

Addressing Library Anxiety (LA) in student nurses: a study in an NHS Foundation Trust Hospital library and information service.

PubMed

Still, Madeleine

2015-12-01

Library anxiety is a concept which has been recognised in academic library circles since the early 1990s. It can result in students actively avoiding the library for the duration of their studies. Madeleine Still is Trust Librarian at North Tees & Hartlepool NHS Foundation Trust and while studying for an MSc, recognised that some student nurses were exhibiting signs of library anxiety. She decided to make it the focus of her MSc dissertation, and this article discusses her research project as well as highlighting the measures she has taken to address the issues she uncovered. Madeleine graduated in July 2013 with an MSc in Information & Library Studies from Robert Gordon University. © 2015 Health Libraries Group.

From vision to reality--managing change in the provision of library and information services to nurses, midwives, health visitors and PAMs: (professions allied to medicine) a case study of the North Thames experience with the Inner London Consortium.

PubMed

Godbolt, S; Williamson, J; Wilson, A

1997-06-01

One of the North Thames' pioneering consortia, the Inner London Consortium (ILC) is a complex body which includes NHS Trusts with teaching hospital university connections, community-based Trusts and general hospital acute Trusts. Within the consortium there are 12,000 trained nurses, midwives, health visitors and other professional staff working in the professions allied to medicine (PAMs), all of whom require access to and provision of appropriate library information services. In 1994, taking into account experiences elsewhere in the Region and nationally, it became clear that library issues were complex and would become acute with the move of nursing libraries from ILC Trust sites over a very short timescale. A report on the issues commissioned by the Consortium recommended that a library project, which built on existing NHS Trust PGMDE funded library resources and moved these to a multidisciplinary base to serve the consortium membership, be implemented. The objective of providing access to library information services for nurses and PAMs was achieved. Successes that emerged from the implementation included: The registration in Trust libraries of almost 12 000 new members within the initial 6-month monitoring period. The development of service level agreements and standards for the delivery of services to these new user groups. This paper describes the processes behind these significant and complex changes.

The most dangerous hospital or the most dangerous equation?

PubMed

Tu, Yu-Kang; Gilthorpe, Mark S

2007-11-15

Hospital mortality rates are one of the most frequently selected indicators for measuring the performance of NHS Trusts. A recent article in a national newspaper named the hospital with the highest or lowest mortality in the 2005/6 financial year; a report by the organization Dr Foster Intelligence provided information with regard to the performance of all NHS Trusts in England. Basic statistical theory and computer simulations were used to explore the relationship between the variations in the performance of NHS Trusts and the sizes of the Trusts. Data of hospital standardised mortality ratio (HSMR) of 152 English NHS Trusts for 2005/6 were re-analysed. A close examination of the information reveals a pattern which is consistent with a statistical phenomenon, discovered by the French mathematician de Moivre nearly 300 years ago, described in every introductory statistics textbook: namely that variation in performance indicators is expected to be greater in small Trusts and smaller in large Trusts. From a statistical viewpoint, the number of deaths in a hospital is not in proportion to the size of the hospital, but is proportional to the square root of its size. Therefore, it is not surprising to note that small hospitals are more likely to occur at the top and the bottom of league tables, whilst mortality rates are independent of hospital sizes. This statistical phenomenon needs to be taken into account in the comparison of hospital Trusts performance, especially with regard to policy decisions.

Trust between managers and physicians in community hospitals: the effects of power over hospital decisions.

PubMed

Succi, M J; Lee, S Y; Alexander, J A

1998-01-01

Trust is a key element of effective work relationships between managers and physicians. Despite its importance, little is known about the factors that promote trust between these two professional groups. We examine whether manager and physician power over hospital decisions fosters manager-physician trust. We expect that with more power, managers and physicians will have greater control to enforce decisions that benefit the interests of both groups. Subsequently, they may gain confidence that their interests are supported and have more trust for each other. We test proposed hypotheses with data collected in a national study of chief executive officers and physician leaders in community hospitals in 1993. Findings indicate that power of managers and physicians over hospital decisions is related to manager-physician trust. Consistent with our expectations, physicians perceive greater trust between the two groups when they hold more power in four separate decision-making areas. Our hypotheses, however, are only partially supported in the manager sample. The relationship between power and trust holds in only one decision area: cost/quality management. Our findings have important implications for physician integration in hospitals. A direct implication is that physicians should be given the opportunity to influence hospital decisions. New initiatives, such as task force committees with open membership or open forums on hospital management, allow physicians a more substantial involvement in decisions. Such initiatives will give physicians more "voice" in hospital decision making, thus creating opportunities for physicians to express their interests and play a more active role in the pursuit of the hospital's mission and objectives.

'Waiting for' and 'waiting in' public and private hospitals: a qualitative study of patient trust in South Australia.

PubMed

Ward, Paul R; Rokkas, Philippa; Cenko, Clinton; Pulvirenti, Mariastella; Dean, Nicola; Carney, A Simon; Meyer, Samantha

2017-05-05

Waiting times for hospital appointments, treatment and/or surgery have become a major political and health service problem, leading to national maximum waiting times and policies to reduce waiting times. Quantitative studies have documented waiting times for various types of surgery and longer waiting times in public vs private hospitals. However, very little qualitative research has explored patient experiences of waiting, how this compares between public and private hospitals, and the implications for trust in hospitals and healthcare professionals. The aim of this paper is to provide a deep understanding of the impact of waiting times on patient trust in public and private hospitals. A qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals). Data collection occurred in 2012-13, and data were analysed using pre-coding, followed by conceptual and theoretical categorisation. Participants differentiated between experiences of 'waiting for' (e.g. for specialist appointments and surgery) and 'waiting in' (e.g. in emergency departments and outpatient clinics) public and private hospitals. Whilst 'waiting for' public hospitals was longer than private hospitals, this was often justified and accepted by public patients (e.g. due to reduced government funding), therefore it did not lead to distrust of public hospitals. Private patients had shorter 'waiting for' hospital services, increasing their trust in private hospitals and distrust of public hospitals. Public patients also recounted many experiences of longer 'waiting in' public hospitals, leading to frustration and anxiety, although they rarely blamed or distrusted the doctors or nurses, instead blaming an underfunded system and over-worked staff. Doctors and nurses were seen to be doing their best, and therefore trustworthy. Although public patients experienced longer 'waiting for' and 'waiting in' public hospitals, it did not lead to widespread distrust in public hospitals or healthcare professionals. Private patients recounted largely positive stories of reduced 'waiting for' and 'waiting in' private hospitals, and generally distrusted public hospitals. The continuing trust by public patients in the face of negative experiences may be understood as a form of exchange trust norm, in which institutional trust is based on base-level expectations of consistency and minimum standards of care and safety. The institutional trust by private patients may be understood as a form of communal trust norm, whereby trust is based on the additional and higher-level expectations of flexibility, reduced waiting and more time with healthcare professionals.

[Increased revenues from secondary diagnoses : A comparison from dermatology, ophthalmology, and infectious diseases].

PubMed

Blaschke, V; Brauns, B; Khaladj, N; Schmidt, C; Emmert, S

2018-02-27

Hospital revenues generated by diagnosis-related groups (DRGs) are in part dependent on the coding of secondary diagnoses. Therefore, more and more hospitals trust specialized coders with this task, thereby relieving doctors from time-consuming administrative burdens and establishing a highly professionalized coding environment. However, it is vastly unknown if the revenues generated by the coders do indeed exceed their incurred costs. Coding data from the departments of dermatology, ophthalmology, and infectious diseases from Rostock University Hospital from 2007-2016 were analyzed for the effects of secondary diagnoses on the resulting DRG, i. e., hospital charges. Ophthalmological case were highly resistant to the addition of secondary diagnoses. In contrast, adding secondary diagnoses to cases from infectious diseases resulted in 15% higher revenues. Although dermatological and infectious cases share the same sensitivity to secondary diagnoses, higher revenues could only rarely be realized in dermatology, probably owing to a younger, less multimorbid patient population. Except for ophthalmology, trusting specialized coders with clinical coding generates additional revenues through the coding of secondary diagnoses which exceed the costs for employing these coders.

Race and trust in the health care system.

PubMed

Boulware, L Ebony; Cooper, Lisa A; Ratner, Lloyd E; LaVeist, Thomas A; Powe, Neil R

2003-01-01

A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross-sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans. Respondents ages 18-75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.

PubMed

2004-09-01

Drink drive: emergency care alcohol liaison nurse at Selly Oak Hospital, Birmingham, Sarah Needham has secured funding from University Hospital Birmingham NHS Trust to set up a nine-month alcohol liaison pilot project. Ms Needham, whose work won her the Tyco Healthcare UK and RCN A&E Nursing Association award in 2000, is due to speak on the topic next month at a conference in Birmingham on tackling alcohol abuse. For details of the conference on October 11, call 0121 765 4222 or email castle.comm@which.net.

Victimization and Vulnerability: A Study of Incarceration, Interpersonal Trauma, and Patient-Physician Trust.

PubMed

Junewicz, Alexandra; Kleinert, Kelly J; Dubler, Nancy Neveloff; Caplan, Arthur

2017-09-01

Despite the critical importance of patient-physician trust, it may be compromised among vulnerable patients, such as (1) incarcerated patients and (2) those patients who have been victims of trauma. The purpose of this study was to examine patient-physician trust among forensic and civilian psychiatric inpatient populations and to explore whether it varied based on a patient's history of incarceration and/or victimization. A trust survey (WFPTS) and a trauma instrument (LEC-5) were administered to 93 patients hospitalized on forensic and civilian psychiatric hospital units in a large, urban public hospital. Results showed no difference in patient-physician trust between incarcerated and civilian patients. Similarly, there was no effect of a history of physical assault or sexual assault on ratings of patient-physician trust. However, the hospitalized civilian and forensic patients who reported being the victim of weapons assault had significantly lower patient-physician trust scores than their counterparts.

The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China.

PubMed

Tang, Liyang

2012-09-14

Patient's satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient's life satisfaction in China's health delivery system/in various kinds of hospitals.The aim of this study was to test whether and to what extent patient's satisfaction with medical service delivery/patient's assessments of various major aspects of medical service/various major aspects of patient's trust in health delivery system influenced patient's life satisfaction in China's health delivery system/in various kinds of hospitals. This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. The key considerations in generating patient's life satisfaction involved patient's overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient's life satisfaction were different among low level public hospital, high level public hospital, and private hospital. The promotion of patient's overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient's trust in prescription, the promotion of patient's trust in doctor, and the promotion of patient's trust in recommended medical examination could all help promote patient's life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital.

The Effect of Hospital Service Quality on Patient's Trust.

PubMed

Zarei, Ehsan; Daneshkohan, Abbas; Khabiri, Roghayeh; Arab, Mohammad

2015-01-01

The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient's trust is the service quality. This study aimed to examine the effect of quality of services provided in private hospitals on the patient's trust. In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P < 0.001) were the strongest factors in predicting patient's trust, but the quality of the environment had no significant effect on the patients' degree of trust. The interaction quality and process quality were the key determinants of patient's trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff.

[Path analysis of the Influence of Hospital Ethical Climate Perceived by Nurses on Supervisor Trust and Organizational Effectiveness].

PubMed

Noh, Yoon Goo; Jung, Myun Sook

2016-12-01

The purpose of this study was to analyze the paths of influence that a hospital's ethical climate exerts on nurses' organizational commitment and organizational citizenship behavior, with supervisor trust as the mediating factor, and verify compatibility of the models in hospital nurses. The sample consisted of 374 nurses recruited from four hospitals in 3 cities in Korea. The measurements included the Ethical Climate Questionnaire, Supervisor Trust Questionnaire, Organizational Commitment Questionnaire and Organizational Citizenship Behavior Questionnaire. Ethical Climate Questionnaire consisted of 6 factors; benevolence, personal morality, company rules and procedures, laws and professional codes, self-interest and efficiency. Data were analysed using SPSS version 18.0 and AMOS version 18.0. Supervisor trust was explained by benevolence and self-interest (29.8%). Organizational commitment was explained by benevolence, supervisor trust, personal morality, and rules and procedures (40.4%). Organizational citizenship behavior was explained by supervisor trust, laws and codes, and benevolence (21.8%). Findings indicate that managers need to develop a positive hospital ethical climate in order to improve nurses' trust in supervisors, organizational commitment and organizational citizenship behavior.

Discussion on wound care in the 21st century.

PubMed

Harrison, Mary

In June of this year, Liverpool John Moores University was the venue for the Advancing Wound Care conference. Experts in wound healing from both the university and from the Royal Liverpool and Broadgreen University Hospital NHS Trust gave keynote speeches aimed at informing, improving and advancing healthcare knowledge on such topics as: wound healing in the 21st century; evidence-based practice for superficial burns; infected and complex wounds; and the use of silver in wound care. This paper introduced the conference and considered some of the complex issues involved in clinical decision making for wound management.

The Effect of Hospital Service Quality on Patient's Trust

PubMed Central

Zarei, Ehsan; Daneshkohan, Abbas; Khabiri, Roghayeh; Arab, Mohammad

2014-01-01

Background: The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient’s trust is the service quality. Objectives: This study aimed to examine the effect of quality of services provided in private hospitals on the patient’s trust. Patients and Methods: In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. Results: The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P < 0.001) were the strongest factors in predicting patient’s trust, but the quality of the environment had no significant effect on the patients' degree of trust. Conclusions: The interaction quality and process quality were the key determinants of patient’s trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff. PMID:25763258

Safe transport from a specialist paediatric intensive care unit to a referral hospital.

PubMed

Solomon, Jennifer; Clarke, Dave

2009-12-01

There are 23 paediatric intensive care units (PICU) in the UK and 19 of these have a retrieval team responsible for the safe and uneventful transfer of critically ill children from referring hospitals. There are two established PICUs in University Hospitals of Leicester (UHL) NHS Trust that work as a team. In 2001, a transfer service was introduced to support the UHL PICU retrieval service and the referring district general hospitals. At the time of writing this article there was no other PICU in the UK providing a dedicated paediatric clinical transport nurse service, whose main responsibility is the safe transfer of infants and children back to their local hospitals. This article will discuss the development of this service and the benefits to PICU and referral hospitals.

Hospital trust engagement with a new vocational learning programme for pharmacists and pharmacy technicians in England.

PubMed

SchafheutleEllen, I; Noyce, Peter R; Cutts, Christopher

2009-08-01

This study aimed to explore hospital trusts' uptake of Learning@Lunch (L@L), a new vocational learning programme for hospital pharmacists and pharmacy technicians in acute and mental health trusts in England, recently introduced by the Centre for Pharmacy Postgraduate Education (CPPE). The CPPE's ordering database for the first eight L@L modules, with addition of hospital trust and pharmacy characteristics, was analysed using SPSS, providing simple frequencies and chi2 cross-tabulations. The CPPE database contained data for 168 acute and 73 mental health trusts, about a third of each being foundation trusts. One-third (33.3%) of acute trusts were teaching, and the majority of them (91.1%) offered pre-registration places for 2009, the mean number being 3.39; only three mental health trusts offered places. L@L uptake by specialist and mental health trusts was lower than by those providing general services. Uptake was highest in the North and South, and lowest in London. Acute trusts with zero to two pre-registration places had a higher uptake than those offering three or more. Despite limitations of the database, analysis provides interesting insights into the uptake of this new learning programme, which are of interest to CPPE, as well as pharmacy academics and educationalists. L@L uptake by specialist and mental health trusts was significantly lower than that by acute trusts providing general services. Reasons for this need to be explored further to ensure that CPPE and other learning providers can meet the needs of hospital pharmacists and pharmacy technicians working in specialist areas, thus ensuring refresher training in core clinical areas.

Ethical climate as a moderator between organizational trust and whistle-blowing among nurses and secretaries

PubMed Central

Aydan, Seda; Kaya, Sidika

2018-01-01

Objectives: To reveal the effect of perception of ethical climate by nurses and secretaries and their level of organizational trust on their whistleblowing intention. Methods: Nurses and secretaries working in a University Hospital in Ankara, Turkey, were enrolled in the study conducted in 2016. Responses were received from 369 nurses and secretaries working at Clinics and Polyclinics. Path analysis, investigation of structural equation models used while multi-regression analysis was also applied. Results: According to the regression model, ethical climate dimensions, profession, gender, and work place had significant impact on the whistleblowing intention. According to Path analysis, ethical climate had direct impact of 69% on whistleblowing intention. It was seen that organizational trust had an indirect impact of 27% on the whistleblowing score when ethical climate had a moderator role. Conclusion: In order to promote whistleblowing in organizations, it is important to keep the ethical climate perception of employees and the level of their organizational trust at high levels. PMID:29805421

Ethical climate as a moderator between organizational trust and whistle-blowing among nurses and secretaries.

PubMed

Aydan, Seda; Kaya, Sidika

2018-01-01

To reveal the effect of perception of ethical climate by nurses and secretaries and their level of organizational trust on their whistleblowing intention. Nurses and secretaries working in a University Hospital in Ankara, Turkey, were enrolled in the study conducted in 2016. Responses were received from 369 nurses and secretaries working at Clinics and Polyclinics. Path analysis, investigation of structural equation models used while multi-regression analysis was also applied. According to the regression model, ethical climate dimensions, profession, gender, and work place had significant impact on the whistleblowing intention. According to Path analysis, ethical climate had direct impact of 69% on whistleblowing intention. It was seen that organizational trust had an indirect impact of 27% on the whistleblowing score when ethical climate had a moderator role. In order to promote whistleblowing in organizations, it is important to keep the ethical climate perception of employees and the level of their organizational trust at high levels.

The influences of patient's satisfaction with medical service delivery, assessment of medical service, and trust in health delivery system on patient's life satisfaction in China

PubMed Central

2012-01-01

Background Patient’s satisfaction with medical service delivery/assessment of medical service/trust in health delivery system may have significant influence on patient’s life satisfaction in China’s health delivery system/in various kinds of hospitals. The aim of this study was to test whether and to what extent patient’s satisfaction with medical service delivery/patient’s assessments of various major aspects of medical service/various major aspects of patient’s trust in health delivery system influenced patient’s life satisfaction in China’s health delivery system/in various kinds of hospitals. Methods This study collaborated with National Bureau of Statistics of China to carry out a 2008 national urban resident household survey in 17 provinces, autonomous regions, and municipalities directly under the central government (N = 3,386), and specified ordered probit models were established to analyze dataset from this household survey. Results The key considerations in generating patient’s life satisfaction involved patient’s overall satisfaction with medical service delivery, assessment of doctor-patient communication, assessment of medical cost, assessment of medical treatment process, assessment of medical facility and hospital environment, assessment of waiting time for medical service, trust in prescription, trust in doctor, and trust in recommended medical examination. But the major considerations in generating patient’s life satisfaction were different among low level public hospital, high level public hospital, and private hospital. Conclusion The promotion of patient’s overall satisfaction with medical service delivery, the improvement of doctor-patient communication, the reduction of medical cost, the improvement of medical treatment process, the promotion of medical facility and hospital environment, the reduction of waiting time for medical service, the promotion of patient’s trust in prescription, the promotion of patient’s trust in doctor, and the promotion of patient’s trust in recommended medical examination could all help promote patient’s life satisfaction. But their promotion effects were different among low level public hospital, high level public hospital, and private hospital. PMID:22978432

Evaluating the impact of the reconfiguration of gynaecology services at a University Hospital NHS trust in the United Kingdom.

PubMed

Choo, Teck; Deb, Shilpa; Wilkins, Joanne; Atiomo, William

2014-09-24

The project aim was to investigate the impact of reconfiguring gynaecology services on the key performance indicators of a University Hospital NHS Trust in the UK. The reconfiguration involved the centralisation of elective gynaecology on one hospital site and emergency gynaecology on the other. Data measuring outcomes of the Trust's performance indicators (clinical outcomes, patient experience, staff satisfaction, teaching/training, research/development and value for money) were collected. Two time periods, 12 months before and after the reconfiguration in March 2011, were compared for all outcome measures except patient experience. Retrospective data from the hospitals audit department on clinical activity/outcomes and emergency gynaecology patient's feedback questionnaires were analysed. Staff satisfaction, teaching/training and research/development were measured through an online survey of gynaecology consultants. Post reconfiguration, the total number of admissions reduced by 6% (6,867 vs 6,446). There was a 14% increase in elective theatre sessions available (902.29 vs 1030.57) and an 84% increase in elective theatre sessions cancelled (44.43 vs 81.71). However, the average number of elective operations performed during each theatre session remained similar (2.63 vs 2.5). There was a significant increase in medical devices related clinical incidents (2 vs 11). With patient experience, there was a significant reduction in patient's overall length of stay on the emergency gynaecology ward and waiting times for investigations. For staff satisfaction, Consultants were significantly more dissatisfied with workload (3.45 vs 2.85) and standards of care (3.75 vs 2.93). With research and development, consultants remained dissatisfied with time/funding/opportunities for research. No significant impact on undergraduate/postgraduate teaching was found. No financial data on gynaecology was provided for the assessment of value for money. Reconfiguration of gynaecology services at this Trust may have resulted in a reduction in gynaecological activity and increased cancellation of elective operations but did not significantly reduce the number of elective operations performed. Although consultants expressed increased dissatisfaction with standards of clinical care, clinical incident reports did not significantly increase apart from medical devices incidents. Patient experience of emergency gynaecology services was improved. This manuscript provides a framework for similar exercises evaluating the impact of service redesign in the NHS.

Power and trust in organizational relations: an empirical study in Turkish public hospitals.

PubMed

Bozaykut, Tuba; Gurbuz, F Gulruh

2015-01-01

Given the salience of the interplay between trust and power relations in organizational settings, this paper examines the perceptions of social power and its effects on trust in supervisors within the context of public hospitals. Following the theoretical background from which the study model is developed, the recent situation of hospitals within Turkish healthcare system is discussed to further elucidate the working conditions of physicians. Sample data were collected employing a structured questionnaire that was distributed to physicians working at seven different public hospitals. The statistical analyses indicate that perceptions of supervisors' social power affect subordinates' trust in supervisors. Although coercive power is found to have the greatest impact on trust in supervisors, the influence of the power base is weak. In addition, the results show that perceptions of social power differ between genders. However, the results do not support any of the hypotheses regarding the relations between trust in supervisors and the examined demographic variables. Copyright © 2014 John Wiley & Sons, Ltd.

An evaluation on the effectiveness of Web 2.0 Startpages (Netvibes & Pageflakes) within NHS libraries.

PubMed

McCormick, Carol; Pickard, Alison Jane

2013-06-01

Carol McCormick was Learning Resources Advisor in the library at James Cook University Hospital, South Teesside when she completed her BSc (Hons) Librarianship (Work Based Learning) degree at Northumbria University. She gained a 1st Class Honours and is now Learning Resources Librarian. Carol's dissertation formed part of a wider action research project into the provision of current awareness services at James Cook University Hospital. This article reports on the evaluation which was conducted after a Web 2.0 Startpage, or portal, had been introduced to improve access to current awareness information for all staff within the Trust. It is the second article in the Dissertations into practice series to examine the use of web-based tools to improve access to information for NHS staff. AM. © 2013 The authors. Health Information and Libraries Journal © 2013 Health Libraries Group.

Respect, trust, and the management of sickle cell disease pain in hospital: comparative analysis of concern-raising behaviors, preliminary model, and agenda for international collaborative research to inform practice

PubMed Central

Elander, James; Beach, Mary Catherine; Haywood, Carlton

2011-01-01

Background/objectives Qualitative interview studies suggest that adult patients’ experiences of hospital treatment for sickle cell disease (SCD) pain reflect an absence of respect by providers for patients, and an absence or breakdown of trust. Systematic comparisons between treatment settings could help identify contextual influences on respect and trust. Design Quantitative comparison of concern-raising behaviors (pain treatment outcomes indicating breakdowns of trust) among adult SCD patients in Baltimore, Maryland, USA, and London, UK, followed by analysis of potential explanations for differences, including socio-cultural and behavioral factors, with a preliminary model of the processes leading to concern-raising behaviors. Results Rates of concern-raising behaviors were significantly higher in Baltimore than London. The model identifies respect and trust as key factors which could be targeted in efforts to improve the quality of SCD pain management in hospital. Conclusion An agenda for international, interdisciplinary research to improve the treatment of SCD pain in hospital should include: comparative analyses between countries and treatment settings of factors that could influence respect and trust; research to test hypotheses derived from models about the roles of respect and trust in the treatment of pain; studies of the impact of healthcare structures and policy on patients’ experiences of care; research focusing on developmental and interpersonal processes related to respect and trust; applications of attribution and other social psychology theories; and development and evaluation of interventions to improve the hospital treatment of SCD pain by increasing respect and trust. PMID:21797726

The influence of a local, media covered hospital incident on public trust in health care.

PubMed

van der Schee, Evelien; de Jong, Judith D; Groenewegen, Peter P

2012-08-01

Incidents in health care happen every now and then. Incidents are often extensively covered by the news media. In this study, we investigated the impact of an incident in a Dutch hospital on public trust in health care in the population living in the vicinity of where the incident took place and in the national population. News media coverage of the incident started in Fall 2008. We collected data in three samples, using a postal questionnaire on public trust in health care. Two samples were a cross-section of the Dutch population; one was questioned in October 2006 and the other in October 2008. The third sample, also questioned in October 2008, consisted of 1000 people living in the surrounding area of the hospital where the incident occurred. The cross-sectional sample of October 2006 was a reference group, and at that time no incidents in health care were covered in the media. In the local population, the incident had a strong impact on public trust in the hospital and among the specialists working there. Also, in the local population, the impact of the incident was generalized to trust in hospitals and specialists in general. In the national population, no impact of the incident on the public's trust was found, despite national news media coverage. Local incidents have an impact on public trust in health care in the local population. However, these incidents do not influence public trust in health care in the national population.

Impact of case-mix on comparisons of patient-reported experience in NHS acute hospital trusts in England.

PubMed

Raleigh, Veena; Sizmur, Steve; Tian, Yang; Thompson, James

2015-04-01

To examine the impact of patient-mix on National Health Service (NHS) acute hospital trust scores in two national NHS patient surveys. Secondary analysis of 2012 patient survey data for 57,915 adult inpatients at 142 NHS acute hospital trusts and 45,263 adult emergency department attendees at 146 NHS acute hospital trusts in England. Changes in trust scores for selected questions, ranks, inter-trust variance and score-based performance bands were examined using three methods: no adjustment for case-mix; the current standardization method with weighting for age, sex and, for inpatients only, admission method; and a regression model adjusting in addition for ethnicity, presence of a long-term condition, proxy response (inpatients only) and previous emergency attendances (emergency department survey only). For both surveys, all the variables examined were associated with patients' responses and affected inter-trust variance in scores, although the direction and strength of impact differed between variables. Inter-trust variance was generally greatest for the unadjusted scores and lowest for scores derived from the full regression model. Although trust scores derived from the three methods were highly correlated (Kendall's tau coefficients 0.70-0.94), up to 14% of trusts had discordant ranks of when the standardization and regression methods were compared. Depending on the survey and question, up to 14 trusts changed performance bands when the regression model with its fuller case-mix adjustment was used rather than the current standardization method. More comprehensive case-mix adjustment of patient survey data than the current limited adjustment reduces performance variation between NHS acute hospital trusts and alters the comparative performance bands of some trusts. Given the use of these data for high-impact purposes such as performance assessment, regulation, commissioning, quality improvement and patient choice, a review of the long-standing method for analysing patient survey data would be timely, and could improve rigour and comparability across the NHS. Performance comparisons need to be perceived as fair and scientifically robust to maintain confidence in publicly reported data, and to support their use by both the public and the NHS. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals.

PubMed

Raghavendran, S; Bagry, H S; Leith, S; Budd, J M

2006-09-01

Hospital staff are at risk from occupational exposure to blood-borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.

Breast cancer patients' trust in physicians: the impact of patients' perception of physicians' communication behaviors and hospital organizational climate.

PubMed

Kowalski, Christoph; Nitzsche, Anika; Scheibler, Fueloep; Steffen, Petra; Albert, Ute-Susann; Pfaff, Holger

2009-12-01

To examine whether patients' perception of a hospital's organizational climate has an impact on their trust in physicians after accounting for physicians' communication behaviors as perceived by the patients and patient characteristics. Patients undergoing treatment in breast centers in the German state of North Rhein-Westphalia in 2006 were asked to complete a standardized postal questionnaire. Disease characteristics were then added by the medical personnel. Multiple linear regressions were performed. 80.5% of the patients responded to the survey. 37% of the variance in patients' trust in physicians can be explained by the variables included in our final model (N=2226; R(2) adj.=0.372; p<0.001). Breast cancer patients' trust in their physicians is strongly associated with their perception of a hospital's organizational climate. The impact of their perception of physicians' communication behaviors persists after introducing hospital organizational characteristics. Perceived physician accessibility shows the strongest association with trust. A trusting physician-patient relationship among breast cancer patients is associated with both the perceived quality of the hospital organizational climate and perceived physicians' communication behaviors. With regard to clinical organization, efforts should be put into improving the organizational climate and making physicians more accessible to patients.

The national one week prevalence audit of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening 2012.

PubMed

Fuller, Christopher; Robotham, Julie; Savage, Joanne; Hopkins, Susan; Deeny, Sarah R; Stone, Sheldon; Cookson, Barry

2013-01-01

The English Department of Health introduced universal MRSA screening of admissions to English hospitals in 2010. It commissioned a national audit to review implementation, impact on patient management, admission prevalence and extra yield of MRSA identified compared to "high-risk" specialty or "checklist-activated" screening (CLAS) of patients with MRSA risk factors. National audit May 2011. Questionnaires to infection control teams in all English NHS acute trusts, requesting number patients admitted and screened, new or previously known MRSA; MRSA point prevalence; screening and isolation policies; individual risk factors and patient management for all new MRSA patients and random sample of negatives. 144/167 (86.2%) trusts responded. Individual patient data for 760 new MRSA patients and 951 negatives. 61% of emergency admissions (median 67.3%), 81% (median 59.4%) electives and 47% (median 41.4%) day-cases were screened. MRSA admission prevalence: 1% (median 0.9%) emergencies, 0.6% (median 0.4%) electives, 0.4% (median 0%) day-cases. Approximately 50% all MRSA identified was new. Inpatient MRSA point prevalence: 3.3% (median 2.9%). 104 (77%) trusts pre-emptively isolated patients with previous MRSA, 63 (35%) pre-emptively isolated admissions to "high-risk" specialties; 7 (5%) used PCR routinely. Mean time to MRSA positive result: 2.87 days (±1.33); 37% (219/596) newly identified MRSA patients discharged before result available; 55% remainder (205/376) isolated post-result. In an average trust, CLAS would reduce screening by 50%, identifying 81% of all MRSA. "High risk" specialty screening would reduce screening by 89%, identifying 9% of MRSA. Implementation of universal screening was poor. Admission prevalence (new cases) was low. CLAS reduced screening effort for minor decreases in identification, but implementation may prove difficult. Cost effectiveness of this and other policies, awaits evaluation by transmission dynamic economic modelling, using data from this audit. Until then trusts should seek to improve implementation of current policy and use of isolation facilities.

A trust-wide review of clinical nurse specialists' productivity.

PubMed

Balsdon, Helen; Wilkinson, Susan

2014-04-01

The contribution made by clinical nurse specialists (CNSs) to patient care needs to be understood fully to provide assurance of effective use of resources. However, CNS roles are often poorly understood and not easily articulated. Due to the diversity of these roles, robust reviews of performance and economic benefits can be regarded as time consuming and resource intense, and many organisations enlist external agencies to clarify the contribution to care made by their CNSs. This article gives an overview of a Cambridge University Hospitals NHS Foundation Trust internal review of CNS roles without the support of an external agency. The review provided assurance that this group of nurses is being used effectively and identified opportunities to use the role in different ways to increase effectiveness.

Developing skills in clinical leadership for ward sisters.

PubMed

Fenton, Katherine; Phillips, Natasha

The Francis report has called for a strengthening of the ward sister's role. It recommends that sisters should operate in a supervisory capacity and should not be office bound. Effective ward leadership has been recognised as being vital to high-quality patient care and experience, resource management and interprofessional working. However, there is evidence that ward sisters are ill equipped to lead effectively and lack confidence in their ability to do so. University College London Hospitals Foundation Trust has recognised that the job has become almost impossible in increasingly large and complex organisations. Ward sisters spend less than 40% of their time on clinical leadership and the trust is undertaking a number of initiatives to support them in this role.

[Is the person of trust a reliable witness in case of organ removal from a deceased person for donation purposes?].

PubMed

Gignon, M; Manaouil, C; Jardé, O

2008-10-01

All adults (people over the age of 18) can assign a person of trust and this person can be a parent, a partner or the treating doctor. Following the introduction of the 4(th) March 2002 law, this third party is now within the doctor-patient relationship. The aim of this study is to find out who is appointed as a person of trust by patients notably concerning the level of education or medical knowledge of these people. We have equally put the person of trust to the test within the realms that they would be questioned regarding organ donation from the deceased. The included subjects were adults admitted to hospital for surgical procedures or medical biopsies that were not deemed life threatening. The data collection was done by doctors from the legal medicine department at the university hospital of Amiens over a period of 18 months. With the permission of the patient and his or her person of trust, a one-to-one discussion was held. Statistical analysis took place focusing on all the variables together and is shown by comparing the patient group versus the person of trust group. The significance threshold returned was 0.05. A total of 125 patients-persons of trust couples were interviewed. The patients and their person of trust were not different in terms of age, social status, occupational groups and education. However, a person of trust is more often a woman (64%) against 50% of patients. A person of trust more often lives as a couple than the patients. Concerning organ donation, over half of the people questioned were for donation but only a third of patients had already discussed the subject with their person of trust. The persons of trust bring in 40% of cases a response that is not concordant in the position of the patient. The creation of a person of trust due to the law of 4(th) March 2002 brings about the opportunity for the patient to take on an approach, with the doctors, of having somebody that can advise them. Yet in this study, there is no significant evidence of a difference between the level of education of patients and that of their person of trust, or a difference in the distribution of the socio-professional categories, or specific choices for the GP. The person of trust can be used to wait on behalf of the patient whilst he or she is not able to do so. Even if the patient feels that the person of trust has come first over other close friends or relatives, the persons of trust assume this role with difficulty. Since its creation, the person of trust was presented as a response to social demand; however, it seems that patients are not sufficiently informed when it comes to the possibilities that are on offer to them.

Trust-based or performance-based management: a study of employment contracting in hospitals.

PubMed

Pettersen, Inger Johanne

2011-01-01

Hospitals are frequently changing managerial practices due to numerous public sector reforms taking place. In general, these reforms include the making and monitoring of contracts that regulate relations between the hospitals and their professional staffs. The aim of this paper is to discuss some main characteristics of the contracts that regulate the perceived relations between physicians as employees and the public hospital as employer. The theoretical framework is based on a contract theory approach. The empirical data is based on survey data from full-time employed physicians in the medical and surgical divisions in one of the largest university hospitals in Norway. This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio-cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems. Copyright © 2009 John Wiley & Sons, Ltd.

The impact of facecards on patients' knowledge, satisfaction, trust, and agreement with hospital physicians: a pilot study.

PubMed

Simons, Yael; Caprio, Timothy; Furiasse, Nicholas; Kriss, Michael; Williams, Mark V; O'Leary, Kevin J

2014-03-01

Simple interventions such as facecards can improve patients' knowledge of names and roles of hospital physicians, but the effect on other aspects of the patient-physician relationship is not clear. To pilot an intervention to improve familiarity with physicians and assess its potential to improve patients' satisfaction, trust, and agreement with physicians. Cluster randomized controlled trial assessing the impact of physician facecards. Physician facecards included pictures of physicians and descriptions of their roles. We performed structured interviews of randomly selected patients to assess outcomes. One of 2 similar hospitalist units and 1 of 2 teaching-service units in a large teaching hospital were randomly selected to implement the intervention. Satisfaction with physician communication and overall hospital care was assessed using the Hospital Consumer Assessment of Healthcare Providers and Systems. Trust and agreement were each assessed through instruments used in prior research. Overall, 138 patients completed interviews, with no differences in age, sex, or race between those receiving facecards and those not. More patients who received facecards correctly identified ≥1 hospital physician (89.1% vs 51.1%; P < 0.01) and their role (67.4% vs 16.3%; P < 0.01) than patients who had not received facecards. Patients had high baseline levels of satisfaction, trust, and agreement with hospital physicians, and we found no significant differences with the use of facecards. Physician facecards improved patients' knowledge of the names and roles of hospital physicians. Larger studies are needed to assess the impact on satisfaction, trust, and agreement with physicians. © 2013 Society of Hospital Medicine.

Organizational justice, trust, and identification and their effects on organizational commitment in hospital nursing staff.

PubMed

Chen, Su-Yueh; Wu, Wen-Chuan; Chang, Ching-Sheng; Lin, Chia-Tzu; Kung, Jung-Yuan; Weng, Hui-Ching; Lin, Yu-Tz; Lee, Shu-I

2015-09-07

It is of importance and urgency for hospitals to retain excellent nursing staff in order to improve patient satisfaction and hospital performance. However, it was found that simply increasing the salary is not the best method to resolve the problem of lacking nursing staff; it is necessary to focus on the impact of non-monetary factors. The delicate relationship between organizational justice, organizational trust, organizational identification, and organizational commitment requires investigation and clarification from more studies if application in nursing practice is to be expected. Therefore, this study was to investigate how the organizational justice perception could affect nurses' organizational trust and organizational identification, and whether the organizational trust and organizational identification could encourage nurses to willingly remain in their jobs and commit themselves to the hospitals. A cross-sectional design was used. Questionnaires were distributed in 2013 to a convenience sample of 400 registered nurses in one teaching hospital in Taiwan: 392 were retrieved. Of these, 386 questionnaires were valid, which was a 96.5% response rate. The SPSS 17.0 and Amos 17.0 (structural equation modeling) statistical software packages were used for data analysis. The organizational justice perceived by nurses significantly and positively affects their organizational trust (γ₁₁ = 0.49) and organizational identification (γ₂₁ = 0.58). Organizational trust (β₃₁ = 0.62) and organizational identification (β₃₂ = 0.53) significantly and positively affect organizational commitment. Hospital managers can enhance the service concepts and attitudes of frontline nursing personnel by maximizing organizational justice, organizational trust and organizational identification. Nursing personnel would then be motivated to provide feedback to the attention and care provided by hospital management by demonstrating substantial improvements in their extra-role performance. Improved service concepts and attitudes would also facilitate teamwork among colleagues, boost the morale of the nursing faculty and reduce resignations and career changes.

An analysis of relationships among transformational leadership, job satisfaction, organizational commitment and organizational trust in two Turkish hospitals.

PubMed

Top, Mehmet; Tarcan, Menderes; Tekingündüz, Sabahattin; Hikmet, Neşet

2013-01-01

The purpose of this study was to investigate the relationships among employee organizational commitment, organizational trust, job satisfaction and employees' perceptions of their immediate supervisors' transformational leadership behaviors in Turkey. First, this study examined the relationships among organizational commitment, organizational trust, job satisfaction and transformational leadership in two Turkish public hospitals. Second, this investigation examined how job satisfaction, organizational trust and transformational leadership affect organizational commitment. Moreover, it was aimed to investigate how organizational commitment, job satisfaction and transformational leadership affect organizational trust. A quantitative, cross-sectional method, self-administered questionnaire was used for this study. Eight hundred four employees from two public hospitals in Turkey were recruited for collecting data. The overall response rate was 38.14%. The measurement instruments of survey were the Job Satisfaction Survey (developed by P. Spector), the Organizational Commitment Questionnaire (developed by J. Meyer and N. Allen), the Organizational Trust Inventory-short form (developed by L. Cummings and P. Bromiley) and the Transformational Leadership Inventory (TLI) (developed by P. M. Podsakoff). Five-point Likert scales were used in these measurement instruments. Correlation test (the Pearson's rank test) was used to examine relationships between variables. Also, multiple regression analysis was used to determine the regressors for organizational commitment and organizational trust. There were significant relationships among overall job satisfaction, overall transformational leadership and organizational trust. Regression analyses showed that organizational trust and two job satisfaction dimensions (contingent rewards and communication) were significant predictors for organizational commitment. It was found that one transformational leadership dimension (articulating a vision), two job satisfaction dimensions (pay and supervision) and two organizational commitment dimensions (affective commitment and normative commitment) were significant regressors for organizational trust. There is a lack of research in the health organizations regarding organizational commitment, organizational trust, job satisfaction and transformational leadership. The investigator of the proposed study intends to add to the literature and intends to prove that the proposed study would be important for healthcare organizations. A number of specific measures should be undertaken to reduce factors that negatively affect organizational commitment, organizational trust and job satisfaction of hospital personnel and to improve transformational leadership behaviors of hospital administrators. Copyright © 2012 John Wiley & Sons, Ltd.

Hospital nurses' lived experiences of intelligent resilience: A phenomenological study.

PubMed

Imani, Behzad; Kermanshahi, Sima Mohamad Khan; Vanaki, Zohreh; Kazemnejad Lili, Anoshiravan

2018-05-01

To explore Iranian hospital nurses' lived experiences of intelligent resilience. Nurses do high levels of emotional work when fulfilling patients' and their family members' complex needs. Intelligent resilience can alleviate nurses' stress and enhance their endurance. This study was based on the Husserlian descriptive phenomenology. A purposive sample of ten hospital nurses was drawn from hospitals affiliated with Hamadan University of Medical Sciences, Hamadan, Iran. In-depth semi-structured interviews were held to collect data. The seven-step data analysis approach proposed by Colaizzi was used for the data analysis. In this study, the adherence to consolidated criteria for reporting qualitative guidelines has been followed. The participating hospital nurses' lived experiences of intelligent resilience came into four main themes of patience and wisdom, reverence, situational self-control and appealing to religiosity. Each of the four main themes included two subthemes which were having peace and wise quietness, reverence for the patients, physicians and nurses, distancing themselves from stressful situations and displacing staff who cause stress, and the nurse's trust in God as well as the patient and his family`s trust in God, respectively. Nurses with intelligent resilience are able to bring peace, reverence for others and situational self-control to stressors thereby providing higher quality of care to their patients. Nurses work in unstable and stressful conditions. The findings of this study provide better understanding about the concept of nurses' intelligent resilience and its indicators and attributes. © 2018 John Wiley & Sons Ltd.

The correlation between organizational justice and trust among employees of rehabilitation clinics in hospitals of Ahvaz, Iran

PubMed Central

Khiavi, Farzad Faraji; Shakhi, Kamal; Dehghani, Roohallah; Zahiri, Mansour

2016-01-01

Introduction Organizational justice is an intricate concept that refers to fair and ethical conduct of individuals within organizations. No research has been conducted on the variables associated with organizational justice in rehabilitation clinics. Thus, the aim of this research was to determine the correlation between organizational justice and organizational trust among the employees of rehabilitation clinics in hospitals of Ahvaz, Iran. Methods This was a cross-sectional research, and it was conducted on 140 rehabilitation staff members of hospital clinics in Ahvaz. The data were gathered using organizational justice and trust questionnaires. The data were analyzed using the independent-samples t-test, ANOVA, and Pearson’s product-moment correlation SPSS software. Results Significant correlations between procedure and interaction justice and organizational trust were identified (p < 0.001). Distributive justice showed small correlation with trust (r = 0.25, p < 0.021). Organizational justice was significantly associated with organizational trust (r = 0.42, p < 0.001). Organizational justice was not significantly related to any demographic variable (p > 0.05). Conclusion There was a positive, medium, and significant correlation between organizational justice and trust. It is suggested that rehabilitation clinics’ managers develop plans to increase their organizational justice subscales in order to develop organizational trust among their employees. PMID:27053997

Self-reported and employer-recorded sickness absence in doctors.

PubMed

Murphy, I J

2014-09-01

Doctors' sickness absence reduces the quality and continuity of patient care and is financially costly. Doctors have lower rates of sickness absence than other healthcare workers. To compare self-reported with recorded sickness absence in doctors in a UK National Health Service hospital trust. A retrospective questionnaire study. The main outcome measures were self-reported and trust-recorded sickness absence episodes of 4 days or more in two consecutive 6-month periods. The response rate was 82% (607/736). Self-reported sickness absence rates were 1.2% compared with a rate of 0.6% from trust-recorded data. There were 38 matched pairs of self-reported (mean duration: 18 days, standard deviation: 22 days) and trust-recorded (mean duration: 10 days, standard deviation: 17 days) sickness absence episodes of 4 days or more in the 12 months studied. A matched pairs t-test determined that the difference between the two means was significant (t = 2.57, P < 0.05). Doctors' sickness absence was significantly under-recorded in this study population. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Determinants of patient loyalty to healthcare providers: An integrative review.

PubMed

Zhou, Wei-Jiao; Wan, Qiao-Qin; Liu, Cong-Ying; Feng, Xiao-Lin; Shang, Shao-Mei

2017-08-01

Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Antecedents of hospital nurses' intention to leave the organization: A cross sectional survey.

PubMed

Bobbio, Andrea; Manganelli, Anna Maria

2015-07-01

Leadership and perceived organizational support inspire trust in the leader and in the organization. Consequently, these aspects may contribute to a reduction in job burnout among nurses and, in the end, of the intention on their part to leave the hospital. It is crucial to develop models in order to simultaneously test the correlations between these relevant psychosocial variables, so that complexity of the nursing work environment may be better understood. We expected to give support to and to further corroborate results in the literature linking perceived leadership style – and particularly servant leadership – perceived organizational support, trust in the leader and in the organization, job burnout among nurses and their subsequent intention to leave the hospital. Cross-sectional study. Two Italian large size public hospitals. Two samples including both graduates and non-graduates members of the nursing staff. Overall mean age was equal to 42.06 years while the general mean for tenure was 12.99 years. Data were collected in 2012. A regression model with latent variables was tested via structural equation modeling using LISREL. The multi-sample procedure was also applied in order to test invariance of results between the two samples. Servant leadership was positively associated with trust in the leader and perceived organizational support was positively associated with trust in the organization. Trust in the leader and trust in the organization displayed a negative correlation with the emotional exhaustion and cynicism factors of job burnout, and a positive correlation with the professional efficacy factor. Furthermore, trust scores mediated the effects of servant leadership and perceived organizational support on job burnout factors. The cynicism factor was negatively associated with intention to leave the organization and it also mediated the effects of both trust in the leader and servant leadership on intention to leave. On the other hand, trust in the organization turned out to be directly and negatively related to intention to leave. Servant leadership and perceived organizational support showed their relevance in the nursing setting. The role of trust in the leader, trust in the organization and job burnout factors as mediating variables received support. Interestingly enough, the higher the cynicism score the higher the intention to leave the hospital. The results achieved may have practical implications not only for recruitment and training of nurse managers but also for hospital management. Copyright © 2015 Elsevier Ltd. All rights reserved.

Foundation Trusts: economics in the 'postmodern hospital'.

PubMed

Newbold, David

2005-09-01

Foundation Trust Hospitals are community-controlled health care providers which have increased autonomy about how they produce outcomes for the British National Health Service. Although there is a literature on hospital economics it is unclear how these innovative providers will behave, if they have to compete for scarce resources with other hospitals. This paper reviews some of the earlier theories, such as the neoclassical theory of the firm, and discusses their relevance along with 'newer' economic theories such as the transaction costs and evolutionary theory of the firm, plus organizational and human resources theory, to the performance of Foundation Trusts. Much contemporary health care provision is shaped along modernist lines, using scientific endeavour to maximize the impact on health outcomes and technical and social efficiency. However, there is an increasingly postmodern standpoint--critical of modernity--being taken by both patients and hospital staff, to deconstruct processes in the organizations that serve them. Foundation Trusts are postmodern hospitals insomuch as they (to attract scarce resources in a competitive environment), need to marshal the diverse theories of the firm together in order to provide a mass-customized, quality experience, transparently and at least cost--whilst maintaining a stable organizational culture for staff.

The Influence of Trust on Knowledge Donating and Collecting: An Examination of Malaysian Universities

ERIC Educational Resources Information Center

Goh, See-Kwong; Sandhu, Manjit-Singh

2014-01-01

The purpose of this research is to examine the influence of affect-based trust and cognition-based trust on knowledge sharing behaviour by adopting the theory of planned behaviour in selected universities in Malaysia. The research adopted survey method and a total of 545 participants from 30 universities. Multiple regression was used to assess the…

An investigation into denture loss in hospitals in Kent, Surrey and Sussex.

PubMed

Mann, J; Doshi, M

2017-08-25

Background The loss of dentures for inpatients can have a detrimental effect on their well-being. Self-respect and dignity become compromised along with their ability to eat meals and communicate clearly, and long-term recovery.Aim This investigation aimed to identify the reported number of dentures lost in hospitals and the financial reimbursements given by trusts to replace them.Method Information on reported denture loss and reimbursement was collected in 12 trusts throughout Kent, Surrey and Sussex.Results Eleven out of 12 trusts returned data about how many dentures were lost in their hospitals, between them 695 dentures were reported lost over five years (2011-16). Seven trusts reported financial reimbursements for dentures losses; results showed £357,672 was reimbursed over six years (2010-16), the highest amount reimbursed for a single denture was £2,200.Conclusion The results indicate that denture loss is a problem in hospitals that contributes to the financial burden for the NHS. Consideration needs to be given by hospitals to find ways to reduce the number of dentures lost every year.

The relationship between organizational trust and nurse administrators’ productivity in hospitals

PubMed Central

Bahrami, Susan; Hasanpour, Marzieh; Rajaeepour, Saeed; Aghahosseni, Taghi; Hodhodineghad, Nilofar

2012-01-01

Context: Management of health care organizations based on employee’s mutual trust will increase the improvement in functions and tasks. Aims: The present study was performed to investigate the relationship between organizational trust and the nurse administrators’ productivity in educational health centers of in Health-Education Centers of Isfahan University of Medical Sciences. Settings and Design: This research was a descriptive and correlational study. Materials and Methods: The population included all nurse administrators. In this research, 165 nurses were selected through random sampling method. Data collection instruments were organizational trust questionnaire based on Robbins’s model and productivity questionnaire based on Hersy and Blanchard’s model. Validity of these questionnaires was determined through content validity and their reliability was calculated through Cranach’s alpha. Statistical analysis was used: The data analysis was done using the SPSS (18) statistical software. Results: The indicators of organizational trust such as loyalty, competence, honesty, and stability were more than average level but explicitness indicator was at average level. The components of productivity such as ability, job knowledge, environmental compatibility, performance feedback, and validity were more than average level but motivation factor was at average level and organizational support was less than average level. There were a significant multiple correlations between organizational trust and productivity. Beta coefficients among organizational trust and productivity were significant and no autocorrelation existed and regression model was significant. Conclusions: Committed employees, timely performing the tasks and developing the sense of responsibility among employees can enhance production and productivity in the health care organizations. PMID:23922588

Establishing a Cloud Computing Success Model for Hospitals in Taiwan.

PubMed

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan

PubMed Central

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services. PMID:28112020

The study of the relationship between value creation and customer loyalty with the role of trust moderation and customer satisfaction in Sari hospitals

PubMed Central

Rahmani, Zienolabedin; Ranjbar, Mansour; Gara, Ali Asgar Nadi; gorji, Mohammad Ali Heidari

2017-01-01

Background Healthcare providers are competitive, owing to heightened customers’ awareness and expectations of health care services. Objective The aim of this study was to determine the relationship between customer value creation and loyalty with mediator trust and customer satisfaction. Methods This is a cross sectional survey study. Participants were 196 patients referred to private hospitals in Sari city, Iran from May to June 2014 which were selected by convenience sampling method. Data were collected using questionnaires. Data were analyzed using the structural equation modeling software Smart PLS. Results The results revealed a relationship between customer value creation and customer loyalty in a Sari city private hospital, and customer satisfaction and trust, mediate the relationship between customer value creation and customer loyalty. The results also revealed significant positive relationship between customer satisfaction and trust (p=0.000 r=0.585). Conclusion customer satisfaction and trust mediate the relationship between customer value creation and customer loyalty. PMID:28848619

The study of the relationship between value creation and customer loyalty with the role of trust moderation and customer satisfaction in Sari hospitals.

PubMed

Rahmani, Zienolabedin; Ranjbar, Mansour; Gara, Ali Asgar Nadi; Gorji, Mohammad Ali Heidari

2017-06-01

Healthcare providers are competitive, owing to heightened customers' awareness and expectations of health care services. The aim of this study was to determine the relationship between customer value creation and loyalty with mediator trust and customer satisfaction. This is a cross sectional survey study. Participants were 196 patients referred to private hospitals in Sari city, Iran from May to June 2014 which were selected by convenience sampling method. Data were collected using questionnaires. Data were analyzed using the structural equation modeling software Smart PLS. The results revealed a relationship between customer value creation and customer loyalty in a Sari city private hospital, and customer satisfaction and trust, mediate the relationship between customer value creation and customer loyalty. The results also revealed significant positive relationship between customer satisfaction and trust (p=0.000 r=0.585). customer satisfaction and trust mediate the relationship between customer value creation and customer loyalty.

Hospital CEOs Need Health IT Knowledge and Trust in CIOs: Insights from a Qualitative Study.

PubMed

Thye, Johannes; Hübner, Ursula; Weiß, Jan-Patrick; Teuteberg, Frank; Hüsers, Jens; Liebe, Jan-David; Babitsch, Birgit

2018-01-01

IT is getting an increasing importance in hospitals. In this context, major IT decisions are often made by CEOs who are not necessarily IT experts. Therefore, this study aimed at a) exploring different types of IT decision makers at CEO level, b) identifying hypotheses if trust exists between these different types of CEOs and their CIOs and c) building hypotheses on potential consequences regarding risk taking and innovation. To this end, 14 qualitative interviews with German hospital CEOs were conducted to explore the research questions. The study revealed three major types: IT savvy CEOs, IT enthusiastic CEOs and IT indifferent CEOs. Depending on these types, their relationship with the CIO varied in terms of trust and common language. In case of IT indifferent CEOs, a potential vicious circle of lack of IT knowledge, missing trust, low willingness to take risks and low innovation power could be identified. In order to break of this circle, CEOs seem to need more IT knowledge and/or greater trust in their CIO.

Pilot project for rapid Legionella testing.

PubMed

Pearson, Susan

2013-08-01

Susan Pearson BSc, a freelance journalist and communications consultant specialising in medicine and the environment (see also HEJ - April 2013), reports on discussions, at a recent educational seminar, on a pilot project undertaken by the Environmental Microbiology Unit at the Brighton and Sussex University Hospitals (BSUH) NHS Trust, which compared the effectiveness and accuracy of conventional 'culture' testing for Legionella in water systems, with a new, 'less labour-intensive', DNA-based testing system that can produce results 'in a matter of hours'.

Enhancing Pupils' Aspirations to University: The St Andrews Sutton Trust School Experience

ERIC Educational Resources Information Center

Lasselle, Laurence; Keir, Fraser; Smith, Ian

2009-01-01

The Sutton Trust Summer School offers to S5/Year 12 pupils the opportunity to sample student life for a week at one of five selecting universities in the UK. Most of the participants on the Sutton Trust Summer School will be the first generation in their family to attend university and have come from schools which traditionally send low numbers to…

Rolling out Productive Ward foundation modules across a hospital trust.

PubMed

Foster, Sam; Gordon, Pete; McSherry, Wilfred

The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

Overseeing oversight: governance of quality and safety by hospital boards in the English NHS.

PubMed

Mannion, Russell; Davies, Huw; Freeman, Tim; Millar, Ross; Jacobs, Rowena; Kasteridis, Panos

2015-01-01

To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS. We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate). Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political). English NHS boards largely hold a wide range of attitudes and behaviours that might be expected to benefit patient safety and quality. However, there is significant scope for improvement as regards formal training for board members on quality and safety, routine morbidity reporting at boards and attention to the interpersonal dynamics within boards. Directors with clinical backgrounds remain a minority on most boards despite policies to increase their representation. A better understanding of board composition, actions and attitudes should help refine policy recommendations around boards. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

10 CFR 600.137 - Property trust relationship.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Property trust relationship. 600.137 Section 600.137..., Hospitals, and Other Nonprofit Organizations Post-Award Requirements § 600.137 Property trust relationship... Federal funds shall be held in trust by the recipient as trustee for the beneficiaries of the project or...

The grounded theory of "trust building".

PubMed

Ramezani, Monir; Ahmadi, Fazlollah; Mohammadi, Eesa; Kazemnejad, Anoshirvan

2017-01-01

Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers. To develop a grounded theory about spiritual care delivery based on Iranian nurses' perceptions and experiences. A grounded theory approach: A qualitative study using the grounded theory approach. Participants and research context: Data were collected through holding 27 interviews with 25 participants (17 staff nurses, 3 physicians, 3 patients, 1 family member, and 1 nurse assistant). The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. Ethical consideration: The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study. The core category of the study was "Trust building" which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security. The "Trust building" theory can be used as a guide for describing and expanding nurses' roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses.

Assessing the sensitivity of images in research collections: A new approach at the Wellcome Library.

PubMed

Wakely, Helen; Dakin, Carly

2015-06-01

In 2014 The Wellcome Library, part of the Wellcome Trust, introduced a new policy in order to address research access to personal data within its collections. The policy has now been used by library staff for almost a year. The policy was devised using a multi-stage approach which consisted of internal surveys and 1:1 interviews. Library staff can use the policy to guide decisions based on what level of access to award material donated or contributed to the Wellcome collections. The policy has been applied to 1 - a series of victorian medical photographs supplied by University Hospitals Bristol NHS Foundation Trust, and 2 - an album of family photographs from the collection of the psychiatrist Dr Ann Dally. Following almost a year in circulation the advantages and disadvantages can now be summarised.

Outsourcing cleaning services increases MRSA incidence: Evidence from 126 english acute trusts.

PubMed

Toffolutti, Veronica; Reeves, Aaron; McKee, Martin; Stuckler, David

2017-02-01

There has been extensive outsourcing of hospital cleaning services in the NHS in England, in part because of the potential to reduce costs. Yet some argue that this leads to lower hygiene standards and more infections, such as MRSA and, perhaps because of this, the Scottish, Welsh, and Northern Irish health services have rejected outsourcing. This study evaluates whether contracting out cleaning services in English acute hospital Trusts (legal authorities that run one or more hospitals) is associated with risks of hospital-borne MRSA infection and lower economic costs. By linking data on MRSA incidence per 100,000 hospital bed-days with surveys of cleanliness among patient and staff in 126 English acute hospital Trusts during 2010-2014, we find that outsourcing cleaning services was associated with greater incidence of MRSA, fewer cleaning staff per hospital bed, worse patient perceptions of cleanliness and staff perceptions of availability of handwashing facilities. However, outsourcing was also associated with lower economic costs (without accounting for additional costs associated with treatment of hospital acquired infections). Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

A follow-up evaluation of the impact of the Chief Nursing Officer's review of mental health nursing in Mental Health Trusts and Universities in England: comparisons of two e-surveys.

PubMed

Baker, John; Swarbrick, Caroline; Campbell, Malcolm; Playle, John; Lovell, Karina

2012-03-01

This article is a report of a study that aimed to establish a national picture of the implementation of Review recommendations over time in both Mental Health Trusts and Higher Education Institutions (Universities) in England. The 2006 Review of Mental Health Nursing in England by the Chief Nursing Officer made 17 key recommendations for Mental Health Trusts and Universities to improve mental health nursing. This article outlines key findings from a national survey of National Health Service Trusts and Universities in England with regard to prioritization and progress on implementation of these recommendations. An e-survey was carried out in 2008-2009 based on the Chief Nursing Officer review recommendations and guidance. Participants included all Trusts which delivered mental health services (n = 68) and Universities which delivered pre-registration mental health nursing education (n = 50) in England. There appears to be some evidence that the Chief Nursing Officer review of Mental Health Nursing in England continues to be implemented in both Mental Health Trusts and Universities. There is variety in levels of implementation, but Mental Health Trusts and Universities broadly agree on priority areas. The Chief Nursing Officer review has been influential in focusing the care and education of mental health nurses and services in England. There appears to be a range of barriers and facilitators which aid the implementation of healthcare policy. More attention is required from researchers to enhance and evaluate the impact of policy implementation on the quality of care provided. © 2011 Blackwell Publishing Ltd.

East Lancashire Hospital Trust creates an open culture paving the way for service improvement 'Below ten thousand'.

PubMed

Tomlinson, Robert

2018-05-01

Reacting to a never event is difficult and often embarrassing for staff involved. East Lancashire Hospitals NHS Trust has demonstrated that treating staff with respect after a never event, creates an open culture that encourages problem solving and service improvement. The approach has allowed learning to be shared and paved the way for the trust to be the first in the UK to launch the patient centric behavioural noise reduction strategy 'Below ten thousand'.

An international study of hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses: A path analysis.

PubMed

Charalambous, Andreas; Radwin, Laurel; Berg, Agneta; Sjovall, Katarina; Patiraki, Elisabeth; Lemonidou, Chryssoula; Katajisto, Jouko; Suhonen, Riitta

2016-09-01

Providing high quality nursing care for patients with malignancies is complex and driven by many factors. Many of the associations between nursing care quality, trust, health status and individualized care remain obscure. To empirically test a model of association linking hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses. A cross-sectional, exploratory and correlational study design was used. This multi-site study was conducted in cancer care clinics, in-patient wards of five tertiary care hospitals in Cyprus, Finland, Greece and Sweden. Out of 876 hospitalized patients with a confirmed histopathological diagnosis of cancer approached to participate in the study in consecutive order, 599 (response rate 68%) agreed to participate and the data from 590 were used for path analysis. Data were collected in 2012-2013 with the Individualized Care Scale-Patient (ICS-Patient), the Oncology Patients' Perceptions of Quality Nursing Care Scale (OPPQNCS), the Euro-Qol (EQ-5D-3L) and the Trust in Nurses Scale. Data were analysed statistically using descriptive and inferential statistics. Mplus version 7.11 was used to determine the best Trust model with path analysis. Although the model fit indices suggested that the hypothesized model did not perfectly to the data, a slightly modified model which includes the reciprocal path between individualized care and nursing care quality demonstrated a good fit. A model of trust in nurses was developed. Health status, individualized care, and nursing care quality were found to be associated with trust. The model highlights the complexity of caring for cancer patients. Trust in nurses is influenced by the provision of individualized care. Generating and promoting trust requires interventions, which promote nursing care quality, individuality and patients' health status. Copyright © 2016 Elsevier Ltd. All rights reserved.

Relationship Between Cybernetics Management and Organizational Trust Among Librarians of Mazandaran University of Medical Sciences.

PubMed

Ghiasi, Mitra; Shahrabi, Afsaneh; Siamian, Hasan

2017-12-01

Organization must keep current skills, abilities, and in the current field of competition, and move one step ahead of other competitors; for this purpose, must be a high degree of trust inside the organization. Cybernetic management is a new approach in management of organizations that its main task according to internal issues. This study aimed to investigate the relationship between cybernetics management and organizational trust among librarians of Mazandaran University of Medical Sciences. This is applied and analytical survey. which its population included all librarians of Mazandaran University of Medical Sciences, amounting to 42 people which were selected by census and participated in this research. There has no relationship between components of Cybernetics management (participative decision making, commitment, pay equity, Correct flow of information, develop a sense of ownership, online education) with organizational trust amongst librarians of Mazandaran University of Medical Sciences. And there has a significant relationship between flat Structure of cybernetics management and organizational trust. For data analysis was used Kolmogorov-Smirnov test and linear regression. There is no significant relationship between Cybernetic management and organizational trust amongst librarians of Mazandaran University of Medical Sciences.

Relationship Between Cybernetics Management and Organizational Trust Among Librarians of Mazandaran University of Medical Sciences

PubMed Central

Ghiasi, Mitra; Shahrabi, Afsaneh; Siamian, Hasan

2017-01-01

Background and purpose: Organization must keep current skills, abilities, and in the current field of competition, and move one step ahead of other competitors; for this purpose, must be a high degree of trust inside the organization. Cybernetic management is a new approach in management of organizations that its main task according to internal issues. This study aimed to investigate the relationship between cybernetics management and organizational trust among librarians of Mazandaran University of Medical Sciences. Materials and methods: This is applied and analytical survey. which its population included all librarians of Mazandaran University of Medical Sciences, amounting to 42 people which were selected by census and participated in this research. Results: There has no relationship between components of Cybernetics management (participative decision making, commitment, pay equity, Correct flow of information, develop a sense of ownership, online education) with organizational trust amongst librarians of Mazandaran University of Medical Sciences. And there has a significant relationship between flat Structure of cybernetics management and organizational trust. For data analysis was used Kolmogorov-Smirnov test and linear regression. Conclusion: There is no significant relationship between Cybernetic management and organizational trust amongst librarians of Mazandaran University of Medical Sciences. PMID:29284914

Budgeting and Organizational Trust in Canadian Universities

ERIC Educational Resources Information Center

Simmons, Cynthia V.

2012-01-01

The purpose of this research was to investigate the relationship between budget processes and levels of organizational trust in universities. A series of semi-structured interviews were conducted with senior administrative personnel in universities across Canada. A relationship was found to exist between university administrators' level of…

Re-building Trust after Physical Restraint During Involuntary Psychiatric Hospitalization.

PubMed

Khatib, Anwar; Ibrahim, Mahajne; Roe, David

2018-06-01

This study attempted to identify the elements which might best minimize the negative consequences of restriction of inpatients and rebuild therapeutic alliance and trust. Through in depth interviews with 15 psychiatric patients who had experience restrained during the last involuntary psychiatric hospitalization. Analysis of the data revealed three major themes with regard to trust between restrained patient and restraining staff members during restriction of the patient's freedom. Duration of Restriction, Contact with a Staff Member while Restrained, Supportive Interactions and Staff's Response to Restricted Patients' Needs were reported by patients as crucial in determining the way restrained is experienced and its later impact. Physical restraint in psychiatric hospitalizations generates many negative feelings and can even be traumatic. The patients interviewed help us learn how to provide more human and therapeutic interactions even in extreme situations of restrain which can be crucial to rebuild therapeutic alliance and trust. Copyright © 2018 Elsevier Inc. All rights reserved.

Documentation of resuscitation decision-making: a survey of practice in the United Kingdom.

PubMed

Clements, Meredith; Fuld, Jonathan; Fritz, Zoë

2014-05-01

Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been in use since the 1990s. The Resuscitation Council UK (RCUK) provides guidance on the content and use of such forms in the UK but there is no national policy. To determine the content of DNACPR forms in the UK, and the geographical distribution of the use of different forms. All acute trusts within the United Kingdom were contacted via a combination of email and telephone, with a request for the current DNACPR form along with information about its development and use. Characteristics of the model RCUK DNACPR form were compared with the non-RCUK DNACPR forms which we received. Free text responses were searched for commonly occurring phrases. 118/161 English NHS Acute Trusts (accounting for 377 hospitals), 3/6 Northern Irish NHS Acute Trusts (accounting for 25 hospitals) and 3/7 Welsh Health Boards (accounting for 73 hospitals) responded. All Scottish hospitals have the same form. All responding trusts had active policies and have a DNACPR form in use. 38.9% of respondent hospitals have adopted the RCUK form with minor amendments. The remainder of the responding hospitals reported independent forms. 66.8% of non-RCUK forms include a transfer plan to ambulance staff and 48.4% of non-RCUK forms are valid in the community. Several independent trusts submitted DNACPR forms with escalation plans. There is wide variation in the forms used for indicating DNACPR decisions. Documentation is rapidly evolving to meet the needs of patients and to respond to new evidence. Copyright © 2014. Published by Elsevier Ireland Ltd.

Healthcare staff attitudes towards the use of electronic cigarettes ('e-cigarettes') compared with a local trust policy.

PubMed

Pippard, Benjamin J; Shipley, Mark D

2017-07-01

E-cigarette use has risen dramatically in recent years, despite uncertainty over long-term health effects and concerns regarding efficacy as a smoking cessation device. Currently, there is no legislation prohibiting use in public, though many trusts have extended the NHS Smokefree policy to include e-cigarettes. The successful implementation of such policy is, however, unclear. This study examined staff attitudes towards the use of e-cigarettes in a hospital environment with respect to enforcement of a local trust smoking policy. A total of 79 healthcare professionals working at South Tyneside District Hospital, South Shields, completed a written questionnaire regarding use of e-cigarettes, particularly views on use in public and on hospital premises. Factors influencing the likelihood of individuals to challenge the use of e-cigarettes were assessed. In all, 45% of respondents thought that e-cigarettes should be allowed in public places, though a majority (62%) favoured use on hospital grounds compared to within hospital buildings (18%). Over 50% of respondents were unaware of trust policy relating to e-cigarettes and only 25% had ever challenged someone using a device. Roughly, one-third reported that they would still not challenge someone in future, despite being informed of trust policy. Fear of abuse was the most cited reason for not challenging. Expressed concerns of e-cigarette use related to fire risk, 'normalising' smoking behaviour and uncertainty of long-term effects. Most staff do not enforce trust policy regarding e-cigarette use. This reflects variation in opinion over use, poor awareness of the policy itself and perceived barriers to implementation, including fear of abuse. Addressing these issues through staff education sessions may help successful future implementation.

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

PubMed

Shan, Linghan; Li, Ye; Ding, Ding; Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders.

[Personalized nursing care in hospital and its effects on the patient-nurse trust relationship].

PubMed

García-Juárez, María del Rosario; López-Alonso, Sergio R; Moreno-Verdugo, Ana; Guerra-González, Sara; Fernández-Corchero, Juana; Márquez-Borrego, M José; Orozco-Cózar, M José; Ramos-Bosquet, Gádor

2013-01-01

To determine the level of implementation of an inpatient personalized nursing care model in four hospitals of the Andalusian Health Service, and to determine if there is an association between this model and the perception of trust in the nurse by the patient. An observational cross-sectional study included the patients discharged during a period of 12 months from hospital wards that used the Inpatient Personalized Nursing Care Model of the Andalusian Health Service (based on Primary Nursing Model). The level of implemention was evaluated using the Nursing Care Personalized Index (IPC), made by «patient report» methodology, and the nurse-patient trust relationship was evaluated at the same time as the IPC. Statistical analysis included descriptive data analysis, Chi-squared test, and bivariate and multivariate logistic regression, with and without stratifying by hospitals wards. A total of 817 patient were included. The implementation of the inpatient personalized nursing care model varied between 61 and 79%. The IPC values showed a strong association with the nurse-patient trust relationship, and that for each point increase in the IPC score, the probability of a nurse-patient trust relationship increased between 50 and 130% (0.120.58). The implementation of a personalized nursing care model in the wards studied was higher in the surgicals wards and at regular level in medical wards. Furthermore, the influence of the inpatient personalized nursing care model on the nurse-patient trust relationship has been demonstrated using the IPC model. This trust is the main component for the establishment of a therapeutic relationship. Copyright © 2013 Elsevier España, S.L. All rights reserved.

10 CFR 600.137 - Property trust relationship.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Property trust relationship. 600.137 Section 600.137 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS FINANCIAL ASSISTANCE RULES Uniform..., Hospitals, and Other Nonprofit Organizations Post-Award Requirements § 600.137 Property trust relationship...

An audit of the use of isolation facilities in a UK National Health Service trust.

PubMed

Damji, S; Barlow, G D; Patterson, L; Nathwani, D

2005-07-01

To aid the ongoing battle against hospital-acquired infection in the UK, all acute National Health Service (NHS) trusts should have audit data about how dedicated isolation beds within the trust are being used. In a previously published audit, we demonstrated that one-third of patients admitted to a dedicated isolation room in Tayside were not thought to be an infection risk by experienced healthcare staff. Since this audit, Tayside's isolation facilities have moved from a small peripheral 'fever' hospital to a large central teaching hospital site. At the time of this move, and using the above audit data, we designed and implemented a guideline for general practitioners and hospital doctors regarding the admission of patients to an isolation bed. The aim of this study was to compare the use of isolation beds before and after the move to the new facilities, which we anticipated would increase the demand for isolation. The results show that by all three criteria used, the utilization of isolation beds has deteriorated following the move, mainly due to the increased admission of general medical 'boarders' and low-risk infection patients. At a time when hospital-acquired infections are increasing, NHS trusts should ensure that dedicated isolation beds are used appropriately.

Trust and British Gas partner in EPC scheme.

PubMed

Bevan, Patrick

2015-02-01

In late August last year the St George's Healthcare NHS Trust in south-west London signed what the Trust's Estates and Facilities team described as 'a historic partnership' with British Gas for a £12 m Energy Performance Contract energy reduction scheme--via which the energy company has guaranteed to deliver £1.1 m in annual savings over the next 15 years. The agreement will see British Gas replace four 35-year-old gas-powered steam boilers and an ageing CHP plant in the boiler house at the Trust's main acute facility, the StGeorge's Hospital in Tooting, and upgrade some of the associated infrastructure. British Gas will also maintain the new plant to ensure that the projected savings are achieved while the Trust owns the new assets. The Trust should gain financially--via lower energy costs and carbon emissions, while estates personnel will be better able to complete the many other estate maintenance issues that would otherwise be contracted out at one of London's biggest acute hospitals.

The development of environmental assessment tools to support the creation of dementia friendly care environments: Innovative practice.

PubMed

Waller, Sarah; Masterson, Abigail; Evans, Simon C

2017-02-01

The need for more dementia friendly design in hospitals and other care settings is now widely acknowledged. Working with 26 NHS Trusts in England as part of a Department of Health commissioned programme, The King's Fund developed a set of overarching design principles and an environmental assessment tool for hospital wards in 2012. Following requests from other sectors, additional tools were developed for hospitals, care homes, health centres and housing with care. The tools have proven to be effective in both disseminating the principles of dementia friendly design and in enabling the case to be made for improvements that have a positive effect on patient outcomes and staff morale. This paper reports on the development, use and review of the environmental assessment tools, including further work that is now being taken forward by The Association for Dementia Studies, University of Worcester.

Trust or Consequences: The Relationship between Faculty Trust and Faculty Learning Communities in Higher Education

ERIC Educational Resources Information Center

Wilson, Gaye R.

2011-01-01

The purpose of this study was to investigate relationships between FLC membership and faculty trust in higher education colleagues and faculty trust in higher education administration in public and private universities in the United States. This quantitative study examines trust in colleagues and trust in administration in higher education, two…

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

PubMed

Laverty, Anthony A; Elkin, Sarah L; Watt, Hilary C; Millett, Christopher; Restrick, Louise J; Williams, Sian; Bell, Derek; Hopkinson, Nicholas S

2015-01-01

We evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation. Interrupted time series analysis, comparing readmission rates for COPD exacerbations at nine trusts that introduced the bundle, to two comparison groups; (1) other NHS trusts in London and (2) all other NHS trusts in England. Care bundles were implemented at different times for different NHS trusts, ranging from October 2009 to April 2011. Nine NHS acute trusts in the London, England. Patients aged 45 years and older admitted to an NHS acute hospital in England for acute exacerbation of COPD. Data come from Hospital Episode Statistics, April 2002 to March 2012. Annual trend readmission rates (and in total bed days) within 7, 28 and 90 days, before and after implementation. In hospitals introducing the bundle readmission rates were rising before implementation and falling afterwards (e.g. readmissions within 28 days +2.13% per annum (pa) pre and -5.32% pa post (p for difference in trends = 0.012)). Following implementation, readmission rates within 7 and 28 day were falling faster than among other trusts in London, although this was not statistically significant (e.g. readmissions within 28 days -4.6% pa vs. -3.2% pa, p = 0.44). Comparisons with a national control group were similar. The COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.

Distrust and patients in intercultural healthcare: A qualitative interview study.

PubMed

Alpers, Lise-Merete

2018-05-01

The importance of trust between patients and healthcare personnel is emphasised in nurses' and physicians' ethical codes. Trust is crucial for an effective healthcare personnel-patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of 'othering'. To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of 'othering'. Qualitative design, in-depth interviews and hermeneutic analysis. Participants and research context: The interviewees were 10 immigrant patients (six women and four men - eight Asians, two Africans - ages 32-85 years) recruited from a south-eastern Norwegian hospital. Ethical considerations: Study approval was obtained from the hospital's Privacy Ombudsman for Research and the hospital's leadership. Participation was voluntary and participants signed an informed consent form. Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient-healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.

29 CFR 95.37 - Property trust relationship.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 1 2011-07-01 2011-07-01 false Property trust relationship. 95.37 Section 95.37 Labor Office of the Secretary of Labor GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS... Requirements Property Standards § 95.37 Property trust relationship. Real property, equipment, intangible...

Empowering leadership, perceived organizational support, trust, and job burnout for nurses: a study in an Italian general hospital.

PubMed

Bobbio, Andrea; Bellan, Maria; Manganelli, Anna Maria

2012-01-01

A strong nursing leadership that instills trust in the leader and in the organization is an important component for an effective leadership, particularly for health care organizations, because trust defines the heart of health care workplaces by promoting patient safety, excellence in care, recruitment, and retention of the nursing staff. This study aimed to test the impact of perceived empowerment leadership style expressed by the nurse supervisor, nurses' perceived organizational support, trust in the leader, and trust in the organization on nurses' job burnout. A group of 273 nurses from an Italian public general hospital took part in a cross-sectional study on a voluntary basis by filling out an anonymous questionnaire. Empowering leadership was an important predictor of trust in the leader. Trust in the organization was influenced by perceived organizational support and by the Informing dimension of the empowering leadership style. Trust in the leader and trust in the organization showed a negative impact on job burnout and also mediated the effects of some empowering leadership dimensions and perceived organizational support on job burnout. The central role of trust in health care organizations was corroborated, as well as the beneficial effects of adopting specific features of empowerment leadership behaviors toward the nursing staff. Empowering leadership could be successfully proposed in training programs directed to nurses' supervisors and health care managers.

Transnational Higher Education: The Importance of Institutional Reputation, Trust and Student-University Identification in International Partnerships

ERIC Educational Resources Information Center

Heffernan, Troy; Wilkins, Stephen; Butt, Muhammad Mohsin

2018-01-01

Purpose: The purpose of this paper is to assess the extent to which the critical relational variables of university reputation, student trust and student-university identification influence student behaviour towards transnational education partnerships. Design/methodology/approach: Students undertaking British degrees at two transnational…

[Crises of trust].

PubMed

Chen, Thai-Form; Tseng, Hsing-Chau

2006-02-01

Extensive media coverage is warning of a crisis of trust that has emerged as a serious issue in our society. This article explores the meaning of "crisis," concepts of crisis management, mechanisms for building trust, and the underlying significance of trust and distrust. Evidence is adduced to testify to the erosion of trust and factors in our society that reflect the potential for crises of trust. Organizational decision makers, including hospital managers, are urged to identify and reflect upon weaknesses in their organizations in order that remedial action can be taken to preempt such crises.

Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations.

PubMed

Björkhem-Bergman, Linda; Andersén-Karlsson, Eva; Laing, Richard; Diogene, Eduardo; Melien, Oyvind; Jirlow, Malena; Malmström, Rickard E; Vogler, Sabine; Godman, Brian; Gustafsson, Lars L

2013-05-01

In September 2012 an interactive course on the "Interface Management of Pharmacotherapy" was organized by the Stockholm Drug and Therapeutics Committee in cooperation with Department of Clinical Pharmacology at Karolinska Institutet and at Karolinska University Hospital in Stockholm, Sweden, in collaboration with the WHO. The basis for the course was the "Stockholm model" for the rational use of medicines but also contained presentations about successful models in interface management of pharmacotherapy in other European countries. The "Stockholm model" consists of 8 components: 1) Independent Drug and Therapeutics Committee with key role for respected drug experts with policy for "interest of conflicts", 2) The "Wise List", recommendations of medicines jointly for primary and hospital care, 3) Communication strategy with continuous medical education, 4) Systematic introduction of new expensive medicines, 5) E-pharmacological support at "point of care", 6) Methods and tools for follow-up of medicines use, 7) Medicines policy strategy and 8) Operative resources. The course highlighted the importance of efficient and targeted communication of drug recommendations building on trust among prescribers and patients for the guidelines to achieve high adherence. Trust is achieved by independent Drug and Therapeutics Committees with a key role for respected experts and a strict policy for "conflicts of interest". Representations of GPs are also crucial for successful implementation, being the link between evidence based medicine and practice. The successful models in Scotland and in Stockholm as well as the ongoing work in Catalonia were considered as examples of multifaceted approaches to improve the quality of medicine use across primary and hospital care.

An Investigation of Children's Peer Trust across Culture: Is the Composition of Peer Trust Universal?

ERIC Educational Resources Information Center

Betts, Lucy R.; Rotenberg, Ken J.; Petrocchi, Serena; Lecciso, Flavia; Sakai, Atsushi; Maeshiro, Kazumi; Judson, Helen

2014-01-01

The components of children's trust in same-gender peers (trust beliefs, ascribed trustworthiness, and dyadic reciprocal trust) were examined in samples of 8-11-year-olds from the UK, Italy, and Japan. Trust was assessed by children's ratings of the extent to which same-gender classmates kept promises and kept secrets. Social relations analyses…

A cross-sectional study of all clinicians' conflict of interest disclosures to NHS hospital employers in England 2015-2016.

PubMed

Feldman, Harriet Ruth; DeVito, Nicholas J; Mendel, Jonathan; Carroll, David E; Goldacre, Ben

2018-03-05

We set out to document how NHS trusts in the UK record and share disclosures of conflict of interest by their employees. Cross-sectional study of responses to a Freedom of Information Act request for Gifts and Hospitality Registers. NHS Trusts (secondary/tertiary care organisations) in England. 236 Trusts were contacted, of which 217 responded. We assessed all disclosures for completeness and openness, scoring them for achieving each of five measures of transparency. 185 Trusts (78%) provided a register. 71 Trusts did not respond within the 28 day time limit required by the FoIA. Most COI registers were incomplete by design, and did not contain the information necessary to assess conflicts of interest. 126/185 (68%) did not record the names of recipients. 47/185 (25%) did not record the cash value of the gift or hospitality. Only 31/185 registers (16%) contained the names of recipients, the names of donors, and the cash amounts received. 18/185 (10%) contained none of: recipient name, donor name, and cash amount. Only 15 Trusts had their disclosure register publicly available online (6%). We generated a transparency index assessing whether each Trust met the following criteria: responded on time; provided a register; had a register with fields identifying donor, recipient, and cash amount; provided a register in a format that allowed further analysis; and had their register publicly available online. Mean attainment was 1.9/5; no NHS trust met all five criteria. Overall, recording of employees' conflicts of interest by NHS trusts is poor. None of the NHS Trusts in England met all transparency criteria. 19 did not respond to our FoIA requests, 51 did not provide a Gifts and Hospitality Register and only 31 of the registers provided contained enough information to assess employees' conflicts of interest. Despite obligations on healthcare professionals to disclose conflicts of interest, and on organisations to record these, the current system for logging and tracking such disclosures is not functioning adequately. We propose a simple national template for reporting conflicts of interest, modelled on the US 'Sunshine Act'. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A multifaceted approach to spreading palliative care consultation services in California public hospital systems.

PubMed

Brousseau, Ruth Tebbets; Jameson, Wendy; Kalanj, Boris; Kerr, Kathleen; O'Malley, Kate; Pantilat, Steven

2012-01-01

Historically, California's 17 public hospital systems-those that are county owned and operated, and those University of California medical centers with the mandate to serve low income, vulnerable populations-have struggled to implement Palliative Care Consultation Services (PCCS)-this, despite demonstrated need for these services among the uninsured and Medicaid populations served by these facilities. Since 2008, through a collaborative effort of a foundation, a palliative care training center, and a nonprofit quality improvement organization, the Spreading Palliative Care in Public Hospitals initiative (SPCPH) has resulted in a 3-fold increase in the number of California public hospitals providing PCCS, from 4 to 12. The SPCPH leveraged grant funding, the trusted relationships between California public hospitals and their quality improvement organization, technical assistance and training, peer support and learning, and a tailored business case demonstrating the financial/resource utilization benefits of dedicated PCCS. This article describes the SPCPH's distinctive design, features of the public hospital PCCS, patient and team characteristics, and PCCS provider perceptions of environmental factors, and SPCPH features that promoted or impeded their success. Lessons learned may have implications for other hospital systems undertaking implementation of palliative care services. © 2012 National Association for Healthcare Quality.

How do NHS general hospitals in England deal with patients with alcohol-related problems? A questionnaire survey.

PubMed

Owens, Lynn; Gilmore, Ian T; Pirmohamed, Munir

2005-01-01

Alcohol-related disease represents a major burden on hospitals. However, it is unclear whether hospitals have developed the necessary expertise and guidelines to deal with this burden. The aim of this survey was to determine what measures general hospital NHS Trusts in England had in place to deal with alcohol-related problems, including the employment of dedicated alcohol specialist nurses. Two postal surveys of all NHS general hospital Trusts in England, the first in 2000 (n = 138; 54% response rate) and the second in 2003 after the publication of the Royal College of Physicians (RCP) report on alcohol in secondary care (n = 164; 75% response rate). Between the two surveys, there was a significant increase (P = 0.005) in the number of dedicated alcohol nurses employed by general hospital trusts; however, the numbers remain low (n = 21). Additionally, the availability of prescribing guidelines for the management of alcohol withdrawal increased significantly (P = 0.0001). The survey indicates that most general hospitals do not have appropriate services in place to deal with such patients. Although there is a need and willingness to develop alcohol services in general hospitals, which is one of the key recommendations of the RCP report, the lack of funding is going to act as a major barrier.

Coventry University and Teenage Cancer Trust eLearning Webapp.

PubMed

2017-04-12

Created by Coventry University in association with the Teenage Cancer Trust, this free e-learning web app aims to help those new to working with teenagers and young adults with cancer to understand their unique needs.

A cryptologic based trust center for medical images.

PubMed

Wong, S T

1996-01-01

To investigate practical solutions that can integrate cryptographic techniques and picture archiving and communication systems (PACS) to improve the security of medical images. The PACS at the University of California San Francisco Medical Center consolidate images and associated data from various scanners into a centralized data archive and transmit them to remote display stations for review and consultation purposes. The purpose of this study is to investigate the model of a digital trust center that integrates cryptographic algorithms and protocols seamlessly into such a digital radiology environment to improve the security of medical images. The timing performance of encryption, decryption, and transmission of the cryptographic protocols over 81 volumetric PACS datasets has been measured. Lossless data compression is also applied before the encryption. The transmission performance is measured against three types of networks of different bandwidths: narrow-band Integrated Services Digital Network, Ethernet, and OC-3c Asynchronous Transfer Mode. The proposed digital trust center provides a cryptosystem solution to protect the confidentiality and to determine the authenticity of digital images in hospitals. The results of this study indicate that diagnostic images such as x-rays and magnetic resonance images could be routinely encrypted in PACS. However, applying encryption in teleradiology and PACS is a tradeoff between communications performance and security measures. Many people are uncertain about how to integrate cryptographic algorithms coherently into existing operations of the clinical enterprise. This paper describes a centralized cryptosystem architecture to ensure image data authenticity in a digital radiology department. The system performance has been evaluated in a hospital-integrated PACS environment.

A cryptologic based trust center for medical images.

PubMed Central

Wong, S T

1996-01-01

OBJECTIVE: To investigate practical solutions that can integrate cryptographic techniques and picture archiving and communication systems (PACS) to improve the security of medical images. DESIGN: The PACS at the University of California San Francisco Medical Center consolidate images and associated data from various scanners into a centralized data archive and transmit them to remote display stations for review and consultation purposes. The purpose of this study is to investigate the model of a digital trust center that integrates cryptographic algorithms and protocols seamlessly into such a digital radiology environment to improve the security of medical images. MEASUREMENTS: The timing performance of encryption, decryption, and transmission of the cryptographic protocols over 81 volumetric PACS datasets has been measured. Lossless data compression is also applied before the encryption. The transmission performance is measured against three types of networks of different bandwidths: narrow-band Integrated Services Digital Network, Ethernet, and OC-3c Asynchronous Transfer Mode. RESULTS: The proposed digital trust center provides a cryptosystem solution to protect the confidentiality and to determine the authenticity of digital images in hospitals. The results of this study indicate that diagnostic images such as x-rays and magnetic resonance images could be routinely encrypted in PACS. However, applying encryption in teleradiology and PACS is a tradeoff between communications performance and security measures. CONCLUSION: Many people are uncertain about how to integrate cryptographic algorithms coherently into existing operations of the clinical enterprise. This paper describes a centralized cryptosystem architecture to ensure image data authenticity in a digital radiology department. The system performance has been evaluated in a hospital-integrated PACS environment. PMID:8930857

Examining Factors Affecting Attitudes toward Nuclear Power in Taiwan

NASA Astrophysics Data System (ADS)

Chan, Tzu-Jen

Nuclear power has become a major issue in Taiwan for several decades. The objective of the present study is to obtain evidence about the major determinants contributing to attitudes toward nuclear power, by investigating socioeconomic factors, environmental attitudes, knowledge of issues, trust, and risk perception, in shaping nuclear attitudes. A face-to-face survey was conducted using paper-based questionnaires from July 2014 to September 2014. Finally, 364 surveys were collected, of which 356 met validation requirements. The findings showed (1) knowledge of issues, trust in university scientists, trust in environmental groups, and risk perception directly influence attitudes toward nuclear power. (2) Risk perception is directly influenced by trust in nuclear authorities, trust in environmental groups, environmental attitudes, and party preference. (3) Gender, age, and party preference directly influence knowledge, trust in nuclear authorities, or trust in university scientists. The potential explanations and implications of findings are discussed.

Trust in Leader and Its Effect on Job Satisfaction and Intent to Leave in a Healthcare Setting

ERIC Educational Resources Information Center

Gibson, David; Petrosko, Joseph

2014-01-01

This article examines trust in leader and its effect on job satisfaction and intent to leave among 294 nurses working in hospitals within two healthcare organizations. Nurses were asked to assess the level of trust in his/her own nurse manager as well as his/her own level of job satisfaction and intent to leave. Results suggest that trust in…

Secondary analysis of hospital patient experience scores across England's National Health Service - How much has improved since 2005?

PubMed

Honeyford, Kate; Greaves, Felix; Aylin, Paul; Bottle, Alex

2017-01-01

To examine trends in patient experience and consistency between hospital trusts and settings. Observational study of publicly available patient experience surveys of three hospital settings (inpatients (IP), accident and emergency (A&E) and outpatients (OP)) of 130 acute NHS hospital trusts in England between 2004/05 and 2014/15. Overall patient experience has been good, showing modest improvements over time across the three hospital settings. Individual questions with the biggest improvement across all three settings are cleanliness (IP: +7.1, A&E: +6.5, OP: +4.7) and information about danger signals (IP: +3.8, A&E: +3.9, OP: +4.0). Trust performance has been consistent over time: 71.5% of trusts ranked in the same cluster for more than five years. There is some consistency across settings, especially between outpatients and inpatients. The lowest-scoring questions, regarding information at discharge, are the same in all years and all settings. The greatest improvement across all three settings has been for cleanliness, which has seen national policies and targets. Information about danger signals and medication side-effects showed least consistency across settings and scores have remained low over time, despite information about danger signals showing a big increase in score. Patient experience of aspects of access and waiting have declined, as has experience of discharge delay, likely reflecting known increases in pressure on England's NHS.

How women with high risk pregnancies perceive interactions with healthcare professionals when discussing place of birth: A qualitative study.

PubMed

Lee, Suzanne; Ayers, Susan; Holden, Des

2016-07-01

to investigate women's perceptions of interactions with obstetricians and midwives during high risk pregnancies. The intention was to examine differences and similarities between women planning to give birth at home or in hospital. qualitative study using semi-structured interviews. Setting Maternity department in a hospital in South East England. twenty-six women with high risk pregnancies, at least 32 weeks pregnant. Half were planning hospital births and half homebirths. semi-structured interviews to investigate women's perception of communication. Results were analysed using thematic analysis. Four themes emerged: women's experiences of communication about risks in pregnancy; women's perceptions of professionals' beliefs about birth; women's trust in professionals; and women's attitude to professionals' advice. Women spoke more positively about communication with midwives than with obstetricians. Women planning hospital births expressed trust in obstetricians. Women planning homebirths expressed more trust in midwives. Women planning hospital births were less likely to question advice from professionals. Women planning homebirths were more inclined to trust their own instincts when these contradicted professional advice. women prefer to communicate with professionals who are respectful of their thoughts and feelings. They may not follow all professional advice. professionals working with women with high risk pregnancies should acknowledge women's concerns and deliver impartial, evidence-based advice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

PubMed Central

Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

2016-01-01

Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The current health care system reform in China has yet to address the fundamental problems embedded in the system that caused distrust. A singular focus on doctor-patient inter-personal interactions will not offer a successful solution to the deteriorated patient-provider relationships unless a systems approach to accountability is put into place involving all stakeholders. PMID:27755558

Rebuilding patient trust. Jump in.

PubMed

Larson, L

2000-06-01

Many people think of hospitals more as businesses than as care providers, and they are wary. As the best connection to their communities, trustees can go a long way to restoring the trust that's gotten lost among the mergers, employee layoffs, and insurance problems. But first, they have to seek community feedback and trust what they hear.

The Relationship between Organizational Trust and Organizational Silence with Job Satisfaction and Organizational Commitment of the Employees of University

ERIC Educational Resources Information Center

Fard, Parastoo Gashtasebi; Karimi, Fariba

2015-01-01

This study aimed to investigate the structural model between organizational trust and organizational silence with job satisfaction and organizational commitment of the employees of Islamic Azad University of Isfahan, (Khorasgan) branch. The study method is descriptive-correlation. The study population is the employees of Islamic Azad University of…

Identifying barriers and facilitators to participation in pressure ulcer prevention in allied healthcare professionals: a mixed methods evaluation.

PubMed

Worsley, Peter R; Clarkson, Paul; Bader, Dan L; Schoonhoven, Lisette

2017-09-01

To evaluate the barriers and facilitators for allied health professional's participation in pressure ulcer prevention. Mixed method cohort study. Single centre study in an acute university hospital trust. Five physiotherapists and four occupational therapists were recruited from the hospital trust. Therapists had been working in the National Health Service (NHS) for a minimum of one year. Therapist views and experiences were collated using an audio recorded focus group. This recording was analysed using constant comparison analysis. Secondary outcomes included assessment of attitudes and knowledge of pressure ulcer prevention using questionnaires. Key themes surrounding barriers to participation in pressure ulcer prevention included resources (staffing and equipment), education and professional boundaries. Fewer facilitators were described, with new training opportunities and communication being highlighted. Results from the questionnaires showed the therapists had a positive attitude towards pressure ulcer prevention with a median score of 81% (range 50 to 83%). However, there were gaps in knowledge with a median score of 69% (range 50 to 77%). The therapist reported several barriers to pressure ulcer prevention and few facilitators. The primary barriers were resources, equipment and education. Attitudes and knowledge in AHPs were comparable to data previously reported from experienced nursing staff. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Communication skills to develop trusting relationships on global virtual engineering capstone teams

NASA Astrophysics Data System (ADS)

Zaugg, Holt; Davies, Randall S.

2013-05-01

As universities seek to provide cost-effective, cross-cultural experiences using global virtual (GV) teams, the 'soft' communication skills typical of all teams, increases in importance for GV teams. Students need to be taught how to navigate through cultural issues and virtual tool issues to build strong trusting relationships with distant team members. Weekly team meetings provide an excellent opportunity to observe key team interactions that facilitate relationship and trust-building among team members. This study observed the weekly team meetings of engineering students attending two US universities and one Asian university as they collaborated as a single GV capstone GV team. In addition local team members were interviewed individually and collectively throughout the project to determine strategies that facilitated team relations and trust. Findings indicate the importance of student choice of virtual communication tools, the refining of communication practices, and specific actions to build trusting relationships. As student developed these attributes, collaboration and success was experienced on this GV team.

Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence.

PubMed

Millar, Ross; Freeman, Tim; Mannion, Russell

2015-06-16

Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in safeguarding the care provided by their organisation. However, recent concerns have been raised over boards' ability to enact their duty to ensure the quality and safety of care. This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of study. The article draws on 10 interviews with key informants and policy actors who form part of the 'issue network' interested in the promotion of patient safety in the English National Health Service. The interviews surfaced a series of narratives regarding hospital board oversight of patient safety. These elaborated on the role of trust and intelligence in highlighting the potential dangers and limitations of approaches to hospital board oversight which have been narrowly focused on a risk-based view of organisational performance. In response, a need to engage with the development of trust based organisational relationships is identified, in which effective board oversight is built on 'trust' characterised by styles of leadership and behaviours that are attentive to the needs and concerns of both staff and patients. Effective board oversight also requires the gathering and triangulating of 'intelligence' generated from both national and local information sources. We call for a re-imagination of hospital board oversight in the light of these different perspectives and articulate an emerging research agenda in this area.

Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study.

PubMed

Aldridge, Cassie; Bion, Julian; Boyal, Amunpreet; Chen, Yen-Fu; Clancy, Mike; Evans, Tim; Girling, Alan; Lord, Joanne; Mannion, Russell; Rees, Peter; Roseveare, Chris; Rudge, Gavin; Sun, Jianxia; Tarrant, Carolyn; Temple, Mark; Watson, Sam; Lilford, Richard

2016-07-09

Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service. Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile. 127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients admitted at weekends was higher than among those admitted on weekdays (adjusted odds ratio 1·10, 95% CI 1·08-1·11; p<0·0001). There was no significant association between Sunday to Wednesday specialist intensity ratios and weekend to weekday mortality ratios (r -0·042; p=0·654). This cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing. National Institute for Health Research Health Services and Delivery Research Programme. Copyright © 2016 Aldridge et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Explaining the justice-performance relationship: trust as exchange deepener or trust as uncertainty reducer?

PubMed

Colquitt, Jason A; Lepine, Jeffery A; Piccolo, Ronald F; Zapata, Cindy P; Rich, Bruce L

2012-01-01

Past research has revealed significant relationships between organizational justice dimensions and job performance, and trust is thought to be one mediator of those relationships. However, trust has been positioned in justice theorizing in 2 different ways, either as an indicator of the depth of an exchange relationship or as a variable that reflects levels of work-related uncertainty. Moreover, trust scholars distinguish between multiple forms of trust, including affect- and cognition-based trust, and it remains unclear which form is most relevant to justice effects. To explore these issues, we built and tested a more comprehensive model of trust mediation in which procedural, interpersonal, and distributive justice predicted affect- and cognition-based trust, with those trust forms predicting both exchange- and uncertainty-based mechanisms. The results of a field study in a hospital system revealed that the trust variables did indeed mediate the relationships between the organizational justice dimensions and job performance, with affect-based trust driving exchange-based mediation and cognition-based trust driving uncertainty-based mediation.

The relationship between social support, shared decision-making and patient's trust in doctors: a cross-sectional survey of 2,197 inpatients using the Cologne Patient Questionnaire.

PubMed

Ommen, Oliver; Thuem, Sonja; Pfaff, Holger; Janssen, Christian

2011-06-01

Empirical studies have confirmed that a trusting physician-patient interaction promotes patient satisfaction, adherence to treatment and improved health outcomes. The objective of this analysis was to investigate the relationship between social support, shared decision-making and inpatient's trust in physicians in a hospital setting. A written questionnaire was completed by 2,197 patients who were treated in the year 2000 in six hospitals in Germany. Logistic regression was performed with a dichotomized index for patient's trust in physicians. The logistic regression model identified significant relationships (p < 0.05) in terms of emotional support (standardized effect coefficient [sc], 3.65), informational support (sc, 1.70), shared decision-making (sc, 1.40), age (sc, 1.14), socioeconomic status (sc, 1.15) and gender (sc, 1.15). We found no significant relationship between 'tendency to excuse' and trust. The last regression model accounted for 49.1% of Nagelkerke's R-square. Insufficient physician communication skills can lead to extensive negative effects on the trust of patients in their physicians. Thus, it becomes clear that medical support requires not only biomedical, but also psychosocial skills.

[Instrumental, directive, and affective communication in hospital leaflets].

PubMed

Vasconcellos-Silva, Paulo Roberto; Uribe Rivera, Francisco Javier; Castiel, Luis David

2003-01-01

This study focuses on the typical semantic systems extracted from hospital staff communicative resources which attempt to validate information as an "object" to be transferred to patients. We describe the models of textual communication in 58 patient information leaflets from five hospital units in Brazil, gathered from 1996 to 2002. Three categories were identified, based on the theory of speech acts (Austin, Searle, and Habermas): 1) cognitive-instrumental utterances: descriptions by means of technical terms validated by self-referred, incomplete, or inaccessible argumentation, with an implicit educational function; 2) technical-directive utterances: self-referred (to the context of the source domains), with a shifting of everyday acts to a technical terrain with a disciplinary function and impersonal features; and 3) expressive modulations: need for inter-subjective connections to strengthen bonds of trust and a tendency to use childish arguments. We conclude that the three categories displayed: fragmentary sources; assumption of univocal messages and invariable use of information (idealized motivations and interests, apart from individualized perspectives); and assumption of universal interests as generators of knowledge.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

PubMed

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

PubMed Central

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

Complex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing.

PubMed

Raven, Kathy E; Gouliouris, Theodore; Brodrick, Hayley; Coll, Francesc; Brown, Nicholas M; Reynolds, Rosy; Reuter, Sandra; Török, M Estée; Parkhill, Julian; Peacock, Sharon J

2017-04-01

Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of nosocomial infection. Here, we describe the utility of whole-genome sequencing in defining nosocomial VREfm transmission. A retrospective study at a single hospital in the United Kingdom identified 342 patients with E. faecium bloodstream infection over 7 years. Of these, 293 patients had a stored isolate and formed the basis for the study. The first stored isolate from each case was sequenced (200 VREfm [197 vanA, 2 vanB, and 1 isolate containing both vanA and vanB], 93 vancomycin-susceptible E. faecium) and epidemiological data were collected. Genomes were also available for E. faecium associated with bloodstream infections in 15 patients in neighboring hospitals, and 456 patients across the United Kingdom and Ireland. The majority of infections in the 293 patients were hospital-acquired (n = 249) or healthcare-associated (n = 42). Phylogenetic analysis showed that 291 of 293 isolates resided in a hospital-associated clade that contained numerous discrete clusters of closely related isolates, indicative of multiple introductions into the hospital followed by clonal expansion associated with transmission. Fine-scale analysis of 6 exemplar phylogenetic clusters containing isolates from 93 patients (32%) identified complex transmission routes that spanned numerous wards and years, extending beyond the detection of conventional infection control. These contained both vancomycin-resistant and -susceptible isolates. We also identified closely related isolates from patients at Cambridge University Hospitals NHS Foundation Trust and regional and national hospitals, suggesting interhospital transmission. These findings provide important insights for infection control practice and signpost areas for interventions. We conclude that sequencing represents a powerful tool for the enhanced surveillance and control of nosocomial E. faecium transmission and infection. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Trust and Fiduciary Relationships in Education: What Happens When Trust Is Breached?

ERIC Educational Resources Information Center

Grierson, Elizabeth Mary

2018-01-01

This paper examines trust as a fundamental aspect of fiduciary relationships in education. The specific relationship under examination is that of academic employee and university employer. Both have the value of trust assigned to them as an implicit part of their social and professional contract. The setting is Australia, but the principles apply…

Clostridium difficile multidisciplinary team root cause analysis: impact on clinical care and circumvention of financial penalties posed by clinical commissioning groups, but at what cost?

PubMed

Saeed, Kordo; Petridou, Christina; Gray, Hazel; Dryden, Matthew; Davis-Blues, Karen; Lucero, Sheryl; Parker, Natalie; Keyser, Taryn; Matthews, Tanya; Cortes, Nick; Kidd, Stephen; Thomas, Claire; Peacock, Heather; Hornzee, Joanna; Wake, Bruce

2018-03-01

In Hampshire Hospitals NHS Foundation Trust, in addition to an on-the-spot investigation into hospital-onset Clostridium difficile infection (CDI) by the infection prevention team, a multidisciplinary team root cause analysis (MDT-RCA) forum has been developed. The MDT-RCA aims to deliver a more thorough investigation into individual cases and the recommendation of cases to the clinical commissioning groups (CCG) appeals panel against potential financial penalties (£10,000 per breached case). We mainly aimed to investigate the financial impact of MDT-RCAs to the Trust. Over two years, 84 cases of hospital-onset CDI cases were reviewed by the MDT-RCA forum. Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations. In total, 543 staff members attended the MDT-RCAs at a potential cost to the Trust of £23,795.74-£51,670.10. The Trust appealed against financial penalties for 27 cases and 14 were successful, i.e. £140,000 would have been avoided had targets been breached by 14 cases. However, targets were only breached by two cases, meaning only £20,000 in fines was avoided. Deducting this from the total costs of the MDT-RCA meant the Trust lost £3,795.74-£31,670.10. Over the two years reviewed, the MDT-RCA proved to be costly to the Trust, with no additional learning or quality improvement measures identified.

Patient‐friendly hospital environments: exploring the patients’ perspective

PubMed Central

Douglas, Calbert H.; Douglas, Mary R.

2004-01-01

Abstract Objective  To investigate the perceptions and attitudes of patients to the built environments of NHS Trust hospitals, in order to inform design excellence so as to make future hospitals places and spaces responsive to patient needs. Design  An exploratory study of patients perceptions based on qualitative semi‐structured personal interviews. Setting and participants  Fifty one‐to‐one interviews held with hospital in‐patients across the four directorates of surgery, medicine, care of the elderly and maternity at Salford Royal Hospitals NHS Trust, Salford, UK. Results  The research found that there was much similarity in the priorities, issues and concerns raised by patients in each of the four directorates. Patients perceived the built environment of the hospital as a supportive environment. Their accounts in each area pointed to the significance of the factors that immediately impacted on them and their families. Patients identified having a need for personal space, a homely welcoming atmosphere, a supportive environment, good physical design, access to external areas and provision of facilities for recreation and leisure. Responses suggest that patient attitudes and perceptions to the built environment of hospital facilities relates to whether the hospital provides a welcoming homely space for themselves and their visitors that promotes health and wellbeing. Conclusions  The findings have important implications for capital development teams, clinical staff, managers and NHS Estates personnel. Although the study has immediate relevance for Salford Royal Hospitals Trust, findings and recommendations reported provide NHS Estates and other relevant stakeholders with evidence‐based knowledge and understanding of patients’ perceptions and expectations of and preferences for particular facilities and estates provision in NHS hospitals. PMID:14982500

To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit.

PubMed

Wagg, A; Duckett, J; McClurg, D; Harari, D; Lowe, D

2011-12-01

OBJECTIVE  To assess the degree of adherence to the current National Institute for Health and Clinical Excellence (NICE) guidelines on the management of urinary incontinence (UI) in women. Retrospective survey of consecutive female inpatients and outpatients with UI as part of a national audit. NHS hospital and primary care (PC) trusts. Twenty-five women <65 years old and 25 women ≥ 65 years old from each participating site. All NHS trusts in England, Wales and Northern Ireland were eligible to participate. A web-based data collection form aligned to the NICE guidelines was constructed for the study. All data submitted to the audit were anonymous and access to the web-tool was password-protected for confidentiality. Data were returned by 128 acute and 75 PC trusts on 7846 women. No diagnosis was documented in 6.8% (153/2254) of younger and 28% (571/2011) of older women in hospitals (P < 0.001), and by 8.6% (123/1435) of younger and 21% (380/1786) of older women in PC trusts. In hospitals, 26% (396/1524) of younger women and 15% (182/1231) of older women (P < 0.001) and in PC trusts 8.2% (77/934) of younger and 4.7% (46/975) of older women underwent multichannel cystometry before conservative therapy. Documentation of discussion of causes and treatment of UI occurred in 76% (1717/2254) of younger and 44% (884/2011) of older women in hospitals (P < 0.001) and in 75% (1080/1435) of younger and 53% (948/1786) of older women in PC trusts (P < 0.001). CONCLUSION Older women are less likely to receive NICE compliant management. Adherence varies according to recommendation. There needs to be concentration on evidence-based community provision of care by competent and interested clinicians before the aims of the NICE guidelines are met. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

42 CFR 422.458 - Risk sharing with regional MA organizations for 2006 and 2007.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Terminology. For purposes of this section— Allowable costs means, with respect to an MA regional plan offered... Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund in the proportion...

Introduction of positron emission tomography into the Western Norwegian Health Region: Regional balance in resource utilization from 2009 to 2014.

PubMed

Stokmo, Henning Langen; Reitan, Bernt Christian; Johnsen, Boel; Gulati, Ankush; Kleven-Madsen, Nina; Adamsen, Tom Christian Holm; Biermann, Martin

2017-09-01

The aim was to compare resource utilization across the four health trusts within the Western Norway Regional Health Authority since the establishment of positron emission tomography (PET) at Haukeland University Hospital in Bergen in 2009. Metadata from all PET examinations from 2009 to 2014 were automatically imported from the PET centre's central production database into a custom-developed database system, MDCake. A PET examination was defined as a procedure based on a single injection of radioactive tracer. The patients' place of residence and tentative diagnosis were coded based on the available clinical information. The total number of PET examinations increased from 293 in 2009 to 1616 in 2014. The number of PET examinations per year increased across all diagnostic groups, but plateaued for lung cancer, gastrointestinal cancer and malignant melanoma since 2013. The number of examinations per capita was evenly distributed between the three northern health trusts with an average of 1260 PET studies per million inhabitants in 2014. However, patients residing in the most southerly health trust received between 44% (2010) and 27% (2014; P<0·001, repeated measures ANOVA) fewer examinations per capita per year. Centralized PET in the Western Norwegian health region meets the current clinical demand for patients residing in the three northern health trusts while patients from the most southern health trust receive approximately 30% fewer PET examinations. Access to specialized health care should be monitored routinely in order to identify inequalities in referral patterns and resource utilization. © 2015 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.

Prevalence and perpetrators of workplace violence by nursing unit and the relationship between violence and the perceived work environment.

PubMed

Park, Mihyun; Cho, Sung-Hyun; Hong, Hyun-Ja

2015-01-01

To identify the prevalence and perpetrators of workplace violence against nurses and to examine the relationship of work demands and trust and justice in the workplace with the occurrence of violence. This study employed cross-sectional data from a 2013 nurse survey conducted at a university hospital in Seoul, South Korea. The study sample included 970 female nurses from 47 nursing units, including general, oncology, intensive care units (ICUs), operating rooms, and outpatient departments. The second version of the medium-sized Copenhagen Psychosocial Questionnaire (COPSOQ II) was used to measure work demands (i.e., quantitative demands, work pace, and emotional demands), trust and justice, and violence. Relationships among those variables were examined by conducting multiple logistic regression analyses with multilevel modeling. The 12-month prevalence of verbal abuse (63.8%) was highest, followed by threats of violence (41.6%), physical violence (22.3%), and sexual harassment (19.7%), but bullying had the lowest prevalence (9.7%). Physical violence, threats of violence, and verbal abuse occurred most frequently in ICUs, whereas sexual harassment and bullying were highest in operating rooms. The main perpetrators were patients, followed by physicians and patients' families. Nurses perceiving greater work demands and less trust and justice were more likely to have been exposed to violence. The prevalence and perpetrators of violence varied considerably among nursing units. Greater work demands and less trust and justice were associated with nurses' experiences of violence. Adequate work demands and a trusted and just work environment may reduce violence against nurses. In return, reduction of violence will contribute to creating a better nursing work environment. © 2014 Sigma Theta Tau International.

Understanding the relationship between trust in health care and attitudes toward living donor transplant among African Americans with end-stage renal disease.

PubMed

McDonald, Evangeline L; Powell, C Lamonte; Perryman, Jennie P; Thompson, Nancy J; Arriola, Kimberly R Jacob

2013-01-01

Transplantation is the favored therapy for patients with end-stage renal disease (ESRD). Unfortunately, demand for available organs far outpaces the supply. African Americans are disproportionately affected by the ever-widening gap between organ supply and demand. Additionally, structural, biological, and social factors contribute to feelings of unease some African Americans may feel regarding living donor transplant (LDT). The present research examines the relationship between trust in health care and attitudes toward LDT among African American ESRD patients. We hypothesized that lower trust in health care would be significantly associated with negative attitudes toward LDT, and that this relationship would be moderated by patient attitudes toward dialysis. Data were collected from August 2011 to April 2012 as part of a larger study. Measures included trust (of doctors, racial equity of treatment, and hospitals) and attitudes toward both LDT and dialysis. Bivariate analysis revealed that trust in one's doctor, hospital, and in racial equity in health care was significantly correlated with attitudes toward LDT (r = 0.265; r = 0.131; and r = 0.202, respectively). Additionally, attitudes toward dialysis moderated the relationships between Trust in Doctors/Attitudes toward LDT and Trust in Racial equity of treatment/Attitudes toward LDT. Findings suggest a strong relationship between trust in health care and attitudes toward LDT. These findings also shed light on how dialysis experiences are related to the relationship between trust in health care and attitudes toward LDT. © 2013 John Wiley & Sons A/S.

Psychometric properties of the Trust in Physician Scale in Tamil Nadu, India.

PubMed

Kalsingh, Maria Jusler; Veliah, Geetha; Gopichandran, Vijayaprasad

2017-01-01

Trust in health care is of high intrinsic value. It also leads to positive outcomes such as better treatment adherence and disclosure of sensitive information. Therefore, there is a need to measure trust in health care objectively. To assess the psychometric properties of the Trust in Physician Scale in Tamil Nadu, India. The study was conducted in a private tertiary hospital setting in Tamil Nadu by a cross-sectional survey design. The Trust in Physician Scale and General Trust Scale were administered to 288 participants in the waiting area of a tertiary care hospital in Tamil Nadu. Descriptive statistics, exploratory factor analysis, and Cronbach's alpha statistics were used to assess the validity and reliability of the scale. The respondents were predominantly men from rural areas, older than 35 years of age, and with lesser than 8 years of schooling. The questionnaire had acceptable internal consistency with Cronbach's alpha of 0.707 (95% confidence interval 0.654-0.755). Exploratory factor analysis divided the questionnaire into four domains. Seven items loaded into factor 1 which explained dependability and competence of the physician, two items loaded on factor 2, and one each in factors 3 and 4. The latter four items had very low item to total correlations and hence did not contribute much to the questionnaire. The Trust in Physician questionnaire needs to be modified to accurately measure the domains of trust in the context of the study area. More qualitative studies are required to understand the domains of trust in this cultural and social context.

What predicts the trust of online health information?

PubMed Central

Kwon, Jeong Hyun; Kye, Su-Yeon; Park, Eun Young; Oh, Kyung Hee; Park, Keeho

2015-01-01

OBJECTIVES: Little attention has been paid to levels of trust in online sources of health information. The objective of this study was to investigate levels of trust in various sources of health information (interpersonal channels, traditional media, and Internet media), and to examine the predictors of trust in health information available on the Internet. METHODS: A questionnaire was administered to 1,300 people (20 years of age or older), evaluating levels of trust in various sources of health information. RESULTS: The highest level of trust was expressed regarding interpersonal channels, with hospital physicians regarded as the most trusted source of information age and income showed an association with trust in online information sources. Elderly people were not likely to trust Internet news sources, and high incomes were found to be strongly associated with trust in online sources of information overall. CONCLUSIONS: Public health organizations must consider the predictors for trust in various sources of information in order to employ appropriate media when targeting vulnerable individuals or developing messaging strategies for health professionals. PMID:26212505

A comparison of alternative medicare reimbursement policies under optimal hospital pricing.

PubMed Central

Dittman, D A; Morey, R C

1983-01-01

This paper applies and extends the use of a nonlinear hospital pricing model, recently posited in the literature by Dittman and Morey [1]. That model applied a hospital profit-maximizing behavior and studied the effects of optimal pricing of hospital ancillary services on the incidence of payment by private insurance companies and the Medicare trust fund. Here, we examine variations of the above model where both hospital profit-maximizing and profit-satisficing postures are of interest. We apply the model to three types of Medicare reimbursement policies currently in use or under legislative mandate to implement. The policies differ according to hospital size and whether cross-subsidies are allowed. We are interested in determining the effects of profit-maximizing and -satisficing behaviors of these three reimbursement policies on the levels of profits received, and on the respective implications for private payors and the Medicare trust fund. PMID:6347973

Investigating the governance of autonomous public hospitals in England: multi-site case study of NHS foundation trusts.

PubMed

Allen, Pauline; Keen, Justin; Wright, John; Dempster, Paul; Townsend, Jean; Hutchings, Andrew; Street, Andrew; Verzulli, Rossella

2012-04-01

To investigate the external and internal governance of NHS foundation trusts (FTs), which have increased autonomy, and local members and governors unlike other NHS trusts. In depth, three-year case studies of four FTs; and analysis of national quantitative data on all FT hospitals and NHS Trust hospitals to give national context. Data included 111 interviews with managers, clinicians, governors and members, and local purchasers; observation of meetings; and analysis of FTs' documents. The four case study FTs were similar to other FTs. They had used their increased autonomy to develop more business-like practices. The FT regulator, Monitor, intervened only when there were reported problems in FT performance. National targets applying to the NHS also had a large effect on FT behaviour. FTs saw themselves as part of the local health economy and tried to maintain good relationships with local organisations. Relationships between governors and the FTs' executives were still developing, and not all governors felt able to hold their FT to account. The skills and experience of staff members and governors were under-used in the new governance structures. It is easier to increase autonomy for public hospitals than to increase local accountability. Hospital managers are likely to be interested in making decisions with less central government control, whilst mechanisms for local accountability are notoriously difficult to design and operate. Further consideration of internal governance of FTs is needed. In a deteriorating financial climate, FTs should be better placed to make savings, due to their more business-like practices.

The impact of the customer relationship management on organizational productivity, customer trust and satisfaction by using the structural equation model: A study in the Iranian hospitals.

PubMed

Yaghoubi, Maryam; Asgari, Hamed; Javadi, Marzieh

2017-01-01

One of the challenges in the fiercely competitive space of health organizations is responding to customers and building trust and satisfaction in them in the shortest time, with best quality and highest productivity. Hence the aim of this study is to survey the impact of customer relationship management (CRM) on organizational productivity, customer loyalty, satisfaction and trust in selected hospitals of Isfahan (in Iran). This study is a correlation descriptive research. Study population was the nurses in selected hospitals of Isfahan and the sampling has been conducted using stratified random method. Data collection tool is a researcher-made questionnaire of CRM and its effects (organizational productivity, customer loyalty, satisfaction and trust) which its validity and reliability has been confirmed by researchers. Structural equation method was used to determine the impact of variables. Data analysis method was structural equation modeling and the software used was SPSS version 16 (IBM, SPSS, 2007 Microsoft Corp., Bristol, UK) and AMOS version 18 (IBM, SPSS, 2010 Microsoft Corp, Bristol, UK). Among the dimensions of CRM, diversification had the highest impact (0.83) and customer acquisition had the lowest (0.57) CRM, had the lowest impact on productivity (0.59) and the highest effect on customer satisfaction (0.83). For the implementation of CRM, it is necessary that the studied hospitals improve strategies of acquiring information about new customers, attracting new customers and keeping them and communication with patients outside the hospital and improve the system of measuring patient satisfaction and loyalty.

Sick Note to Fit Note: one trust’s project to improve usage by hospital clinicians

PubMed Central

Moran, Amy; Mainwaring, Cathryn; Keane, Oliver; Sanctuary, Thomas; Watson, Kathryn; Lasoye, Tunji

2018-01-01

Introduction In April 2010, the government introduced a new Statement of Fitness to Work or ’Fit Note' for patients requiring time off of work or adaptations to their work due to illness. Responsibility to issue these documents has shifted from primary to secondary care. Hospital clinicians are required to issue for inpatients and for outpatients where clinical responsibility has not been taken over by the general practitioner (GP). However, awareness of this change is lacking. Misdirecting patients to their GP for the sole purpose of receiving a ’Fit Note' is an unnecessary use of appointment time and negatively impacts on patients. King’s College Hospital NHS Trust receives a number of quality alerts from primary care regarding this issue. Methods A trust-wide educational initiative was designed and implemented to increase staff awareness of Fit Notes and their correct usage in order to reduce the number of patients being misdirected to their GP to obtain one. Interventions included direct staff engagement, a trust-wide promotional campaign and creation of an electronic version of the document. Results Uptake of the electronic version of the Fit Note has steadily increased and there has been a fall in the number of quality alerts received by the trust. However, staff awareness on the whole remains low. Conclusions Patients being misdirected to their general practice for Fit Notes is an important issue and one on which the baseline level of awareness among hospital clinicians is low. Challenges during this intervention have been in penetrating a trust of this size and getting the message across to staff. However, digitising the Fit Note can help to increase its use. PMID:29333499

The Role of Trust between International Students and Their American Instructors at Intensive English-Language Programs at American Universities

ERIC Educational Resources Information Center

Mirzoyants, Anastasia

2012-01-01

The study proposes an alternative approach to studying interpersonal trust. The researcher uses the Rasch analysis to design a quantitative instrument that can be used to measure trust when exploring the effects that various aspects of educational environment have on students' experiences. Prior empirical studies examined trust from a…

How Navigating Uncertainty Motivates Trust in Medicine.

PubMed

Imber, Jonathan B

2017-04-01

Three significant factors in the shaping of modern medicine contribute to broad perceptions about trust in the patient-physician relationship: moral, professional, and epidemiological uncertainty. Trusting a physician depends first on trusting a person, then trusting a person's skills and training, and finally trusting the science that underwrites those skills. This essay, in part based on my book, Trusting Doctors: The Decline of Moral Authority in American Medicine (Princeton University Press, 2008), will address the forms of uncertainty that contribute to the nature of difficult encounters in the patient-physician relationship. © 2017 American Medical Association. All Rights Reserved.

Results of a population-based-assessment: we need better communication and more profound patient involvement.

PubMed

Sendlhofer, Gerald; Pregartner, Gudrun; Leitgeb, Karina; Hoffmann, Magdalena; Berghold, Andrea; Smolle, Christian; Brunner, Gernot; Kamolz, Lars Peter

2017-04-01

In Austria several regulations were published in order to support initiatives to increase patient safety. Since then, many patient safety projects were implemented in Austrian hospitals; therefore, it was the aim of the current survey to examine the perceptions of Austrian citizens with respect to topics relevant to patient safety. Between 8 and 22 October 2015 a qualitative cross-sectional telephone interview study was performed. A sample of citizens above 14 years of age was randomly drawn. The survey contained 6 questions. In each of the nine states of Austria, a representative number of citizens were interviewed. In total 1021(female: 52.3%) telephone interviews were performed and 249 (24.7%) citizens stated that trust/confidence in patient safety is very high, 571 (55.9%) assessed the reputation of a hospital as very important and 739 (72.4%) stated that a detailed explanation of the treatment as well as information on associated risk factors and possibilities of further treatments is very important. Of the respondents 722 (70.7%) stated that patient safety measures in a given hospital are very important, 807 (79.0%) stated that it is important to be informed about patient safety measures and 547 (53.6%) stated that if something did not satisfactorily function they would complain to the hospital. Significant differences occurred for states with and without university hospitals. The results of the survey give cause for concern as the majority of interviewed citizens have medium or low trust/confidence in patient safety. Furthermore, more than two-thirds of Austrian citizens revealed that detailed explanation of treatment, information on associated risk factors, information about patient safety measures to predict medical errors and information about patient safety measures which are in place in a hospital are very important. The study showed that patient safety is an important topic for Austrian citizens and they want to be informed and involved. The study also indicated the need to promote patient safety aspects and to decrease the number of people who are not confident concerning patient safety in Austrian hospitals.

Ethical tissue: a not-for-profit model for human tissue supply.

PubMed

Adams, Kevin; Martin, Sandie

2011-02-01

Following legislative changes in 2004 and the establishment of the Human Tissue Authority, access to human tissues for biomedical research became a more onerous and tightly regulated process. Ethical Tissue was established to meet the growing demand for human tissues, using a process that provided ease of access by researchers whilst maintaining the highest ethical and regulatory standards. The establishment of a licensed research tissue bank entailed several key criteria covering ethical, legal, financial and logistical issues being met. A wide range of stakeholders, including the HTA, University of Bradford, flagged LREC, hospital trusts and clinical groups were also integral to the process.

Investment vital to deliver 5YFV goals.

PubMed

Naylor, Robert

2017-05-01

Without substantial investment in the NHS estate, the Five Year Forward View cannot be delivered, and the estate will 'remain unfit for purpose and continue to deteriorate', an independent review of NHS property and estate in England headed by Sir Robert Naylor, the former CEO of University College London Hospitals NHS Foundation Trust (pictured), concludes. Among the recommendations of the DH-commissioned review--which considers the opportunities to generate valuable funds via the sale of under-utilised NHS properties--is the establishment of 'a powerful new NHS Property Board', to 'provide leadership to the centre, and expertise and delivery support to Sustainability and Transformation Plans'.

A SHOCKING REQUIREMENT IN THE LAW ON NEGLIGENCE LIABILITY FOR PSYCHIATRIC ILLNESS: LIVERPOOL WOMEN'S HOSPITAL NHS FOUNDATION TRUST V RONAYNE [2015] EWCA CIV 588.

PubMed

Burrows, Andrew S; Burrows, John H

2016-01-01

The Ronayne case concerned a husband who suffered a psychiatric illness, described as an adjustment disorder, in seeing the condition of his wife who was the primary victim of admitted medical negligence. His claim for compensation, as a 'secondary victim', failed because he could not satisfy the legal requirement that there must be a sudden shocking event. This commentary criticises that requirement which appears to make no medical sense. © The Author 2016. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Preventing falls in hospital.

PubMed

Pearce, Lynne

2017-01-31

Essential facts Falls are the most frequently reported adverse events in hospitals, especially among older patients. According to the Royal College of Physicians (RCP) more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wale.

An educational intervention to change planned behavior concerning midwife-assisted out-of-hospital childbirth.

PubMed

Hans, Jason D; Kimberly, Claire

2011-01-01

'The Business of Being Born' is a documentary film that reviews the history, economics, and culture of birth in the United States, with an emphasis on viewing low-risk birth as a natural and reasonably safe experience that does not require medical intervention. A nonequivalent control group design with 468 American university students was used to examine the potential of 'The Business of Being Born' for changing attitudes toward, and planned behavior concerning, midwife-assisted out-of-hospital childbirth. Viewing the film had a large positive effect on planned behavior concerning midwife-assisted out-of-hospital childbirth. Rationales for planned behaviors indicated that trust and safety concerns accounted for the appeal of physician-assisted hospital childbirth over midwife-assisted out-of-hospital childbirth, but that viewing the film substantially tempered these concerns vis-à-vis midwife-assisted out-of-hospital childbirth among a large portion of participants. The results indicate that 'The Business of Being Born' can increase awareness of and support for the midwifery profession, and that these changes may result in increased demand for midwifery services. However, proactive efforts must be taken to ensure that the film reaches its target audience. © 2011 by the American College of Nurse-Midwives.

Reputation offsets trust judgments based on social biases among Airbnb users.

PubMed

Abrahao, Bruno; Parigi, Paolo; Gupta, Alok; Cook, Karen S

2017-09-12

To provide social exchange on a global level, sharing-economy companies leverage interpersonal trust between their members on a scale unimaginable even a few years ago. A challenge to this mission is the presence of social biases among a large heterogeneous and independent population of users, a factor that hinders the growth of these services. We investigate whether and to what extent a sharing-economy platform can design artificially engineered features, such as reputation systems, to override people's natural tendency to base judgments of trustworthiness on social biases. We focus on the common tendency to trust others who are similar (i.e., homophily) as a source of bias. We test this argument through an online experiment with 8,906 users of Airbnb, a leading hospitality company in the sharing economy. The experiment is based on an interpersonal investment game, in which we vary the characteristics of recipients to study trust through the interplay between homophily and reputation. Our findings show that reputation systems can significantly increase the trust between dissimilar users and that risk aversion has an inverse relationship with trust given high reputation. We also present evidence that our experimental findings are confirmed by analyses of 1 million actual hospitality interactions among users of Airbnb.

Reputation offsets trust judgments based on social biases among Airbnb users

PubMed Central

Abrahao, Bruno; Parigi, Paolo; Gupta, Alok; Cook, Karen S.

2017-01-01

To provide social exchange on a global level, sharing-economy companies leverage interpersonal trust between their members on a scale unimaginable even a few years ago. A challenge to this mission is the presence of social biases among a large heterogeneous and independent population of users, a factor that hinders the growth of these services. We investigate whether and to what extent a sharing-economy platform can design artificially engineered features, such as reputation systems, to override people’s natural tendency to base judgments of trustworthiness on social biases. We focus on the common tendency to trust others who are similar (i.e., homophily) as a source of bias. We test this argument through an online experiment with 8,906 users of Airbnb, a leading hospitality company in the sharing economy. The experiment is based on an interpersonal investment game, in which we vary the characteristics of recipients to study trust through the interplay between homophily and reputation. Our findings show that reputation systems can significantly increase the trust between dissimilar users and that risk aversion has an inverse relationship with trust given high reputation. We also present evidence that our experimental findings are confirmed by analyses of 1 million actual hospitality interactions among users of Airbnb. PMID:28847948

The good, the bad, and the ugly of partnered research: revisiting the sequestration thesis and the role of universities in promoting social justice.

PubMed

Yassi, Annalee; Dharamsi, Shafik; Spiegel, Jerry; Rojas, Alejandro; Dean, Elizabeth; Woollard, Robert

2010-01-01

As universities increasingly rely on external sources of research funding, researchers worldwide are realizing that if their work is financially supported by organizations with distinct political or financial interests, they risk their careers if their results deviate from the interests of their funding partners. This article presents a case that illustrates how ugly this situation can become. Reviewing the literature on the advantages and dangers of partnered research, the historical role of universities, funding trends, and university mission statements, the authors contend that universities must engage in service learning and participatory action research, but must ensure that faculty members engaging in academic activity with partners-whether industry, hospitals, governments, nongovernmental organizations, or communities-have their professional integrity protected. If doubt exists about whether the partner can or will honor these principles or the mission of universities for social good, universities should avoid granting joint or affiliate appointments or accepting funds or favors of any kind. Universities also need formal structures to ensure ethical application of innovation and principled partnership engagement. In becoming servants of government or corporatism, universities have become less vital to society and are failing in their mission to promote social justice and sustainability. Strong measures are needed to restore public trust.

Does distrust in providers affect health-care utilization in China?

PubMed Central

Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt

2016-01-01

How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483

Team Trust in Online Education: Assessing and Comparing Team-Member Trust in Online Teams versus Face-to-Face Teams

ERIC Educational Resources Information Center

Beranek, Peggy M.; French, Monique L.

2011-01-01

Trust is a key factor in enabling effective team performance and, in online teams, needs to be built quickly and early. As universities expand their online offerings students are increasingly working in online teams. Understanding how trust development may differ in online teams versus face-to-face can have implications for online education…

Impact of universal screening on MRSA bacteremias in a single acute NHS organisation (2006-12): interrupted time-series analysis.

PubMed

Sarma, Jayanta B; Marshall, Bryan; Cleeve, Victoria; Tate, David; Oswald, Tamsin

2013-01-14

In November 2004, a national target was set for the English hospital trusts to reduce the Meticillin-Resistant Staphylococcus aureus (MRSA) bacteremia rate by 60% by April 2008 against the number during 2003/04 (baseline year). In our organisation the number of MRSA bacteremias had risen since 2002 and peaked at 75 in 2005/06. A target was set to reduce the number and series of specific and non- specific interventions was introduced including universal MRSA screening. This study analyzes the impact of universal MRSA screening using a quasi-experimental design using routinely gathered data. This study used data gathered routinely for clinical governance, quality control, financial management and outbreak monitoring purposes. Interrupted Time Series (ITS) analysis of 15 pre- and 19 post- universal MRSA screening (and decolonisation) quarterly numbers of bacteremias was carried out where Meticillin-Sensitive Staphylococcus aureus (MSSA) numbers served as non-equivalent dependent variable (control). An immediate sharp fall in MRSA bacteremias was observed following the universal MRSA screening (and decolonisation) commenced in Q2, 2007. The number dropped sharply from 23 (Q2, 2007) to 10 (Q3, 2007) for all MRSA bacteremias, and, from 15 (Q2, 2007) to 6 (Q3, 2007) for bacteremias ≥48 hours of hospitalization. The declining trend continued reaching zero in Q2, 2009 and Q4, 2010 for those with ≥48 hours of hospitalization and all bacteremias, respectively. ITS analysis revealed significant impact of universal MRSA screening on all MRSA bacteremias (β2 -0.554, p 0.000) and those with ≥48 of hospitalization (β2 -0.577, p 0.001). Impact estimation predicted 17 and 13 bacteremias for all and those with ≥48 hours hospitalization, respectively in the 19th quarter post-intervention, if the intervention did not occur. The number of MRSA isolates from non-blood culture systemic sources as percentage of admissions also dropped significantly from 3.32% in Q2, 2007 to 1.51% in Q3, 2007 (β2 -0.506, p 0.000) which is still running low at 0.33% at the end of Q1, 2012. On the other hand, there was no statistically significant impact of universal screening on MSSA bacteremias. We conclude that of all interventions, the universal MRSA screening (and decolonisation) is the most effective intervention associated with significant and sharp drop in MRSA burden.

Impact of universal screening on MRSA bacteremias in a single acute NHS organisation (2006–12): interrupted time-series analysis

PubMed Central

2013-01-01

Background In November 2004, a national target was set for the English hospital trusts to reduce the Meticillin-Resistant Staphylococcus aureus (MRSA) bacteremia rate by 60% by April 2008 against the number during 2003/04 (baseline year). In our organisation the number of MRSA bacteremias had risen since 2002 and peaked at 75 in 2005/06. A target was set to reduce the number and series of specific and non- specific interventions was introduced including universal MRSA screening. This study analyzes the impact of universal MRSA screening using a quasi-experimental design using routinely gathered data. Methods This study used data gathered routinely for clinical governance, quality control, financial management and outbreak monitoring purposes. Interrupted Time Series (ITS) analysis of 15 pre- and 19 post- universal MRSA screening (and decolonisation) quarterly numbers of bacteremias was carried out where Meticillin-Sensitive Staphylococcus aureus (MSSA) numbers served as non-equivalent dependent variable (control). Results An immediate sharp fall in MRSA bacteremias was observed following the universal MRSA screening (and decolonisation) commenced in Q2, 2007. The number dropped sharply from 23 (Q2, 2007) to 10 (Q3, 2007) for all MRSA bacteremias, and, from 15 (Q2, 2007) to 6 (Q3, 2007) for bacteremias ≥48 hours of hospitalization. The declining trend continued reaching zero in Q2, 2009 and Q4, 2010 for those with ≥48 hours of hospitalization and all bacteremias, respectively. ITS analysis revealed significant impact of universal MRSA screening on all MRSA bacteremias (β2 -0.554, p 0.000) and those with ≥48 of hospitalization (β2 -0.577, p 0.001). Impact estimation predicted 17 and 13 bacteremias for all and those with ≥48 hours hospitalization, respectively in the 19th quarter post-intervention, if the intervention did not occur. The number of MRSA isolates from non-blood culture systemic sources as percentage of admissions also dropped significantly from 3.32% in Q2, 2007 to 1.51% in Q3, 2007 (β2 -0.506, p 0.000) which is still running low at 0.33% at the end of Q1, 2012. On the other hand, there was no statistically significant impact of universal screening on MSSA bacteremias. Conclusions We conclude that of all interventions, the universal MRSA screening (and decolonisation) is the most effective intervention associated with significant and sharp drop in MRSA burden. PMID:23316746

Control, Trust, and Rethinking Traditional Roles: Critical Elements in Creating a Mutually Beneficial University-School Partnership.

ERIC Educational Resources Information Center

Lewison, Mitzi; Holliday, Sue

1997-01-01

Describes a partnership between a university graduate student and the principal and teachers of a traditional elementary school who collaborated to engage in study group sessions, keep professional journals, and read and discuss research articles on writing instruction. The paper addresses issues of building trust, equalizing power, and…

Teacher Learning in a School-University Partnership: Exploring the Role of Social Trust and Teaching Efficacy Beliefs

ERIC Educational Resources Information Center

Fisler, Jennifer L.; Firestone, William A.

2006-01-01

Teacher learning has been studied in numerous contexts using a variety of theoretical frameworks. Our research examines variation in teacher learning in a school-university partnership. We explore the personal characteristics of social trust and teaching efficacy beliefs in relation to teachers' levels of learning. We classify teachers in the…

The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units.

PubMed

Vogus, Timothy J; Sutcliffe, Kathleen M

2011-01-01

Prior research has found that safety organizing behaviors of registered nurses (RNs) positively impact patient safety. However, little research exists on the joint benefits of safety organizing and other contextual factors that help foster safety. Although we know that organizational practices often have more powerful effects when combined with other mutually reinforcing practices, little research exists on the joint benefits of safety organizing and other contextual factors believed to foster safety. Specifically, we examined the benefits of bundling safety organizing with leadership (trust in manager) and design (use of care pathways) factors on reported medication errors. A total of 1033 RNs and 78 nurse managers in 78 emergency, internal medicine, intensive care, and surgery nursing units in 10 acute-care hospitals in Indiana, Iowa, Maryland, Michigan, and Ohio who completed questionnaires between December 2003 and June 2004. Cross-sectional analysis of medication errors reported to the hospital incident reporting system for the 6 months after the administration of the survey linked to survey data on safety organizing, trust in manager, use of care pathways, and RN characteristics and staffing. Multilevel Poisson regression analyses indicated that the benefits of safety organizing on reported medication errors were amplified when paired with high levels of trust in manager or the use of care pathways. Safety organizing plays a key role in improving patient safety on hospital nursing units especially when bundled with other organizational components of a safety supportive system.

Vantage point.

PubMed

Kay, Jenny

2010-04-28

A RECENT BBC Panorama television programme asked how we know which hospitals are 'good'. It argued that the hospital rating system cannot always be trusted because it depends in large part on self-assessment.

Explaining Math Achievement: Personality, Motivation, and Trust

ERIC Educational Resources Information Center

Kilic-Bebek, Ebru

2009-01-01

This study investigated the statistical significance of student trust next to the well-tested constructs of personality and motivation to determine whether trust is a significant predictor of course achievement in college math courses. Participants were 175 students who were taking undergraduate math courses in an urban public university. The…

The REIT stuff. Do real estate investment trusts have what it takes to bridge hospital compliance gaps?

PubMed

Haugh, R

1998-11-05

Up to now, real estate investment trusts have put most of their health care dollars into nursing homes. Thanks to federal fraud probes, some REIT executives see medical office buildings as their next big market.

The cost of ignoring acute cholecystectomy.

PubMed

Garner, J P; Sood, S K; Robinson, J; Barber, W; Ravi, K

2009-01-01

Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over 40,000 pounds. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.

Standards for gene therapy clinical trials based on pro-active risk assessment in a London NHS Teaching Hospital Trust.

PubMed

Bamford, K B; Wood, S; Shaw, R J

2005-02-01

Conducting gene therapy clinical trials with genetically modified organisms as the vectors presents unique safety and infection control issues. The area is governed by a range of legislation and guidelines, some unique to this field, as well as those pertinent to any area of clinical work. The relevant regulations covering gene therapy using genetically modified vectors are reviewed and illustrated with the approach taken by a large teaching hospital NHS Trust. Key elements were Trust-wide communication and involvement of staff in a pro-active approach to risk management, with specific emphasis on staff training and engagement, waste management, audit and record keeping. This process has led to the development of proposed standards for clinical trials involving genetically modified micro-organisms.

The impact of the customer relationship management on organizational productivity, customer trust and satisfaction by using the structural equation model: A study in the Iranian hospitals

PubMed Central

Yaghoubi, Maryam; Asgari, Hamed; Javadi, Marzieh

2017-01-01

Context: One of the challenges in the fiercely competitive space of health organizations is responding to customers and building trust and satisfaction in them in the shortest time, with best quality and highest productivity. Hence the aim of this study is to survey the impact of customer relationship management (CRM) on organizational productivity, customer loyalty, satisfaction and trust in selected hospitals of Isfahan (in Iran). Materials and Methods: This study is a correlation descriptive research. Study population was the nurses in selected hospitals of Isfahan and the sampling has been conducted using stratified random method. Data collection tool is a researcher-made questionnaire of CRM and its effects (organizational productivity, customer loyalty, satisfaction and trust) which its validity and reliability has been confirmed by researchers. Structural equation method was used to determine the impact of variables. Data analysis method was structural equation modeling and the software used was SPSS version 16 (IBM, SPSS, 2007 Microsoft Corp., Bristol, UK) and AMOS version 18 (IBM, SPSS, 2010 Microsoft Corp, Bristol, UK). Results: Among the dimensions of CRM, diversification had the highest impact (0.83) and customer acquisition had the lowest (0.57) CRM, had the lowest impact on productivity (0.59) and the highest effect on customer satisfaction (0.83). Conclusions: For the implementation of CRM, it is necessary that the studied hospitals improve strategies of acquiring information about new customers, attracting new customers and keeping them and communication with patients outside the hospital and improve the system of measuring patient satisfaction and loyalty. PMID:28546971

The influences of patient's trust in medical service and attitude towards health policy on patient's overall satisfaction with medical service and sub satisfaction in China

PubMed Central

2011-01-01

Background It is widely accepted that patient generates overall satisfaction with medical service and sub satisfaction on the basis of response to patient's trust in medical service and response to patient's attitude towards health policy in China. This study aimed to investigate the correlations between patient's trust in medical service/patient's attitude towards health policy and patient's overall satisfaction with medical service/sub satisfaction in current medical experience and find inspiration for future reform of China's health delivery system on improving patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy. Methods This study collaborated with the National Bureau of Statistics to collect a sample of 3,424 residents from 17 provinces and municipalities in a 2008 China household survey on patient's trust in medical service, patient's attitude towards health policy, patient's overall satisfaction and sub satisfaction in current medical experience. Results Patient's overall satisfaction with medical service and most kinds of sub satisfaction in current medical experience were significantly influenced by both patient's trust in medical service and patient's attitude towards health policy; among all kinds of sub satisfaction in current medical experience, patient's trust in medical service/patient's attitude towards health policy had the largest influence on patient's satisfaction with medical costs, the influences of patient's trust in medical service/patient's attitude towards health policy on patient's satisfaction with doctor-patient interaction and satisfaction with treatment process were at medium-level, patient's trust in medical service/patient's attitude towards health policy had the smallest influence on patient's satisfaction with medical facilities and hospital environment, while patient's satisfaction with waiting time in hospital was not influenced by patient's trust in medical service/patient's attitude towards health policy. Conclusion In order to improve patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy, both improving patient's interpersonal trust in medical service from individual's own medical experience/public trust in medical service and improving patient's attitude towards health policy were indirect but effective ways. PMID:21676228

The influences of patient's trust in medical service and attitude towards health policy on patient's overall satisfaction with medical service and sub satisfaction in China.

PubMed

Tang, Liyang

2011-06-15

It is widely accepted that patient generates overall satisfaction with medical service and sub satisfaction on the basis of response to patient's trust in medical service and response to patient's attitude towards health policy in China. This study aimed to investigate the correlations between patient's trust in medical service/patient's attitude towards health policy and patient's overall satisfaction with medical service/sub satisfaction in current medical experience and find inspiration for future reform of China's health delivery system on improving patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy. This study collaborated with the National Bureau of Statistics to collect a sample of 3,424 residents from 17 provinces and municipalities in a 2008 China household survey on patient's trust in medical service, patient's attitude towards health policy, patient's overall satisfaction and sub satisfaction in current medical experience. Patient's overall satisfaction with medical service and most kinds of sub satisfaction in current medical experience were significantly influenced by both patient's trust in medical service and patient's attitude towards health policy; among all kinds of sub satisfaction in current medical experience, patient's trust in medical service/patient's attitude towards health policy had the largest influence on patient's satisfaction with medical costs, the influences of patient's trust in medical service/patient's attitude towards health policy on patient's satisfaction with doctor-patient interaction and satisfaction with treatment process were at medium-level, patient's trust in medical service/patient's attitude towards health policy had the smallest influence on patient's satisfaction with medical facilities and hospital environment, while patient's satisfaction with waiting time in hospital was not influenced by patient's trust in medical service/patient's attitude towards health policy. In order to improve patient's overall satisfaction with medical service and sub satisfaction in considering patient's trust in medical service and patient's attitude towards health policy, both improving patient's interpersonal trust in medical service from individual's own medical experience/public trust in medical service and improving patient's attitude towards health policy were indirect but effective ways.

A blessing and a curse? Political institutions in the growth and decay of generalized trust: a cross-national panel analysis, 1980-2009.

PubMed

Robbins, Blaine G

2012-01-01

Despite decades of research on social capital, studies that explore the relationship between political institutions and generalized trust-a key element of social capital-across time are sparse. To address this issue, we use various cross-national public-opinion data sets including the World Values Survey and employ pooled time-series OLS regression and fixed- and random-effects estimation techniques on an unbalanced panel of 74 countries and 248 observations spread over a 29-year time period. With these data and methods, we investigate the impact of five political-institutional factors-legal property rights, market regulations, labor market regulations, universality of socioeconomic provisions, and power-sharing capacity-on generalized trust. We find that generalized trust increases monotonically with the quality of property rights institutions, that labor market regulations increase generalized trust, and that power-sharing capacity of the state decreases generalized trust. While generalized trust increases as the government regulation of credit, business, and economic markets decreases and as the universality of socioeconomic provisions increases, both effects appear to be more sensitive to the countries included and the modeling techniques employed than the other political-institutional factors. In short, we find that political institutions simultaneously promote and undermine generalized trust.

A Model of Trust, Moods, and Emotions in Multiagent Systems and its Empirical Evaluation

DTIC Science & Technology

2014-05-05

North Carolina State University 2701 Sullivan Drive Suite 240, Campus Bx 7514 Raleigh, NC 27695 -7003 1 ABSTRACT A Model of Trust, Moods, and Emotions...Chan 2Jin-Hee Cho 3Sibel Adalı 1Munindar P. Singh 1North Carolina State University, Raleigh, NC- 27695 , US 2US Army Research Lab, Adelphi, MD-20783

TRACEY AND RESPECT FOR AUTONOMY: WILL THE PROMISE BE DELIVERED?

PubMed

Samanta, Jo

2015-01-01

The central issue of the Court of Appeal decision in R (Tracey) v Cambridge University Hospitals NHS Foundation Trust & Ors [2014] EWCA Civ 822 concerned whether competent adults should be involved in the decision-making process for Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions. These are sensitive decisions made on the basis that cardio-pulmonary resuscitation would be futile, or that efforts to resuscitate would not be in the best clinical interests of the person concerned. The Court held that patient involvement in DNACPR decisions should be the presumption, even if clinicians sincerely believed that resuscitation would be futile, unless that involvement would cause actual psychological or physical harm. This case commentary explores the potential implications of this decision in the context of contemporary healthcare. © The Author 2015. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Study of Organizational Trust and Related Variables among Faculty Members at HBCUs

ERIC Educational Resources Information Center

Vineburgh, James Hollander, Jr.

2010-01-01

Trust in the workplace has been linked to higher levels of organizational performance and competitiveness. The imperative of variants of trust among a spectrum of institutional types, including colleges and universities, has been deemed to be considered essential for organizational effectiveness, stability and continuity. One variant,…

Establishing and Maintaining Organizational Trust in the 21st Century

ERIC Educational Resources Information Center

Hunt, Matt; Lara, Tracy M.; Hughey, Aaron W.

2009-01-01

Recent corporate and academic scandals have led to decreasing levels of trust and confidence in many organizations. Whether the organization is a college or university, a government agency, a private company or a public corporation, the establishment and maintenance of trust is essential to both short-term success and long-term efficacy. This…

Poetic Re-Presentations on Trust in Higher Education

ERIC Educational Resources Information Center

West, Kim; Bloomquist, Candace

2015-01-01

This article discusses using poetic transcription (Glesne, 1997) as a tool for examining trust, including what trust looks and feels like from the "lived experiences" (Richardson, 1992) of university educators. We first explore the rationale for using poetic transcription in this study, discussing how and why poetry may be used as a…

Preventing falls in hospital.

PubMed

Pearce, Lynne

2017-01-04

Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 per day, according to the Royal College of Physicians (RCP).

Intelligent Monitoring? Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections.

PubMed

Griffiths, Alex; Beaussier, Anne-Laure; Demeritt, David; Rothstein, Henry

2017-02-01

The Care Quality Commission (CQC) is responsible for ensuring the quality of the health and social care delivered by more than 30 000 registered providers in England. With only limited resources for conducting on-site inspections, the CQC has used statistical surveillance tools to help it identify which providers it should prioritise for inspection. In the face of planned funding cuts, the CQC plans to put more reliance on statistical surveillance tools to assess risks to quality and prioritise inspections accordingly. To evaluate the ability of the CQC's latest surveillance tool, Intelligent Monitoring (IM), to predict the quality of care provided by National Health Service (NHS) hospital trusts so that those at greatest risk of providing poor-quality care can be identified and targeted for inspection. The predictive ability of the IM tool is evaluated through regression analyses and χ 2 testing of the relationship between the quantitative risk score generated by the IM tool and the subsequent quality rating awarded following detailed on-site inspection by large expert teams of inspectors. First, the continuous risk scores generated by the CQC's IM statistical surveillance tool cannot predict inspection-based quality ratings of NHS hospital trusts (OR 0.38 (0.14 to 1.05) for Outstanding/Good, OR 0.94 (0.80 to -1.10) for Good/Requires improvement, and OR 0.90 (0.76 to 1.07) for Requires improvement/Inadequate). Second, the risk scores cannot be used more simply to distinguish the trusts performing poorly-those subsequently rated either 'Requires improvement' or 'Inadequate'-from the trusts performing well-those subsequently rated either 'Good' or 'Outstanding' (OR 1.07 (0.91 to 1.26)). Classifying CQC's risk bandings 1-3 as high risk and 4-6 as low risk, 11 of the high risk trusts were performing well and 43 of the low risk trusts were performing poorly, resulting in an overall accuracy rate of 47.6%. Third, the risk scores cannot be used even more simply to distinguish the worst performing trusts-those subsequently rated 'Inadequate'-from the remaining, better performing trusts (OR 1.11 (0.94 to 1.32)). Classifying CQC's risk banding 1 as high risk and 2-6 as low risk, the highest overall accuracy rate of 72.8% was achieved, but still only 6 of the 13 Inadequate trusts were correctly classified as being high risk. Since the IM statistical surveillance tool cannot predict the outcome of NHS hospital trust inspections, it cannot be used for prioritisation. A new approach to inspection planning is therefore required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Trust and altruism--organ distribution scandals: do they provide good reasons to refuse posthumous donation?

PubMed

Dufner, Annette; Harris, John

2015-06-01

A recent organ distribution scandal in Germany raises questions of general importance on which many thousands of lives may well depend. The scandal in Germany has produced reactions that are likely to occur whenever and wherever distribution irregularities occur and become public knowledge. After it had become known that physicians in three German hospitals were in the habit of manipulating records in order to fast-track their patients' cases, the country experienced a decrease of available organs by a staggering 40% in October 2012. Even though this loss of trust by donors and their families is understandable, and potentially a legitimate form of protest against wrongful distribution, the withdrawal of agreement to serve as a posthumous donor in response to irregularities also inevitably results in avoidable poor outcomes for highly vulnerable individuals. In this paper, we provide a moral analysis of such dilemmas and make recommendations as to the way forward. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A Multidisciplinary Osteoporosis Service-Based Action Research Study

ERIC Educational Resources Information Center

Whitehead, Dean; Keast, John; Montgomery, Val; Hayman, Sue

2004-01-01

Objective: To investigate an existing Trust-based osteoporosis service's preventative activity, determine any issues and problems and use this data to reorganise the service, as part of a National Health Service Executive/Regional Office-commissioned and funded study. Setting: A UK Hospital Trust's Osteoporosis Service. Design & Method: A…

The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

PubMed Central

Peacock, M

2013-01-01

Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy. PMID:27433195

Universal coverage and its impact on reproductive health services in Thailand.

PubMed

Tangcharoensathien, Viroj; Tantivess, Sripen; Teerawattananon, Yot; Auamkul, Nanta; Jongudoumsuk, Pongpisut

2002-11-01

Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

Patient costs in anticoagulation management: a comparison of primary and secondary care.

PubMed Central

Parry, D; Bryan, S; Gee, K; Murray, E; Fitzmaurice, D

2001-01-01

BACKGROUND: The demand for anticoagulation management is increasing. This has led to care being provided in non-hospital settings. While clinical studies have similarly demonstrated good clinical care in these settings, it is still unclear as to which alternative is the most efficient. AIM: To determine the costs borne by patients when attending an anticoagulation management clinic in either primary or secondary care and to use this information to consider the cost-effectiveness of anticoagulation management in primary and secondary care, both from the National Health Service and patient perspectives. DESIGN OF STUDY: Observational study comparing two cohorts of patients currently attending anticoagulation management clinics. SETTING: Four primary care clinics in Birmingham and one in Warwickshire, and the haematology clinics at the University of Birmingham Hospitals Trust and the City Hospital NHS Trust. METHOD: The survey of patients attending the clinics was used to ascertain patient costs. This information was then used in conjunction with the findings of a recent randomised controlled trial to establish cost-effectiveness. RESULTS: Patient costs were lower in primary care than in secondary care settings; the mean (standard deviation) costs per visit were Pound Sterling6.78 (Pound Sterling5.04) versus Pound Sterling14.58 (Pound Sterling9.08). While a previous cost-effectiveness analysis from a health sector perspective alone found a higher cost for primary care, the adoption of the societal perspective lead to a marked change in the result: a similar total cost per patient in both sectors. CONCLUSION: There are significantly higher costs borne by patients attending secondary care anticoagulation management clinics than similar patients attending primary care clinics. This study also demonstrates that the perspective adopted in an economic evaluation can influence the final result. PMID:11766869

Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis.

PubMed

Grob, Silvia; Bläuer, Cornelia; Frei, Irena Anna

2017-12-01

Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members. © 2017 Nordic College of Caring Science.

Not for resuscitation instructions: the law for children in the UK.

PubMed

Dimond, Bridgit

CASE SCENARIO: David Glass, a boy of 13 years, was severely disabled with only a limited life span. His mother wished him to receive whatever medical treatment was necessary to prolong his life. Following an incident in which the hospital gave the child diamorphine against the mother's wishes, family members resuscitated the child and prevented him from dying. There was a complete breakdown of trust between the family and the hospital. His mother, Ms Glass, sought a declaration as to the course doctors in the hospital should take if the boy were admitted for emergency treatment and disagreements arose as to the treatment to be given to or withheld from the child. The judge refused the mother's application for judicial review and she appealed to the Court of Appeal (R v. Portsmouth Hospitals NHS Trust ex p. Glass [1999]).

The impact of profitability of hospital admissions on mortality.

PubMed

Lindrooth, Richard C; Konetzka, R Tamara; Navathe, Amol S; Zhu, Jingsan; Chen, Wei; Volpp, Kevin

2013-04-01

Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality. Our sample included all Medicare discharges from PPS-eligible hospitals (1997, 2001, and 2005). The results reveal a statistically significant inverse relationship between changes in profitability and mortality. A $0.19 average reduction in profit per $1.00 of costs led to a 0.010-0.020 percentage-point increase in mortality rates (p < .001). Mortality in newly unprofitable service lines is significantly more sensitive to reduced payment generosity than in service lines that remain profitable. Policy simulations that target service line inequities in payment generosity result in lower mortality rates, roughly 700-13,000 fewer deaths nationally. The policy simulations raise questions about the trade-offs implicit in universal reductions in reimbursement. The effect of reduced payment generosity on mortality could be mitigated by targeting highly profitable services only for lower reimbursement. © Health Research and Educational Trust.

Hierarchical Hopping through Localized States in a Random Potential

NASA Astrophysics Data System (ADS)

Rajan, Harihar; Srivastava, Vipin

2003-03-01

Generalisation of Mott's idea on (low - temperature, large-time), Variable-range-hopping is considered to include hopping at some what higher temperature(that do not kill localization). These transitions complement the variable- range-hopping in that they do not conserve energy and occur at relatively lower time scales. The hopper picks the next state in a hierarchical fashion in accordance with certain conditions. The results are found to tie up nicely with an interesting property pertaining to the energy dependence of localized states. Acknowlwdgements: One of us(VS) would like to thank Association of Commonwealth Universities and Leverhulme Trust for financial help and to Sir Sam Edwards for hospitality at Cavendish Laboratory,Cambridge CB3 0HE.

A survey of the health needs of hospital staff: implications for health care managers.

PubMed

Jinks, Annette M; Lawson, Valerie; Daniels, Ruth

2003-09-01

Developing strategies to address the health needs of the National Health Services (NHS) workforce are of concern to many health care managers. Focal to the development of such strategies are of being in receipt of baseline information about employees expressed health needs and concerns. This article addresses obtaining such baseline information and presents the findings of a health needs survey of acute hospital staff in a trust in North Wales. The total population of trust employees were surveyed (n = 2300) and a 44% (n = 1021) response rate was achieved. A number of positive findings are given. Included are that the majority of those surveyed stated that their current health status is good, are motivated to improve their health further, do not smoke and their alcohol consumption is within recommended levels. There appears, however, to be a number of areas where trust managers can help its staff improve their health. Included are trust initiatives that focus on weight control and taking more exercise. In addition, there appears to be a reported lack of knowledge and positive health behaviour amongst the male respondents surveyed that would imply the trust needs to be more effective in promoting well man type issues. Finally there appears to be a general lack of pride in working for the trust and a pervasive feeling that the trust does not care about its employees that needs to be addressed. It is concluded that the findings of this survey have implications for management practices in the trust where the survey was conducted and also wider applicability to the management of health care professionals. For example, addressing work-related psychological and physical problems of employees are of importance to all health care managers. This is especially so when considering recruitment and retention issues.

Perceptions of College of Education Students in Turkey towards Organizational Justice, Trust in Administrators, and Instructors

ERIC Educational Resources Information Center

Kale, Mustafa

2013-01-01

In this research, the perceptions of college of education students in Turkey regarding organizational justice, trust in administrators, and trust in instructors were determined. In the present study, the answers to three research questions were sought. The research was done using the survey method. After choosing six universities of various sizes…

Tutor Trust Primary: Evaluation Report and Executive Summary

ERIC Educational Resources Information Center

Buchanan, Emily; Worth, Jack; Aston, Helen

2015-01-01

The Tutor Trust is a Manchester-based charity that aims to provide affordable small group and one to one tuition to schools. The Trust recruits university students and recent graduates, which enables it to provide tuition at a competitive rate. It predominantly aims to support schools in challenging communities and pupils who are looked-after or…

Should Medicare's trust fund be removed from the budget?

PubMed

Burke, M

1990-03-05

The recent proposal to to roll back the recent increase in the Social Security payroll tax has some health care executives worried. The Hospital Insurance Trust Fund is closely linked to the Social Security fund, and what affects one will surely affect the other. However, analysts say that the question of whether the trust funds should or should not be part of the federal budget masks a much bigger question. Are the Administration, Congress, and the American public ready to raise taxes to adequately fund Medicare?

A Blessing and a Curse? Political Institutions in the Growth and Decay of Generalized Trust: A Cross-National Panel Analysis, 1980–2009

PubMed Central

Robbins, Blaine G.

2012-01-01

Despite decades of research on social capital, studies that explore the relationship between political institutions and generalized trust–a key element of social capital–across time are sparse. To address this issue, we use various cross-national public-opinion data sets including the World Values Survey and employ pooled time-series OLS regression and fixed- and random-effects estimation techniques on an unbalanced panel of 74 countries and 248 observations spread over a 29-year time period. With these data and methods, we investigate the impact of five political-institutional factors–legal property rights, market regulations, labor market regulations, universality of socioeconomic provisions, and power-sharing capacity–on generalized trust. We find that generalized trust increases monotonically with the quality of property rights institutions, that labor market regulations increase generalized trust, and that power-sharing capacity of the state decreases generalized trust. While generalized trust increases as the government regulation of credit, business, and economic markets decreases and as the universality of socioeconomic provisions increases, both effects appear to be more sensitive to the countries included and the modeling techniques employed than the other political-institutional factors. In short, we find that political institutions simultaneously promote and undermine generalized trust. PMID:22558122

Impact of star performance ratings in English acute hospital trusts.

PubMed

Mannion, Russell; Davies, Huw; Marshall, Martin

2005-01-01

To explore some of the impacts of star performance ratings in acute hospital trusts in England. A multiple case study design was used which incorporated purposeful sampling of 'low' and 'high' performing trusts using the star rating system. In each case study site, data collection comprised semi-structured interviews and documentary analysis. Between eight and 12 senior managers and senior clinicians were interviewed in each organisation. There was a general view that the star ratings as presently constituted did not represent a rounded or balanced scorecard of their own organisation's performance and a widespread belief that the information used to calculate the ratings was often incomplete and inaccurate. The star ratings were viewed by some managers as useful, in that they gave added weight to their trust's modernisation agenda. In addition to driving beneficial change, the ratings were also sometimes reported to have inadvertently induced a range of unintended and dysfunctional consequences, including tunnel vision and a distortion of clinical priorities, bullying and intimidation, erosion of public trust and reduced staff morale, and ghettoisation. Set in the context of an international body of research, this study highlights some important gaps in knowledge and failings in current policy and practice. In particular, the many dysfunctional consequences of publishing star ratings indicate a need for a re-examination of performance management policies.

The national bowel cancer audit project: the impact of organisational structure on outcome in operative bowel cancer within the United Kingdom.

PubMed

Cornish, J A; Tekkis, P P; Tan, E; Tilney, H S; Thompson, M R; Smith, J J

2011-06-01

To investigate the relationship between organisational structure, process and surgical outcomes for bowel cancer surgery. An e-survey was sent to the members of the Association of Coloproctology of Great Britain and Ireland to determine the organisational structure of their Trusts. Responses were combined with the National Bowel Cancer Audit (NBOCAP) data. Items investigated included; number of consultants, nurse specialists, volume of cases and intensive care facilities. Main outcome measures included: 30-day risk-adjusted mortality, length of stay (LOS), lymph node yield and circumferential margin involvement (CRM). One hundred and seventeen Trusts responded (65.8%), matched to 7666 patient episodes (NBOCAP data) from 54 (62.8%)Trusts who submitted data to the audit. Trusts treating <190 cases/annum (p > 0.001), <4 colorectal consultants (p > 0.001), <4 HDU beds (p > 0001) and <8 ITU beds (p > 0001) were more likely to have a 30-day-risk-adjusted mortality twice that of the national mean. Sixty five percent (n = 1603) of Trusts treating ≥ 190 cases/annum harvested ≥ 12 lymph nodes vs. 58.3% (n = 1435) in Trusts <190 cases/annum (p < 0.001). Trusts with ≥ 2 pathologists with an interest in bowel cancer harvested ≥ 12 lymph nodes more frequently (p=<0.001) and were more likely to identify extramural vascular invasion in the specimen (p = 0.015). Negative CRM was achieved in 81.4% (n = 81.4) of patients in Trusts treating ≥ 190 cases vs. 66.5% (n = 569) in Trusts<190 cases/annum (p < 0.001). Trusts offering fast track discharge were more likely to have a LOS < 15 days (p = 0.006). Surgeons treating ≤ 35 cases/annum had increased major post-operative complications (<35 cases = 70.2% vs. ≥ 35 cases = 21.9%; p < 0.001), however 30 day risk adjusted mortality was not increased in surgeons treating <35 cases/annum. This study shows that the organisational infrastructure of hospitals appears to have as great an impact on patient outcomes as the volume of cases performed by hospital Trusts. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

Survival curves to support quality improvement in hospitals with excess 30-day mortality after acute myocardial infarction, cerebral stroke and hip fracture: a before-after study.

PubMed

Kristoffersen, Doris Tove; Helgeland, Jon; Waage, Halfrid Persdatter; Thalamus, Jacob; Clemens, Dirk; Lindman, Anja Schou; Rygh, Liv Helen; Tjomsland, Ole

2015-03-25

To evaluate survival curves (Kaplan-Meier) as a means of identifying areas in the clinical pathway amenable to quality improvement. Observational before-after study. In Norway, annual public reporting of nationwide 30-day in-and-out-of-hospital mortality (30D) for three medical conditions started in 2011: first time acute myocardial infarction (AMI), stroke and hip fracture; reported for 2009. 12 of 61 hospitals had statistically significant lower/higher mortality compared with the hospital mean. Three hospitals with significantly higher mortality requested detailed analyses for quality improvement purposes: Telemark Hospital Trust Skien (AMI and stroke), Østfold Hospital Trust Fredrikstad (stroke), Innlandet Hospital Trust Gjøvik (hip fracture). Survival curves, crude and risk-adjusted 30D before (2008-2009) and after (2012-2013). Unadjusted survival curves for the outlier hospitals were compared to curves based on pooled data from the other hospitals for the 30-day period 2008-2009. For patients admitted with AMI (Skien), stroke (Fredrikstad) and hip fracture (Gjøvik), the curves suggested increased mortality from the initial part of the clinical pathway. For stroke (Skien), increased mortality appeared after about 8 days. The curve profiles were thought to reflect suboptimal care in various phases in the clinical pathway. This informed improvement efforts. For 2008-2009, hospital-specific curves differed from other hospitals: borderline significant for AMI (p=0.064), highly significant (p≤0.005) for the remainder. After intervention, no difference was found (p>0.188). Before-after comparison of the curves within each hospital revealed a significant change for Fredrikstad (p=0.006). For the three hospitals, crude 30D declined and they were non-outliers for risk-adjusted 30D for 2013. Survival curves as a supplement to 30D may be useful for identifying suboptimal care in the clinical pathway, and thus informing design of quality improvement projects. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study

PubMed Central

Elliott, Martin J; De Coppi, Paolo; Speggiorin, Simone; Roebuck, Derek; Butler, Colin R; Samuel, Edward; Crowley, Claire; McLaren, Clare; Fierens, Anja; Vondrys, David; Cochrane, Lesley; Jephson, Christopher; Janes, Samuel; Beaumont, Nicholas J; Cogan, Tristan; Bader, Augustinus; Seifalian, Alexander M; Hsuan, J Justin; Lowdell, Mark W; Birchall, Martin A

2015-01-01

Summary Background Stem-cell-based, tissue engineered transplants might offer new therapeutic options for patients, including children, with failing organs. The reported replacement of an adult airway using stem cells on a biological scaffold with good results at 6 months supports this view. We describe the case of a child who received a stem-cell-based tracheal replacement and report findings after 2 years of follow-up. Methods A 12-year-old boy was born with long-segment congenital tracheal stenosis and pulmonary sling. His airway had been maintained by metal stents, but, after failure, a cadaveric donor tracheal scaffold was decellularised. After a short course of granulocyte colony stimulating factor, bone marrow mesenchymal stem cells were retrieved preoperatively and seeded onto the scaffold, with patches of autologous epithelium. Topical human recombinant erythropoietin was applied to encourage angiogenesis, and transforming growth factor β to support chondrogenesis. Intravenous human recombinant erythropoietin was continued postoperatively. Outcomes were survival, morbidity, endoscopic appearance, cytology and proteomics of brushings, and peripheral blood counts. Findings The graft revascularised within 1 week after surgery. A strong neutrophil response was noted locally for the first 8 weeks after surgery, which generated luminal DNA neutrophil extracellular traps. Cytological evidence of restoration of the epithelium was not evident until 1 year. The graft did not have biomechanical strength focally until 18 months, but the patient has not needed any medical intervention since then. 18 months after surgery, he had a normal chest CT scan and ventilation-perfusion scan and had grown 11 cm in height since the operation. At 2 years follow-up, he had a functional airway and had returned to school. Interpretation Follow-up of the first paediatric, stem-cell-based, tissue-engineered transplant shows potential for this technology but also highlights the need for further research. Funding Great Ormond Street Hospital NHS Trust, The Royal Free Hampstead NHS Trust, University College Hospital NHS Foundation Trust, and Region of Tuscany. PMID:22841419

Specialty differences in the association between health care climate and patient trust.

PubMed

Weng, Hui-Ching; Chen, Yaw-Sen; Lin, Chia-Shiang; Tu, Yuan-Kun; Lin, Hsi-Hsun; Yu, Shang-Won

2011-09-01

Previous studies have suggested that there is a positive correlation between doctors' emotional intelligence (EI) and patients' trust in their attending physicians; however, there is only limited evidence of specialty differences between internists and surgeons for such an association. This study examined the association of nursing director assessments of doctors' EI, outside observer assessments of doctors' health care climate (HCC) in the examining room and patient-rated trust in internists and surgeons. Health care climate refers to a key component in communication and reflects the extent to which patients perceive their health care providers as supporting patient autonomy rather than controlling the provision of treatment. In this observational study, 2702 patients seen by 110 internists and 2642 patients seen by 101 surgeons were surveyed in face-to-face interviews by trained nurses in two teaching hospitals in Taiwan. Using hierarchical linear modelling, we examined the association between EI and HCC as well as patient trust in doctors working in the specialties of internal medicine and surgery. We found a significantly positive correlation between doctor EI and patient trust for all patients (p<0.01). In addition, although HCC was positively associated with patient trust for internists (p<0.01), it was not so for surgeons. We conclude that doctors might benefit from training programmes aimed at improving EI and that differences in patient expectations might be considered when hospitals attempt to evaluate doctors in different specialties. © Blackwell Publishing Ltd 2011.

Paying for the Medicare program.

PubMed

Munnell, A H

1985-01-01

Although the hospital insurance (HI) trust fund acted as a source of strength for the old-age, survivors, and disability insurance program during its recent financial crises, projections by HCFA and CBO reveal that the Medicare program will experience financing problems of its own within the next decade. No one would argue that Medicare's financing problems should be solved simply by raising more money. However, the prospect of insolvency in the HI trust fund and the increasing strain on general revenues from the Supplementary Medical Insurance trust fund require policymakers to survey the options for increasing Medicare revenues while cost-control devices are being developed. Indeed, even if cost-control efforts are completely successful, additional revenues may be needed in the future to finance new initiatives in the Medicare program. Therefore, this paper will look briefly at current efforts to regain control of soaring hospital and physician costs and then examine some of the more feasible options for increasing Medicare revenues.

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study

PubMed Central

Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter

2017-01-01

Objective In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Design Data for patients diagnosed with CRC in England in 2001–2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Results Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer ‘centres of excellence’, although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%–5%, p<2.2×10−6) and an improvement in survival (p<10−19; 5-year difference: 3.8% (41.0%–44.8%)) comparing high participation for ≥4 years with 0 years. Conclusions There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. PMID:27797935

Patient satisfaction and non-UK educated nurses: a cross-sectional observational study of English National Health Service Hospitals

PubMed Central

Griffiths, Peter; Sloane, Douglas M; Rafferty, Anne Marie; Ball, Jane E; Aiken, Linda H

2015-01-01

Objectives To examine whether patient satisfaction with nursing care in National Health Service (NHS) hospitals in England is associated with the proportion of non-UK educated nurses providing care. Design Cross-sectional analysis using data from the 2010 NHS Adult Inpatient Survey merged with data from nurse and hospital administrator surveys. Logistic regression models with corrections for clustering were used to determine whether the proportions of non-UK educated nurses were significantly related to patient satisfaction before and after taking account of other hospital, nursing and patient characteristics. Setting 31 English NHS trusts. Participants 12 506 patients 16 years of age and older with at least one overnight stay that completed a satisfaction survey; 2962 bedside care nurses who completed a nurse survey; and 31 NHS trusts. Main outcome measure Patient satisfaction. Results The percentage of non-UK educated nurses providing bedside hospital care, which ranged from 1% to 52% of nurses, was significantly associated with patient satisfaction. After controlling for potential confounding factors, each 10-point increase in the percentage of non-UK educated nurses diminished the odds of patients reporting good or excellent care by 12% (OR=0.88), and decreased the odds of patients agreeing that they always had confidence and trust in nurses by 13% (OR=0.87). Other indicators of patient satisfaction also revealed lower satisfaction in hospitals with higher percentages of non-UK educated nurses. Conclusions Use of non-UK educated nurses in English NHS hospitals is associated with lower patient satisfaction. Importing nurses from abroad to substitute for domestically educated nurses may negatively impact quality of care. PMID:26634400

From the general to the specific: How social trust motivates relational trust.

PubMed

Robbins, Blaine G

2016-01-01

When people form beliefs about the trustworthiness of others with respect to particular matters (i.e., when individuals trust), theory suggests that they rely on preexistent cognitive schemas regarding the general cooperativeness of individuals and organizations (i.e., social trust). In spite of prior work, the impact of social trust on relational trust-or what Russell Hardin (2002) calls trust as a three-part relation where actor A trusts actor B with reference to matter Y-is not well established. Four vignette experiments were administered to Amazon.com Mechanical Turk workers (N = 1388 and N = 1419) and to public university undergraduate students (N = 995 and N = 956) in order to investigate the relationship between social trust and relational trust. Measures of general social trust and particular social trust produced statistically equivalent effects that were positively associated with relational trust. Political trust, however, was statistically unrelated to relational trust. These results support the idea that people rely on schemas and stereotypes concerned with the general cooperativeness and helpfulness of others when forming beliefs about another person's trustworthiness with respect to a particular matter at hand. Copyright © 2015 Elsevier Inc. All rights reserved.

Work-related psychosocial risk factors and mental health problems amongst nurses at a university hospital in Estonia: a cross-sectional study.

PubMed

Freimann, Tiina; Merisalu, Eda

2015-07-01

Rapid changes in the Estonian health care system have placed extra pressure on the nursing profession, but the potential impacts of psychosocial changes have not been investigated. We aimed to explore the work-related psychosocial risk factors and their relationships with mental health problems (MHPs) amongst nurses at the university hospital in Estonia. A cross-sectional survey was undertaken amongst registered nurses at Tartu University Hospital (TUH). Psychosocial work factors and MHPs (stress, somatic symptoms, depressive symptoms and burnout) were measured using version two of the Copenhagen Psychosocial Questionnaire (COPSOQ II). Descriptive statistics and Pearson's r correlation with sequential Bonferroni correction were used to analyse the data. The analysis was based on 404 nurses (45% of the full-time working population of nurses). The highest mean scores recorded for the positive work-related psychosocial factors studied were meaning of work, role clarity, social relationships and mutual trust between employees. The highest scores for the negative factors studied were the demands for hiding emotions, work pace, cognitive and emotional demands. Stress and burnout showed the highest mean scores amongst the MHPs. Quantitative and emotional demands were positively related to all of the studied MHPs, while work pace and role conflicts had a positive correlation with stress and burnout. All of the studied negative psychosocial factors were significantly correlated with burnout. work-related psychosocial risk factors such as quantitative demands work load, emotional demands, work pace and role conflicts, had significant positive relationships with MHPS in nurses in Estonia, and may contribute to high levels of stress as well as burnout amongst nurses: . © 2015 the Nordic Societies of Public Health.

The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation.

PubMed

Steventon, Adam; Bardsley, Martin; Billings, John; Georghiou, Theo; Lewis, Geraint Hywel

2012-08-01

To test whether two hospital-avoidance interventions altered rates of hospital use: "intermediate care" and "integrated care teams." Linked administrative data for England covering the period 2004 to 2009. This study was commissioned after the interventions had been in place for several years. We developed a method based on retrospective analysis of person-level data comparing health care use of participants with that of prognostically matched controls. Individuals were linked to administrative datasets through a trusted intermediary and a unique patient identifier. Participants who received the intermediate care intervention showed higher rates of unscheduled hospital admission than matched controls, whereas recipients of the integrated care team intervention showed no difference. Both intervention groups showed higher rates of mortality than did their matched controls. These are potentially powerful techniques for assessing impacts on hospital activity. Neither intervention reduced admission rates. Although our analysis of hospital utilization controlled for a wide range of observable characteristics, the difference in mortality rates suggests that some residual confounding is likely. Evaluation is constrained when performed retrospectively, and careful interpretation is needed. © Health Research and Educational Trust.

Trust Development With the Spanish-Speaking Mexican American Patient: A Grounded Theory Study.

PubMed

Jones, Sharon M

2018-06-01

Interpersonal trust between patient and nurse is important in patient-centered care. Trust development may be more difficult if the patient and nurse do not speak the same language. In this grounded theory study, Spanish-speaking Mexican American adults ( n = 20) hospitalized on a medical-surgical or obstetric unit in the Midwestern United States were interviewed. Through data analysis, a model of how trust develops between nurse and patient revealed eight categories and the core category Caring for Me Well Even When Not Understanding Me. The beginning phase had four categories: Asking for Help, Bothering, Communicating, and Understanding. The middle phase had two categories: Platicando (chatting) and Being Available. The end point category was Having Trust, and outcomes were Feeling Comfortable and Feeling Supported. The language barrier was a hindrance to trust development but the nurse's way of being (personality) was more important. Therefore, the patient did develop trust with nurses who did not speak Spanish.

Should Governments engage health insurance intermediaries? A comparison of benefits with and without insurance intermediary in a large tax funded community health insurance scheme in the Indian state of Andhra Pradesh.

PubMed

Nagulapalli, Srikant; Rokkam, Sudarsana Rao

2015-09-10

A peculiar phenomenon of engaging insurance intermediaries for government funded health insurance schemes for the poor, not usually found globally, is gaining ground in India. Rajiv Aarogyasri Scheme launched in the Indian state of Andhra Pradesh, is first largest tax funded community health insurance scheme in the country covering more than 20 million poor families. Aarogyasri Health Care Trust (trust), the scheme administrator, transfers funds to hospitals through two routes one, directly and the other through an insurance intermediary. The objective of this paper is to find out if engaging an insurance intermediary has any effect on cost efficiency of the insurance scheme. We used payment data of RAS for the period 2007-12, to find out the influence of insurance intermediary on the two variables, benefit cost ratio defined as benefit payment divided by premium payment, and claim denial ratio defined as benefit payment divided by treatment cost. Relationship between scheme expenditure and number of beds empanelled under the scheme is examined. OLS regression is used to perform all analyses. We found that adding an additional layer of insurance intermediary between the trust and hospitals reduced the benefit cost ratio under the scheme by 12.2% (p-value = 0.06). Every addition of 100 beds under the scheme increases the scheme payments by US$ 0.75 million (p-value < 0.001). The gap in claim denial ratio between insurance and trust modes narrowed down from 2.84% in government hospitals to 0.41% in private hospitals (p-value < 0.001). The scheme is a classic case of Roemer's principle in operation. Introduction of insurance intermediary has the twin effects of reduction in benefit payments to beneficiaries, and chocking fund flow to government hospitals. The idea of engaging insurance intermediary should be abandoned.

"It depends on us": employee perspective of healthy working conditions during continual reorganisations in a radiology department.

PubMed

Nilsson, Kerstin; Hertting, Anna; Petterson, Inga-Lill

2009-01-01

This study focuses on employees' experience of occupational health in a radiology department within a Swedish university hospital during years of continual reorganisations. This department's stable personal health trends in terms of self-rated mental health and sick-leave rates diverged from the general trends of deteriorating working conditions in the hospital. The aim was to identify dimensions of working conditions as positive determinants contributing to occupational health in a department of radiology undergoing continual reorganisations. Open-ended interviews with twelve employees were transcribed and analyzed using content-analysis. The employees experienced their new stimulating working tasks and a supporting organizational climate as important contributors to the healthy work condition. The positive effects of handling new technical challenges and the positive organisational climate, which were characterized by mutual trust, as well as work-confidence and respect for each others' competence, seem to function as buffering factors, balancing the negative effects of parallel downsizing and restructuring processes.

Parental trust in health care--a prospective study from the Children's Cancer Hospital in Egypt.

PubMed

El Malla, Hanan; Kreicbergs, Ulrika; Steineck, Gunnar; Wilderäng, Ulrica; Elborai, Yasser El Sayed; Ylitalo, Nathalie

2013-03-01

Patient-physician communication and patient satisfaction are important elements of cancer care. Trust is considered to be crucial for the patient-physician relationship, yet little is to be found in the literature regarding what factors may influence trust. We assessed predictors of trust in health-care professionals and in the medical care by administering two questionnaires, one at start of chemotherapy treatment and one at the time of the third chemotherapy cycle, to 304 parents of children with newly diagnosed cancer at the Children's Cancer Hospital in Cairo, Egypt. Parents' trust in the medical care at the time of the child's third chemotherapy cycle was significantly associated with the following at the start of treatment: having received at least moderate information about the disease (relative risk (RR) 13.2; 95% CI 7.8-22.3) and the treatment (RR 17.2; 95% CI 9.5-31.4), having the opportunity to communicate with the child's physicians (RR 21.3; 95% CI 11.7-38.8), being satisfied with the physicians conversation style (RR 30.6; 95% CI 14.4-64.9), having the emotional needs met (RR 22.2; 95% CI 11.8-41.9), and being met with care by the child's physicians (RR 32.0; 95% CI 15.2-67.7). After multivariable model selection, the strongest predictor of trust at the time of the third chemotherapy cycle was to be met with care at the start of treatment. Parents being met with care by the child's physicians at the beginning of the child's chemotherapy treatment develop an increased trust in the medical care. Copyright © 2012 John Wiley & Sons, Ltd.

The Relationship Between Trust-in-God, Positive and Negative Affect, and Hope.

PubMed

Fadardi, Javad S; Azadi, Zeinab

2017-06-01

We aimed to test the relationships between Trust-in-God, positive and negative affect, and feelings of hope. A sample of university students (N = 282, 50 % female) completed the Positive and Negative Affect Schedule, the Adult Dispositional Hope Scale, and a Persian measure of Trust-in-God for Muslims. The results of a series of hierarchical regression analyses indicated that Trust-in-God was positively associated with participants' scores for hope and positive affect but was negatively associated with their scores for negative affect. The results support the relationship between Trust-in-God and indices of mental health.

From pamphlets to podcasts: health information at Great Ormond Street Hospital for Children NHS trust.

PubMed

Moult, Beki; Stephenson, Paula; Geddes, Nicholas; Webb, Jo

2009-06-01

This paper outlines the development of information for children and families at Great Ormond Street Hospital for Children NHS Trust. Starting in 1995, guidelines for producing written information have been developed and a regular audit programme carried out, resulting in information of consistently high quality being produced. The 'rules' set out for the provision of written information have now been developed to cover multimedia information, so that technology can be harnessed to develop podcasts and other non-written information materials. Technical processes are explained both for production and delivery. Future plans for multimedia information are also outlined.

Relationship between preventable hospital deaths and other measures of safety: an exploratory study.

PubMed

Hogan, Helen; Healey, Frances; Neale, Graham; Thomson, Richard; Vincent, Charles; Black, Nick

2014-06-01

To explore associations between the proportion of hospital deaths that are preventable and other measures of safety. Retrospective case record review to provide estimates of preventable death proportions. Simple monotonic correlations using Spearman's rank correlation coefficient to establish the relationship with eight other measures of patient safety. Ten English acute hospital trusts. One thousand patients who died during 2009. The proportion of preventable deaths varied between hospitals (3-8%) but was not statistically significant (P = 0.94). Only one of the eight measures of safety (Methicillin-resistant Staphylococcus aureus bacteraemia rate) was clinically and statistically significantly associated with preventable death proportion (r = 0.73; P < 0.02). There were no significant associations with the other measures including hospital standardized mortality ratios (r = -0.01). There was a suggestion that preventable deaths may be more strongly associated with some other measures of outcome than with process or with structure measures. The exploratory nature of this study inevitably limited its power to provide definitive results. The observed relationships between safety measures suggest that a larger more powerful study is needed to establish the inter-relationship of different measures of safety (structure, process and outcome), in particular the widely used standardized mortality ratios. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Trust in the medical profession and patient attachment style.

PubMed

Klest, Bridget; Philippon, Olivia

2016-10-01

Attachment style is a person's approach to interpersonal relationships, which develops from early experiences with primary caregivers and can remain stable into adulthood. Depending on a person's attachment style, the amount of trust one has in others can vary when forming relationships, and trust is important in formation of the patient-physician relationship. The purpose of this study was to see if there is an association between attachment style and trust in physicians in general. Participants were recruited from an emergency department (ED) and an online university participant pool, and completed short questionnaires assessing attachment style and trust in the medical profession. Results revealed that individuals with a fearful attachment style reported significantly lower levels of trust in the medical profession than those with a secure attachment style. ED participants also reported higher levels of trust in the medical profession in comparison to student participants. This study provides a better understanding of trust in the medical profession, and insight into future care for patients who have low trust.

Managing outbreaks of norovirus in an NHS hospital.

PubMed

Aziz, Ann-Marie

Noroviruses are highly infectious and easily transmitted by contact with contaminated surfaces and objects, as airborne particles and by contact between individuals. While illness caused by norovirus is usually self-limiting, it can be serious in very young and elderly people, or in those who are debilitated or have a serious illness; they may require hospital treatment. Norovirus outbreaks in hospitals create significant disruption to patient care. They also have huge cost implications for NHS trusts through staff absence and ward closures, which are extremely disruptive and increase pressures on bed demand. The three most important actions during an outbreak of norovirus are effective hand hygiene, isolation of affected patients and enhanced cleaning of the environment. This article outlines how to identify norovirus infection and outbreaks, and describes how an acute trust managed outbreaks of norovirus and the procedures it adopted.

Sapientia: accelerating rare disease diagnosis and treatment.

PubMed

Furness, Mike

2016-09-01

Congenica (Cambridge, UK) is a world leading developer of genome-based discovery and diagnostic technologies. The UK company is a spin-out from the Wellcome Trust Sanger Institute (Cambridge, UK) and was founded by scientists and clinicians at the leading edge of genomic analysis. Congenica's Sapientia™ technology platform allows whole-genome sequence analysis to be easily interpreted and presented within a clinically actionable diagnostic report. It is based on pioneering research from Wellcome Trust Sanger Institute, National Health Service clinicians and regional genetic testing laboratories and validated by Genomics England Ltd (London, UK). Sapientia used for medical diagnosis in hospitals including Great Ormond Street Hospital (London, UK), Manchester Centre for Genomic Medicine (Manchester, UK), Birmingham Women's Hospital (Birmingham, UK) and for new drug development by pharmaceutical companies. This profile follows the journey from proof of concept to clinical diagnosis.

The resource costs of wound care in Bradford and Airedale primary care trust in the UK.

PubMed

Vowden, K; Vowden, P; Posnett, J

2009-03-01

To estimate the resource costs of providing wound care for the 488,000 catchment population of the Bradford and Airedale primary care trust (PCT). A wound survey was carried out over a one-week period in March 2007 covering three hospitals in two acute trusts, district nurses, nursing homes and residential homes within the geographical area defined by the PCT. The survey included information on the frequency of dressing change, treatment time and district nurse travel time. The resource costs of wound care in the PCT were estimated by combining this information with representative costs for the UK National Health Service and information on dressing spend. Prevalence of patients with a wound was 3.55 per 1000 population. The majority of wounds were surgical/trauma (48%), leg/foot (28%) and pressure ulcers (21%). Prevalence of wounds among hospital inpatients was 30.7%. Of these, 11.6% were pressure ulcers, of which 66% were hospital-acquired. The attributable cost of wound care in 2006-2007 was pounds 9.89 million: pounds 2.03 million per 100,000 population and 1.44% of the local health-care budget. Costs included pounds 1.69 million spending on dressings, 45.4 full-time nurses (valued at pounds 3.076 million) and 60-61 acute hospital beds (valued at pounds 5.13 million). The cost of wound care is significant. The most important components are the costs of wound-related hospitalisation and the opportunity cost of nurse time. The 32% of patients treated in hospital accounted for 63% of total costs. Putting in place care pathways to avoid hospitalisation and avoiding the development of hospital-acquired pressure ulcers and other wound complications are important ways to reduce costs. John Posnett is an employee of Smith & Nephew.

How does trust affect patient preferences for participation in decision-making?

PubMed

Kraetschmer, Nancy; Sharpe, Natasha; Urowitz, Sara; Deber, Raisa B

2004-12-01

Does trust in physicians aid or hinder patient autonomy? We examine the relationship between trust in the recipient's doctor, and desire for a participative role in decisions about medical treatment. We conducted a cross-sectional survey in an urban Canadian teaching hospital. A total of 606 respondents in three clinics (breast cancer, prostate cancer, fracture) completed questionnaires. The instrument included the Problem Solving Decision Making (PSDM) Scale, which used two vignettes (current health condition, chest pain) to categorize respondents by preferred role, and the Trust-in-Physician Scale. Few respondents preferred an autonomous role (2.9% for the current health condition vignette and 1.2% for the chest pain vignette); most preferred shared decision-making (DM) (67.3% current health condition; 48.7% chest pain) or a passive role (29.6% current health condition; 50.1% chest pain). Trust-in-physician yielded 6.3% with blind trust, 36.1% with high trust, 48.6% moderate trust and 9.0% low trust. As hypothesized, autonomous patients had relatively low levels of trust, passive respondents were more likely to have blind trust, while shared respondents had high but not excessive trust. Trust had a significant influence on preferred role even after controlling for the demographic factors such as sex, age and education. Very few respondents wish an autonomous role; those who do tend to have lower trust in their providers. Familiarity with a clinical condition increases desire for a shared (as opposed to passive) role. Shared DM often accompanies, and may require, a trusting patient-physician relationship.

Advancing working and learning through critical action research: creativity and constraints.

PubMed

Bellman, Loretta; Bywood, Catherine; Dale, Susan

2003-12-01

Continuous professional development is an essential component within many health care 'Learning Organisations'. The paper describes the first phase of an initiative to develop a professional practice development framework for nurses in an NHS general hospital. The project was undertaken within a critical action research methodology. A tripartite arrangement between the hospital, a university and professional nursing organisation enabled clinical, educational and research support for the nurses (co-researchers) engaged in the project. Initial challenges were from some managers, educationalists and the ethics committee who did not appear to understand the action research process. A multi-method approach to data collection was undertaken to capture the change process from different stakeholders' perceptions. Triangulation of the data was undertaken. Despite organisational constraints, transformational leadership and peer support enabled the co-researchers to identify and initiate three patient-focused initiatives. The change process for the co-researchers included: enlightening personal journey, exploring the research-practice gap, enhancing personal and professional knowledge, evolving cultural change and collaborative working, empowering and disempowering messages. A hospital merger and corporate staff changes directly impacted on the project. A more flexible time-scale and longer term funding are required to enable continuity for trust-wide projects undertaken in dynamic clinical settings.

REFINE (Reducing Falls in In-patient Elderly)--a randomised controlled trial.

PubMed

Vass, Catherine D; Sahota, Opinder; Drummond, Avril; Kendrick, Denise; Gladman, John; Sach, Tracey; Avis, Mark; Grainge, Matthew

2009-09-10

Falls in hospitals are common, resulting in injury and anxiety to patients, and large costs to NHS organisations. More than half of all in-patient falls in elderly people in acute care settings occur at the bedside, during transfers or whilst getting up to go to the toilet. In the majority of cases these falls are unwitnessed. There is insufficient evidence underpinning the effectiveness of interventions to guide clinical staff regarding the reduction of falls in the elderly inpatient. New patient monitoring technologies have the potential to offer advances in falls prevention. Bedside sensor equipment can alert staff, not in the immediate vicinity, to a potential problem and avert a fall. However no studies utilizing this assistive technology have demonstrated a significant reduction in falls rates in a randomised controlled trial setting. The research design is an individual patient randomised controlled trial of bedside chair and bed pressure sensors, incorporating a radio-paging alerting mode to alert staff to patients rising from their bed or chair, across five acute elderly care wards in Nottingham University Hospitals NHS Trust. Participants will be randomised to bedside chair and bed sensors or to usual care (without the use of sensors). The primary outcome is the number of bedside in-patient falls. The REFINE study is the first randomised controlled trial of bedside pressure sensors in elderly inpatients in an acute NHS Trust. We will assess whether falls can be successfully and cost effectively reduced using this technology, and report on its acceptability to both patients and staff.

High profile backing for GS1 drive.

PubMed

Hodgson, Glen

2016-09-01

At the 2016 GS1 UK Healthcare Conference in London, delegates heard from speakers including Pat Mills, the Department of Health's commercial director, on the ongoing work to embed GS1 standards throughout the NHS in England in line with the DH's eProcurement Strategy, published in April 2014. This mandated that any service or product procured by an English NHS acute Trust comply with the standards--one of the most obvious representations of which is on barcodes--'to enable Trusts to manage their non-pay spending by adopting master procurement data, automating the exchange of such data, and benchmarking their procurement against other Trusts and healthcare providers'. One of six 'demonstrator site' Trusts to provide a speaker at the 2016 GS1 UK national conference to report on their progress to date was Leeds Teaching Hospitals NHS Trust. Shortly after, HEJ editor, Jonathan Baillie, spoke to the Trust's associate director, Commercial and Procurement, Chris Slater, and to head of Healthcare at GS1 UK, Glen Hodgson.

Hierarchical Trust Management of COI in Heterogeneous Mobile Networks

DTIC Science & Technology

2017-08-01

PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 5c. PROGRAM ELEMENT NUMBER 5b. GRANT NUMBER 5a. CONTRACT NUMBER Form Approved OMB NO. 0704...Report: Hierarchical Trust Management of COI in Heterogeneous Mobile Networks The views, opinions and/or findings contained in this report are those of...Institute & State University Title: Hierarchical Trust Management of COI in Heterogeneous Mobile Networks Report Term: 0-Other Email: irchen@vt.edu

Religious People Are Trusted Because They Are Viewed as Slow Life-History Strategists.

PubMed

Moon, Jordan W; Krems, Jaimie Arona; Cohen, Adam B

2018-06-01

Religious people are more trusted than nonreligious people. Although most theorists attribute these perceptions to the beliefs of religious targets, religious individuals also differ in behavioral ways that might cue trust. We examined whether perceivers might trust religious targets more because they heuristically associate religion with slow life-history strategies. In three experiments, we found that religious targets are viewed as slow life-history strategists and that these findings are not the result of a universally positive halo effect; that the effect of target religion on trust is significantly mediated by the target's life-history traits (i.e., perceived reproductive strategy); and that when perceivers have direct information about a target's reproductive strategy, their ratings of trust are driven primarily by his or her reproductive strategy, rather than religion. These effects operate over and above targets' belief in moralizing gods and offer a novel theoretical perspective on religion and trust.

Behavioural Indicators of Perceived Managerial and Leadership Effectiveness within Romanian and British Public Sector Hospitals

ERIC Educational Resources Information Center

Hamlin, Robert G.; Patel, Taran

2012-01-01

Purpose: This paper aims to report the results of a replication study of perceived managerial and leadership effectiveness within a Romanian public sector hospital, and to discuss the extent to which they are similar to and different from findings from equivalent studies carried out in two British NHS Trust hospitals. Design/methodology/approach:…

Awareness of Stress-Reduction Interventions on Work Attitudes: The Impact of Tenure and Staff Group in Australian Universities.

PubMed

Pignata, Silvia; Winefield, Anthony H; Provis, Chris; Boyd, Carolyn M

2016-01-01

This study explored the impact of staff group role and length of organizational tenure in the relationship between the awareness of stress interventions (termed intervention awareness: IA) and the work-related attitudinal outcomes of university employees. A two-wave longitudinal study of a sample of 869 employees from 13 universities completed a psychosocial work factors and health questionnaire. Hierarchical regression analyses examined the contribution of staff role and different lengths of organizational tenure with IA and employees' reports of job satisfaction, affective organizational commitment, trust in senior management, and perceived procedural justice. Employees' length of tenure affected the relation between IA and work attitudes, and there were also differences between academic and non-academic staff groups. For non-academic employees, IA predicted job satisfaction, affective organizational commitment, trust in senior management, and perceived procedural justice. However, for academics, IA only predicted job satisfaction and trust which identifies a need to increase the visibility of organizational interventions. Across the tenure groups, IA predicted: (1) perceived procedural justice for employees with five or less years of tenure; (2) job satisfaction for employees with 0-19 years of tenure; (3) trust in senior management for employees with 6-19 years of tenure; and (4) affective organizational commitment for employees with a tenure length of 6-10 years. Employees working at the university for an intermediate period had the most positive perceptions of their organization in terms of IA, job satisfaction, trust in senior management, and affective organizational commitment, whereas employees with 20-38 years of tenure had the least positive perceptions. Results suggest that employees in the middle of their careers report the most positive perceptions of their university. The findings highlight the need to attend to contextual issues in organizational stress and wellbeing interventions and suggest that management may need to implement new strategies and/or promote existing stress-management and reduction strategies to academics, and employees whom are either new to the university or those who have been working for the organization for longer periods of time to ensure that they are aware of organizational strategies to promote employee wellbeing and morale within their work environments.

Successful School Leadership

ERIC Educational Resources Information Center

Day, Christopher; Sammons, Pamela

2016-01-01

Working with partners including the Department of Education at Oxford University, the Centre for Equity in Education at the University of Manchester, the University of Glasgow, the University of Nottingham and the Hong Kong Institute of Education, "Education Development Trust" has commissioned a series of reviews of international…

Evaluating the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme': A mixed method study in England.

PubMed

Marshall, Joyce L; Spiby, Helen; McCormick, Felicia

2015-02-01

caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants׳ perceptions of factors that sustain or hinder work within participating maternity units. a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors. Copyright © 2014 Elsevier Ltd. All rights reserved.

Trust in Sources of Advice about Infant Care Practices: The SAFE Study.

PubMed

Hwang, Sunah S; Rybin, Denis V; Heeren, Timothy C; Colson, Eve R; Corwin, Michael J

2016-09-01

Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

Social capital and trust in providers.

PubMed

Ahern, Melissa M; Hendryx, Michael S

2003-10-01

Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional. Data are from (1) the 1996 Household Survey of the Community Tracking Study, drawn from 24 Metropolitan Statistical Areas; (2) a 1996 multi-city broadcast media marketing database including key social capital indicators; (3) Interstudy; (4) the American Hospital Association; and (5) the American Medical Association. Independent variables include individual socio-demographic variables, HMO enrollment, community-level health sector variables, and social capital. The dependent variable is self-reported trust in physicians. Data are merged from the various sources and analyzed using SUDAAN. Subjects include adults in the Household Survey who responded to the items on trust in physicians (N=17,653). Trust in physicians is independently predicted by community social capital (p<0.001). Trust is also negatively related to HMO enrollment and to many individual characteristics. The effect of HMOs is not uniform across all communities. Social capital plays a role in how health care is perceived by citizens, and how health care is delivered by providers. Efforts to build trust and collaboration in a community may improve trust in physicians, health care quality, access, and preserve local health care control.

Unauthorized Immigrants Prolong the Life of Medicare's Trust Fund.

PubMed

Zallman, Leah; Wilson, Fernando A; Stimpson, James P; Bearse, Adriana; Arsenault, Lisa; Dube, Blessing; Himmelstein, David; Woolhandler, Steffie

2016-01-01

Unauthorized immigrants seldom have access to public health insurance programs such as Medicare Part A, which pays hospitals and other health facilities and is funded through the Medicare Trust Fund. We tabulated annual and total Trust Fund contributions and withdrawals by unauthorized immigrants (i.e., outlays on their behalf) from 2000 to 2011 using the Current Population Survey and Medical Expenditure Panel Surveys. We estimated when the Trust Fund would be depleted if unauthorized immigrants had neither contributed to it nor withdrawn from it. We estimated Trust Fund surpluses by unauthorized immigrants if 10 % were to become authorized annually over the subsequent 7 years. From 2000 to 2011, unauthorized immigrants contributed $2.2 to $3.8 billion more than they withdrew annually (a total surplus of $35.1 billion). Had unauthorized immigrants neither contributed to nor withdrawn from the Trust Fund during those 11 years, it would become insolvent in 2029-1 year earlier than currently predicted. If 10 % of unauthorized immigrants became authorized annually for the subsequent 7 years, Trust Fund surpluses contributed by unauthorized immigrants would total $45.7 billion. Unauthorized immigrants have prolonged the life of the Medicare Trust Fund. Policies that curtail the influx of unauthorized immigrants may accelerate the Trust Fund's depletion.

Communicating with Clinicians: The Experiences of Surrogate Decision Makers for Hospitalized Older Adults

PubMed Central

Torke, Alexia M.; Petronio, Sandra; Purnell, Christianna E.; Sachs, Greg A.; Helft, Paul R.; Callahan, Christopher M.

2012-01-01

Background/Objectives When hospitalized older adults have impaired cognition, family members or other surrogates must communicate with clinicians to provide information and make medical decisions for the patient. The present study describes communication experiences of surrogates who recently made a major medical decision for a hospitalized older adult. Design Semi-structured interviews about a recent hospitalization. Setting Two hospitals both affiliated with 1 large medical school: an urban, public hospital; and a university-affiliated tertiary referral hospital. Participants Surrogates were eligible if they had recently made a major medical decision for a hospitalized patient aged 65 or older and were available for an interview within 1 month (2-5 months if the patient died). Measurements Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory. Results We interviewed 35 surrogates. They were 80% female, 44% white and 56% African American. Three primary themes emerged. We found the Nature of Surrogate/Clinician Relationships was best characterized as a relationship with a “team” of clinicians rather than individual clinicians due to frequent staff changes and multiple clinicians. Surrogates reported their Communication Needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described Trust and Mistrust, which were formed largely through surrogates’ communication experiences. Conclusion In the hospital, surrogates form relationships with a “team” of clinicians rather than with individuals. Yet effective communication and expressions of emotional support frequently occur and are highly valued by surrogates. Future interventions should focus on meeting surrogates’ needs for frequent communication, high levels of information and emotional support. PMID:22881864

Improving service quality in NHS Trust hospitals: lessons from the hotel sector.

PubMed

Desombre, T; Eccles, G

1998-01-01

This article looks to review recent practice undertaken within the UK hotel sector to improve customer service, and suggests ideals that could be implemented within National Health (NHS) Trust hospitals. At a time of increasing competition, hotel firms are using service enhancement as a means to gain competitive advantage, and therefore developing a range of techniques to measure levels of service quality improvement. With continued change in the health service, where greater focus now lies with patient satisfaction, so there is a requirement for managers to adapt techniques presently being offered in other service industries to improve levels of customer service and ensure patients are targeted to define their levels of satisfaction.

Physician involvement enhances coding accuracy to ensure national standards: an initiative to improve awareness among new junior trainees.

PubMed

Nallasivan, S; Gillott, T; Kamath, S; Blow, L; Goddard, V

2011-06-01

Record Keeping Standards is a development led by the Royal College of Physicians of London (RCP) Health Informatics Unit and funded by the National Health Service (NHS) Connecting for Health. A supplementary report produced by the RCP makes a number of recommendations based on a study held at an acute hospital trust. We audited the medical notes and coding to assess the accuracy, documentation by the junior doctors and also to correlate our findings with the RCP audit. Northern Lincolnshire & Goole Hospitals NHS Foundation Trust has 114,000 'finished consultant episodes' per year. A total of 100 consecutive medical (50) and rheumatology (50) discharges from Diana Princess of Wales Hospital from August-October 2009 were reviewed. The results showed an improvement in coding accuracy (10% errors), comparable to the RCP audit but with 5% documentation errors. Physician involvement needs enhancing to improve the effectiveness and to ensure clinical safety.

The financial status of Medicare.

PubMed

Foster, R S

1998-01-01

Medicare is the largest health care program in the country, providing medical care to 38 million aged and disabled Americans. Concerns over rapid cost increases and the imminent insolvency of the Medicare Hospital Insurance trust fund led to enactment of sweeping Medicare legislation as part of the Balanced Budget Act of 1997. Preliminary estimates indicate that this legislation will result in program savings of $150 billion in the first five years and will postpone the depletion of the Hospital Insurance fund from the year 2001 until about 2010. While the Balanced Budget Act significantly reduces Hospital Insurance expenditure in the long range, serious deficits are still expected when the "baby boom" generation reaches retirement. The Medicare Supplementary Medical Insurance trust fund is automatically in financial balance, but policy makers remain concerned about continuing rapid cost increases. A new National Bipartisan Commission on the Future of Medicare will attempt to determine effective solutions to these long-range problems.

Joint-venture proposals strengthen hospital-physician relationship.

PubMed

Rovinsky, M

2000-12-01

By proposing the joint-venture development of an ambulatory surgery center and medical office space with a group practice, one hospital succeeded in enhancing its relationship with the practice and paved the way for future collaboration. Although the hospital's proposal to jointly develop an ambulatory surgery center was not accepted, the hospital was able to dissuade the group practice from developing a competing ambulatory surgery facility while increasing the group's trust in and loyalty to the hospital. As a result, the hospital potentially will benefit from increased inpatient admissions.

High hospital research participation and improved colorectal cancer survival outcomes: a population-based study.

PubMed

Downing, Amy; Morris, Eva Ja; Corrigan, Neil; Sebag-Montefiore, David; Finan, Paul J; Thomas, James D; Chapman, Michael; Hamilton, Russell; Campbell, Helen; Cameron, David; Kaplan, Richard; Parmar, Mahesh; Stephens, Richard; Seymour, Matt; Gregory, Walter; Selby, Peter

2017-01-01

In 2001, the National Institute for Health Research Cancer Research Network (NCRN) was established, leading to a rapid increase in clinical research activity across the English NHS. Using colorectal cancer (CRC) as an example, we test the hypothesis that high, sustained hospital-level participation in interventional clinical trials improves outcomes for all patients with CRC managed in those research-intensive hospitals. Data for patients diagnosed with CRC in England in 2001-2008 (n=209 968) were linked with data on accrual to NCRN CRC studies (n=30 998). Hospital Trusts were categorised by the proportion of patients accrued to interventional studies annually. Multivariable models investigated the relationship between 30-day postoperative mortality and 5-year survival and the level and duration of study participation. Most of the Trusts achieving high participation were district general hospitals and the effects were not limited to cancer 'centres of excellence', although such centres do make substantial contributions. Patients treated in Trusts with high research participation (≥16%) in their year of diagnosis had lower postoperative mortality (p<0.001) and improved survival (p<0.001) after adjustment for casemix and hospital-level variables. The effects increased with sustained research participation, with a reduction in postoperative mortality of 1.5% (6.5%-5%, p<2.2×10 -6 ) and an improvement in survival (p<10 -19 ; 5-year difference: 3.8% (41.0%-44.8%)) comparing high participation for ≥4 years with 0 years. There is a strong independent association between survival and participation in interventional clinical studies for all patients with CRC treated in the hospital study participants. Improvement precedes and increases with the level and years of sustained participation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Can hospital promotional activities be more ethical?

PubMed Central

Chen, Yiyi; Yin, Zhou; Xie, Qiong; Shao, Zhexin

2014-01-01

At present, there exist a lot of violations of medical ethics in advertising and promotional activities, which have been infringing the rights of patients. Therefore, the ethical criteria should be established as soon as possible to regulate the hospital promotional activities, to regain the trust of people. PMID:24948998

Preventing falls in hospital.

PubMed

Pearce, Lynne

2017-02-27

Essential facts Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 a day, according to the Royal College of Physicians (RCP). But research shows that when nurses, doctors and therapists work together, falls can be reduced by 20-30%.

A Changing World: Expectations of Higher Education

ERIC Educational Resources Information Center

Daniel, John

2017-01-01

The vocabulary of higher education is being devalued. The use of "expert" and "elite" as pejorative terms undermines the trust on which successful societies are based. In a "post-factual" society, universities have to re-establish a respect for objective truth and powerful arguments, becoming trust building as well as…

Do Higher Education Institutes Communicate Trust Well?

ERIC Educational Resources Information Center

Gibbs, Paul; Dean, Aftab

2015-01-01

The relationship between trust and information sources for new purchasers of higher education is discussed. A range of sources is evaluated by potential entrants into UK higher education, and indicates that universities tend to be regarded as the most trustworthy when information is directly associated with them and social networks, and friends…

Group Trust, Communication Media, and Interactivity: Toward an Integrated Model of Online Collaborative Learning

ERIC Educational Resources Information Center

Du, Jianxia; Wang, Chuang; Zhou, Mingming; Xu, Jianzhong; Fan, Xitao; Lei, Saosan

2018-01-01

The present investigation examines the multidimensional relationships among several critical components in online collaborative learning, including group trust, communication media, and interactivity. Four hundred eleven university students from 103 groups in the United States responded survey items on online collaboration, interactivity,…

How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study.

PubMed

Sheu, Leslie; O'Sullivan, Patricia S; Aagaard, Eva M; Tad-Y, Darlene; Harrell, Heather E; Kogan, Jennifer R; Nixon, James; Hollander, Harry; Hauer, Karen E

2016-10-01

Although residents trust interns to provide patient care, little is known about how trust forms. Using a multi-institutional mixed-methods study design, the authors interviewed (March-September 2014) internal medicine (IM) residents in their second or third postgraduate year at a single institution to address how they develop trust in interns. Transcript analysis using grounded theory yielded a model for resident trust. Authors tested (January-March 2015) the model with residents from five IM programs using a two-section quantitative survey (38 items; 31 rated 0 = not at all to 100 = very much; 7 rated 0 = strongly disagree to 100 = strongly agree) to identify influences on how residents form trust. Qualitative analysis of 29 interviews yielded 14 themes within five previously identified factors of trust (resident, intern, relationship, task, and context). Of 478 residents, 376 (78.7%) completed the survey. Factor analysis yielded 11 factors that influence trust. Respondents rated interns' characteristics (reliability, competence, and propensity to make errors) highest when indicating importance to trust (respective means 86.3 [standard deviation = 9.7], 76.4 [12.9], and 75.8 [20.0]). They also rated contextual factors highly as influencing trust (access to an electronic medical record, duty hours, and patient characteristics; respective means 79.8 [15.3], 73.1 [14.4], and 71.9 [20.0]). Residents form trust based on primarily intern- and context-specific factors. Residents appear to consider trust in a way that prioritizes interns' execution of essential patient care tasks safely within the complexities and constraints of the hospital environment.

Modelling University Governance

ERIC Educational Resources Information Center

Trakman, Leon

2008-01-01

Twentieth century governance models used in public universities are subject to increasing doubt across the English-speaking world. Governments question if public universities are being efficiently governed; if their boards of trustees are adequately fulfilling their trust obligations towards multiple stakeholders; and if collegial models of…

Does a chest x-ray alter the management of new patients attending a geriatric day hospital?

PubMed

Logan, J A; Vallance, R; Williams, B O; Paul, H

1997-01-01

Studies have suggested that routine chest x-ray is never indicated but all new attenders at our day hospitals have a chest x-ray carried out. Our aim was to determine if this investigation altered the clinical management of patients and to try to select those patients in whom a chest x-ray is indicated. A prospective study was carried out over a 7 month period from February to September 1995. All new patients had cardiorespiratory symptoms/signs documented and a management plan made. A chest x-ray was then carried out and change in management as a result of the x-ray report noted. Knightswood and Drumchapel Geriatric Day Hospitals, West Glasgow University NHS Trust. All new Day Hospital attenders. Of 207 new Day Hospital attenders, 53 had no clinical indication for a chest x-ray and although 70% had an abnormal film in no case was patient management changed as a result of this. A chest x-ray was indicated in 154 patients and of these 114 (74%) had an abnormal film with a resultant change in management in 23 patients (this comprised either a change in drug treatment or a further investigation.) Of those whose management was changed as a result of the x-ray report 61% had respiratory symptoms. We would recommend that chest x-ray should be performed in those patients who have a clear clinical indication and that the diagnostic yield is highest in the presence of respiratory symptoms or signs.

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law.

PubMed

O'Brien, J W; Natarajan, M; Shaikh, I

2017-06-01

The UK Supreme Court recently ruled that when consenting patients for treatments or procedures, clinicians must also discuss any associated material risks. We surveyed medical staff at a large UK teaching hospital in order to ascertain knowledge of consent law and current understanding of this change. Email survey sent to medical staff in all specialities at Norfolk and Norwich University Hospital in February 2016. 245 responses (141 Consultants and 104 junior doctors, response rate 32%). 82% consent patients for procedures at least monthly and 23% daily. 31% were not familiar with the concept of material risk. 35% were familiar with the recent change in consent law, 41% were not. 18% were "very uncertain" and 64% "a little uncertain" that their consenting process meets current legal requirements. >92% think that landmark cases and changes in law should be discussed through professional bodies and circulated better locally. The majority were not familiar with the concept of material risk and recent legal changes. A majority were not confident that their practice meets current requirements, suggesting that recent changes in consent law may not be widely understood at this hospital. We suggest more guidance and education may be necessary than is currently available. Increased understanding of recent changes to consent law will reduce the risk taken by NHS trusts and offer patients a service compliant with Supreme Court guidance.

Sound Trust and the Ethics of Telecare.

PubMed

Voerman, Sander A; Nickel, Philip J

2017-02-01

The adoption of web-based telecare services has raised multifarious ethical concerns, but a traditional principle-based approach provides limited insight into how these concerns might be addressed and what, if anything, makes them problematic. We take an alternative approach, diagnosing some of the main concerns as arising from a core phenomenon of shifting trust relations that come about when the physician plays a less central role in the delivery of care, and new actors and entities are introduced. Correspondingly, we propose an applied ethics of trust based on the idea that patients should be provided with good reasons to trust telecare services, which we call sound trust. On the basis of this approach, we propose several concrete strategies for safeguarding sound trust in telecare. © The Author 2016. Published by Oxford University Press, on behalf of The Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effects of organizational justice on organizational citizenship behaviors: mediating effects of institutional trust and affective commitment.

PubMed

Guh, Wei-Yuan; Lin, Shang-Ping; Fan, Chwei-Jen; Yang, Chin-Fang

2013-06-01

This study investigated the mediating role of institutional trust and affective commitment on the relationship between organizational justice and organizational citizenship behaviors. The study participants were 315 faculty members at 67 public/private universities of technology and vocational colleges in Taiwan. Structural equation modeling was used to analyze the relationships between the variables and assess the goodness of fit of the overall model. Organizational justice was positively related to institutional trust and there was an indirect effect of organizational justice on affective commitment through institutional trust. In addition, the relation between institutional trust and affective commitment was positive and affective commitment was shown to have a positive relation to organizational citizenship behaviors. Institutional trust was found to indirectly affect organizational citizenship behaviors through affective commitment. Most importantly, this study suggested a mediating effect of institutional trust and affective commitment on the relation between organizational justice and organizational citizenship behaviors. Implications, limitations, and future research were also discussed.

Organ transplantation scandal influencing corneal donation rate.

PubMed

Röck, Tobias; Bramkamp, Matthias; Bartz-Schmidt, Karl Ulrich; Röck, Daniel

2017-01-01

In the majority of countries, there is a shortage of donor corneas for corneal transplantations. This study investigated the impact of organ transplantation scandals on corneal donation rate at the University Hospital Tübingen. Each deceased patient was considered as a potential corneal donor. An ophthalmic resident handled with stable methods of procedures the corneal donor procurement from 2009 to 2015. The rates of corneal donation were examined and analyzed. Among the 5712 hospital deaths, consent for corneal donation was obtained in 711 cases. The mean annual corneal donation rate was 12.4%. Since 2009, the donation rate per year could be increased with exception of 2013 and 2015. In the end of 2012 and 2014 two huge organ donation scandals were known in Germany. In the following years 2013 and 2015 corneal donation rate decreased significantly ( P =0.0181 and P =0.0006). We concluded that transplantation scandals have a significant impact on corneal donation rate. Improving professional's performance through full transparency and honesty is very important to earn trust of potential donors and their families.

Organ transplantation scandal influencing corneal donation rate

PubMed Central

Röck, Tobias; Bramkamp, Matthias; Bartz-Schmidt, Karl Ulrich; Röck, Daniel

2017-01-01

In the majority of countries, there is a shortage of donor corneas for corneal transplantations. This study investigated the impact of organ transplantation scandals on corneal donation rate at the University Hospital Tübingen. Each deceased patient was considered as a potential corneal donor. An ophthalmic resident handled with stable methods of procedures the corneal donor procurement from 2009 to 2015. The rates of corneal donation were examined and analyzed. Among the 5712 hospital deaths, consent for corneal donation was obtained in 711 cases. The mean annual corneal donation rate was 12.4%. Since 2009, the donation rate per year could be increased with exception of 2013 and 2015. In the end of 2012 and 2014 two huge organ donation scandals were known in Germany. In the following years 2013 and 2015 corneal donation rate decreased significantly (P=0.0181 and P=0.0006). We concluded that transplantation scandals have a significant impact on corneal donation rate. Improving professional's performance through full transparency and honesty is very important to earn trust of potential donors and their families. PMID:28730094

Commissioning for COPD care: a new, recordable metric that supports the patient interest.

PubMed

Walker, Paul Phillip; Thompson, E; Hill, S L; Holton, K; Bodger, K; Pearson, M G

2016-06-01

Healthcare metrics have been used to drive improvement in outcome and delivery in UK hospital stroke and cardiac care. This model is attractive for chronic obstructive pulmonary disease (COPD) care because of disease frequency and the burden it places on primary, secondary and integrated care services. Using 'hospital episode statistics' (UK 'coding'), we examined hospital 'bed days/1000 population' in 150 UK Primary Care Trusts (PCTs) during 2006-07 and 2007-08. Data were adjusted for COPD prevalence. We looked at year-on-year consistency and factors which influenced variation. There were 248 996 COPD admissions during 2006-08. 'Bed days/1000 PCT population' was consistent between years (r = 0.87; P < 0.001). There was a >2-fold difference in bed days between the best and worst performing PCTs which was primarily a consequence of variation in emergency admission rate (P < 0.001) and proportion of emergency admissions due to COPD (P < 0.001) and to only a lesser extent length of hospital stay (P < 0.001). Bed days/1000 population appears a useful annual metric of COPD care quality. Good COPD care keeps patients active and out of hospital and requires co-ordinated action from both hospital and community services, with an important role for integrated care. This metric demonstrates that current care is highly variable and offers a measurable target to commission against. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Facilitators and barriers of independent decisions by midwives during labor and birth.

PubMed

Everly, Marcee C

2012-01-01

The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. A qualitative study was conducted using one-on-one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open-ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. Four overall themes were identified: trust birth, the woman, the environment, and the labor team. When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions. © 2011 by the American College of Nurse-Midwives.

Tutor Trust Secondary: Evaluation Report and Executive Summary

ERIC Educational Resources Information Center

Buchanan, Emily; Morrison, Jo; Walker, Matthew; Aston, Helen; Cook, Rose

2015-01-01

The Tutor Trust is a Manchester-based charity that aims to provide affordable small group and one-to-one tuition, predominantly to disadvantaged pupils in schools in challenging communities. The tutors are university students and recent graduates, enabling tuition to be provided at a competitive rate on a not-for-profit basis. This three-year…

Quality Assurance in UK Higher Education: Issues of Trust, Control, Professional Autonomy and Accountability

ERIC Educational Resources Information Center

Hoecht, Andreas

2006-01-01

This article explores the issues of trust, control, professional autonomy and accountability in higher education quality assurance in the UK. The main part of this article is conceptual, but it includes results from semi-structured interviews with academic staff that were conducted at two "new university" business schools. Both…

Antiplagiarism Software Takes on the Honor Code

ERIC Educational Resources Information Center

Wasley, Paula

2008-01-01

Among the 100-odd colleges with academic honor codes, plagiarism-detection services raise a knotty problem: Is software compatible with a system based on trust? The answer frequently devolves to the size and culture of the university. Colleges with traditional student-run honor codes tend to "forefront" trust, emphasizing it above all else. This…

Communication Skills to Develop Trusting Relationships on Global Virtual Engineering Capstone Teams

ERIC Educational Resources Information Center

Zaugg, Holt; Davies, Randall S.

2013-01-01

As universities seek to provide cost-effective, cross-cultural experiences using global virtual (GV) teams, the "soft" communication skills typical of all teams, increases in importance for GV teams. Students need to be taught how to navigate through cultural issues and virtual tool issues to build strong trusting relationships with…

Participative Budgeting, Budget Evaluation, and Organizational Trust in Post-Secondary Educational Institutions in Canada

ERIC Educational Resources Information Center

Simmons, Cynthia V.

2012-01-01

The purpose of this research was to investigate the relationship between a participative budgeting system, the attitudes toward the budget, and levels of organizational trust held by administrators in post-secondary institutions. A 50-item questionnaire was distributed to college and university administrators across Canada. A series of regression…

Too Little and Too Much Trust: Performance Measurement in Australian Higher Education

ERIC Educational Resources Information Center

Woelert, Peter; Yates, Lyn

2015-01-01

A striking feature of contemporary Australian higher education governance is the strong emphasis on centralized, template style, metric-based, and consequential forms of performance measurement. Such emphasis is indicative of a low degree of political trust among the central authorities in Australia in the intrinsic capacity of universities and…

Impact of Facebook Usage on Students' Academic Achievement: Role of Self-Regulation and Trust

ERIC Educational Resources Information Center

Rouis, Sana; Limayem, Moez; Salehi-Sangari, Esmail

2011-01-01

Introduction: The paper provides a preliminary analysis of the effects of Facebook usage by undergraduate students at Lulea University of Technology in Sweden. The proposed research model tests the perceived effect of personality traits, self-regulation, and trust on students' achievements. Based on flow theory, the model suggests negative…

Summary of the 1983 Annual Reports of the Medicare Board of Trustees

PubMed Central

1983-01-01

This summary presents an overview of the information contained in the annual reports of the trustees required under Title XVIII of the Social Security Act, Health Insurance for the Aged and Disabled, commonly known as Medicare. There are two basic programs under Medicare: Hospital insurance (HI), which pays for inpatient hospital care and other related care of those 65 years of age and over and of the long-term disabled.Supplementary medical insurance (SMI), which pays for physicians' services, outpatient hospital services, and other medical expenses of those 65 years of age and over and of the long-term disabled. The HI program is financed primarily by payroll taxes, with the taxes paid by current workers used to pay benefits to current beneficiaries. However, the HI program maintains a trust fund that provides a small reserve against fluctuations. This type of financing is generally known as pay-as-you-go financing. By contrast, the SMI program is financed on an accrual basis with a contingency margin. This means that the SMI trust fund should always be somewhat greater than the claims that have been incurred by enrollees but not yet paid by the program. The trust funds hold all of the income not currently needed to pay benefits and related expenses. The assets of the funds may not be used for any other purpose; however, they may be invested in certain interest-bearing obligations of the U.S. Government. The Secretaries of Treasury, Labor, and Health and Human Services serve as trustees of the HI and SMI trust funds. The Secretary of Treasury is the managing trustee. The Administrator of the Health Care Financing Administration, the agency charged with administering the Medicare program, is the secretary of the Board of Trustees. PMID:10310524

An evaluation of a toolkit for the early detection, management, and control of carbapenemase-producing Enterobacteriaceae: a survey of acute hospital trusts in England.

PubMed

Coope, C M; Verlander, N Q; Schneider, A; Hopkins, S; Welfare, W; Johnson, A P; Patel, B; Oliver, I

2018-03-09

Following hospital outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), Public Health England published a toolkit in December 2013 to promote the early detection, management, and control of CPE colonization and infection in acute hospital settings. To examine awareness, uptake, implementation and usefulness of the CPE toolkit and identify potential barriers and facilitators to its adoption in order to inform future guidance. A cross-sectional survey of National Health Service (NHS) acute trusts was conducted in May 2016. Descriptive analysis and multivariable regression models were conducted, and narrative responses were analysed thematically and informed using behaviour change theory. Most (92%) acute trusts had a written CPE plan. Fewer (75%) reported consistent compliance with screening and isolation of CPE risk patients. Lower prioritization and weaker senior management support for CPE prevention were associated with poorer compliance. Awareness of the CPE toolkit was high and all trusts with patients infected or colonized with CPE had used the toolkit either as provided (32%), or to inform (65%) their own local CPE plan. Despite this, many respondents (80%) did not believe that the CPE toolkit guidance offered an effective means to prevent CPE or was practical to follow. CPE prevention and control requires robust IPC measures. Successful implementation can be hindered by a complex set of factors related to their practical execution, insufficient resources and a lack of confidence in the effectiveness of the guidance. Future CPE guidance would benefit from substantive user involvement, processes for ongoing feedback, and regular guidance updates. Copyright © 2018 The Healthcare Infection Society. All rights reserved.

Awareness of Stress-Reduction Interventions on Work Attitudes: The Impact of Tenure and Staff Group in Australian Universities

PubMed Central

Pignata, Silvia; Winefield, Anthony H.; Provis, Chris; Boyd, Carolyn M.

2016-01-01

This study explored the impact of staff group role and length of organizational tenure in the relationship between the awareness of stress interventions (termed intervention awareness: IA) and the work-related attitudinal outcomes of university employees. A two-wave longitudinal study of a sample of 869 employees from 13 universities completed a psychosocial work factors and health questionnaire. Hierarchical regression analyses examined the contribution of staff role and different lengths of organizational tenure with IA and employees' reports of job satisfaction, affective organizational commitment, trust in senior management, and perceived procedural justice. Employees' length of tenure affected the relation between IA and work attitudes, and there were also differences between academic and non-academic staff groups. For non-academic employees, IA predicted job satisfaction, affective organizational commitment, trust in senior management, and perceived procedural justice. However, for academics, IA only predicted job satisfaction and trust which identifies a need to increase the visibility of organizational interventions. Across the tenure groups, IA predicted: (1) perceived procedural justice for employees with five or less years of tenure; (2) job satisfaction for employees with 0–19 years of tenure; (3) trust in senior management for employees with 6–19 years of tenure; and (4) affective organizational commitment for employees with a tenure length of 6–10 years. Employees working at the university for an intermediate period had the most positive perceptions of their organization in terms of IA, job satisfaction, trust in senior management, and affective organizational commitment, whereas employees with 20–38 years of tenure had the least positive perceptions. Results suggest that employees in the middle of their careers report the most positive perceptions of their university. The findings highlight the need to attend to contextual issues in organizational stress and wellbeing interventions and suggest that management may need to implement new strategies and/or promote existing stress-management and reduction strategies to academics, and employees whom are either new to the university or those who have been working for the organization for longer periods of time to ensure that they are aware of organizational strategies to promote employee wellbeing and morale within their work environments. PMID:27588011

Dead in the water--are we killing the hospital autopsy with poor consent practices?

PubMed

Henry, Jaimie; Nicholas, Nick

2012-07-01

It is now a recognized fact that the practice of conducting a consent (or hospital) post-mortem examination is in decline. There have been many reasons put forth to explain this demise, but the quality of the consenting process is frequently cited as having a high impact. This article focuses on consent practices for post-mortem examinations in England and Wales, and considers if our consent techniques are adversely affecting post-mortem examination uptake. We examine the regulatory compliance of trusts with their statutory obligations by analyzing the Human Tissue Authority's compliance and inspection reports. We further analyze 21 publicly available NHS Trust policies on post-mortem examination consent procedures, and consider whether these are fit for the purpose of meeting the dual needs of clinicians and the bereaved. Despite more Human Tissue Authority inspections, there is a disproportionate rise in enforcement actions, with up to 48% of sampled Trusts exhibiting shortcomings in their legal duties. Additionally, only 52.4% of sampled trusts follow the Human Tissue Authority best-practice model, with 23.8% having no documented procedures. Despite the well founded evidence base for best-practice models, consent practices for post-mortem examinations remains poor and is likely to have a gross adverse effect on the rate of post-mortem examinations. We recommend that NHS Trusts rigorously review their protocols and introduce a team-approach between clinicians and trained bereavement staff in core-consent teams, as the Human Tissue Authority suggests, whilst at the same time placing a strong emphasis on education for junior and senior colleagues alike.

The 'dark side' of social capital: trust and self-rated health in European countries.

PubMed

Campos-Matos, Inês; Subramanian, S V; Kawachi, Ichiro

2016-02-01

Generalized interpersonal trust (as an indicator of social capital) has been linked to health status at both the individual and ecological level. We sought to examine how changes in contextual and individual trust are associated with changes in self-rated health in the European Social Surveys 2002-12. A multilevel analysis using a variance components model was performed on 203 452 individuals nested within 145 country cohorts covering 35 countries. Conditional on sociodemographic covariates, we sought to examine the association between self-rated health and individual trust, country average trust and a cross-level interaction between the two. Although individual trust perceptions were significantly correlated with self-rated health [OR = 0.95, 95% confidence interval (0.94-0.96)], country-level trust was not associated [OR = 1.12, 95% confidence interval (0.95-1.32)]. There was, however, a strong crosslevel interaction between contextual and individual trust (P < 0.001), such that individuals with high interpersonal trust reported better health in contexts in which other individuals expressed high average interpersonal trust. Conversely, low trust individuals reported worse health in high trust contexts. Our findings suggest that contexts with increasing average trust can be harmful for low trust individuals, which might reflect the negative impact that social capital can have in certain groups. These findings suggest that contextual trust has a complex role in explaining health inequalities and individual self-rated health. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Impact of the Department of Health initiative to equip and train acute trusts to manage chemically contaminated casualties

PubMed Central

Al-Damouk, M; Bleetman, A

2005-01-01

Background: Before 1999, there was no national model or standard doctrine for managing casualties from chemical incidents in the UK. A Department of Health (DoH) initiative to prepare the National Health Service (NHS) for chemical incidents was launched in the same year. This led to the distribution of an NHS standard chemical personal protective equipment suit (CPPE) together with a new single half day training package (Structured Approach to Chemical Casualties (SACC)) in 2001. Objectives: To assess the impact of the DoH initiative on acute hospital and ambulance trusts. To identify deficiencies in the design and operational deployment of the new CPPE, training initiative, and decontamination procedures at hospital level. Method: A survey to assess progress in specific areas of chemical incident preparedness and two simulated incidents with "live" chemically contaminated casualties conducted in two acute trusts. Umpires evaluated the operational performance against DoH SACC standards. Results: There has been marked improvement in many aspects of preparedness for chemical incidents since the original National Focus survey. Some deficiencies remain and this study identified areas for further work. In the live casualty exercises, hospital staff complied well with SACC protocols. Some practical difficulties were encountered with the deployment of the CPPE and in some aspects of the operational response, leading to some delays in the delivery of care to the casualties and to the integrity of the uncontaminated (clean) zones within the hospitals. Conclusion: Problems with the design and deployment of the CPPE, together with training difficulties have been fed back into the planning and development process. PMID:15843703

The importance of relationships in mental health care: A qualitative study of service users' experiences of psychiatric hospital admission in the UK

PubMed Central

Gilburt, Helen; Rose, Diana; Slade, Mike

2008-01-01

Background While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care. Methods This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatric hospitals in London were interviewed in the community. Results Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships. Conclusion Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems. PMID:18439254

Non-price competition in NHS secondary care contracting: empirical results.

PubMed

Gray, Keith; Bailey, Mark F

2008-01-01

The purpose of this paper is, for English acute NHS hospitals, to investigate how they operate their governance systems in the area of secondary care contracting and identify the key determinants of relationship building within the contacting/commissioning of secondary care focusing upon non-price competitive behaviour. A survey instrument was designed and mailed to a sample of all acute NHS hospitals in England of whom 35 per cent responded. This survey was then analysed using logit techniques. The analysis suggests that: those NHS Trusts offering volume discounts, non-price competitive incentives or having a strong belief in performance being by "payment by results" criteria are significantly more likely to offer augmented services to secondary care purchasers over and above contractual minima; those NHS Trusts strongly believing in the importance of non-price factors (such as contract augmentation or quality) in the contracting process are more likely to offer customisation of generic services; and those NHS Trusts using cost-sharing agreements to realign contracts when negotiating contracts or who strongly believe in the importance of service augmentation in strengthening relationships, or that increased hospital efficiency is the most important aspect of recent NHS reform are more likely to utilise default measures to help realign contracts. This paper fills a gap in the area of non-price competition in English NHS acute secondary care contracting.

Developing a foundation apprenticeship in care.

PubMed

Cunningham, A

This article explores the development of a foundation apprenticeship in care at Sheffield Teaching Hospitals NHS Foundation Trust. The benefits for recruitment and development of the workforce are discussed.

"An Absolute Prerequisite": The Importance of User Privacy and Trust in Maintaining Academic Freedom at the Library

ERIC Educational Resources Information Center

Sutlieff, Lisa; Chelin, Jackie

2010-01-01

This research investigated the importance of user-library trust in ensuring vital freedom of inquiry in academic libraries, exploring its strength through comparison with attitudes towards the National Identity Card Scheme (NICS) within the various libraries of a large UK university. An online survey of students and interviews with librarians…

Sticking with Your University: The Importance of Satisfaction, Trust, Image, and Shared Values

ERIC Educational Resources Information Center

Schlesinger, Walesska; Cervera, Amparo; Pérez-Cabañero, Carmen

2017-01-01

In a context of increasing competition and financial difficulties for higher education institutions, alumni loyalty is a key factor for survival and success. This study tests a model derived from a relationship marketing perspective to investigate the roles of four variables (brand image, trust, satisfaction, and shared values) in the direct and…

The Relationships between Brand Association, Trust, Commitment, and Satisfaction of Higher Education Institutions

ERIC Educational Resources Information Center

Chen, Yu-Chuan

2017-01-01

Purpose: The purpose of this paper is to explore structural relationships among the variables of brand association, student trust, commitment, and satisfaction in the higher education sector. Design/methodology/approach: A survey was used to collect data from a sample of 500 students who studied at universities in Taiwan in 2016. These data were…

Mapping the Social Side of Pre-Service Teachers: Connecting Closeness, Trust, and Efficacy with Performance

ERIC Educational Resources Information Center

Liou, Yi-Hwa; Daly, Alan J.; Canrinus, Esther T.; Forbes, Cheryl A.; Moolenaar, Nienke M.; Cornelissen, Frank; Van Lare, Michelle; Hsiao, Joyce

2017-01-01

This exploratory study foregrounds the important, but often understudied social side of pre-service teacher development and its relation to teaching performance in one university-based teacher preparation program in the US. We examine the extent to which pre-service elementary teachers' social relationships and perceptions of peer trust and…

The Impact of Various Demographic and Educational Attributes on International Students' Propensity to Trust School Officials

ERIC Educational Resources Information Center

Brown, Samuel D.; Hallam, Pamela R.; Hite, Steven J.; Hite, Julie M.

2016-01-01

This study examined "propensity to trust" of students studying at a foreign university. Responses were collected from 576 international students from 71 countries attending a large private institution of higher education in the Midwestern United States. Findings indicated that students who were not native speakers of the dominant…

Thirteen proves lucky number at Ipswich.

PubMed

Coppard, Mark

2008-10-01

At one of East Anglia's largest hospitals, OCS Healthcare claims to have contributed to a "remarkable climate of change" with 13 specialist services, bringing tangible benefits to the half million people served by The Ipswich Hospital NHS Trust. The head of OCS Healthcare, Mark Coppard, describes what the company dubs an "exemplar of private sector expertise supporting public healthcare excellence".

The financial status of Medicare.

PubMed Central

Foster, R S

1998-01-01

Medicare is the largest health care program in the country, providing medical care to 38 million aged and disabled Americans. Concerns over rapid cost increases and the imminent insolvency of the Medicare Hospital Insurance trust fund led to enactment of sweeping Medicare legislation as part of the Balanced Budget Act of 1997. Preliminary estimates indicate that this legislation will result in program savings of $150 billion in the first five years and will postpone the depletion of the Hospital Insurance fund from the year 2001 until about 2010. While the Balanced Budget Act significantly reduces Hospital Insurance expenditure in the long range, serious deficits are still expected when the "baby boom" generation reaches retirement. The Medicare Supplementary Medical Insurance trust fund is automatically in financial balance, but policy makers remain concerned about continuing rapid cost increases. A new National Bipartisan Commission on the Future of Medicare will attempt to determine effective solutions to these long-range problems. Images p110-a p111-a p111-b PMID:9719810

Improving Access to, Use of, and Outcomes from Public Health Programs: The Importance of Building and Maintaining Trust with Patients/Clients.

PubMed

Ward, Paul Russell

2017-01-01

The central argument in this paper is that "public trust" is critical for developing and maintaining the health and wellbeing of individuals, communities, and societies. I argue that public health practitioners and policy makers need to take "public trust" seriously if they intend to improve both the public's health and the engagement between members of the public and public health systems. Public health practitioners implement a range of services and interventions aimed at improving health but implicit a requirement for individuals to trust the practitioners and the services/interventions, before they engage with them. I then go on to provide an overview of the theory of trust within sociology and show why it is important to understand this theory in order to promote trust in public health services. I then draw on literature in three classic areas of public health-hospitals, cancer screening, and childhood immunization-to show why trust is vital in terms of understanding and potentially improving uptake of services. The case studies in this paper reveal that public health practitioners need to understand the centrality of building and maintaining trusting relationships with patients/clients because people who distrust public health services are less likely to use them, less likely to follow advice or recommendations, and more likely to have poorer health outcomes.

How and Why the University of California Got Its Autonomy. Research & Occasional Paper Series: CSHE.4.15

ERIC Educational Resources Information Center

Douglass, John Aubrey

2015-01-01

The University of California became a "public trust" in 1879 as part of a larger revision of California's Constitution approved by California voters. The University henceforth gained the exclusive power to operate, control, and administer the University of California, becoming virtually a fourth branch of state government, a…

Investigating the association of alerts from a national mortality surveillance system with subsequent hospital mortality in England: an interrupted time series analysis.

PubMed

Cecil, Elizabeth; Bottle, Alex; Esmail, Aneez; Wilkinson, Samantha; Vincent, Charles; Aylin, Paul P

2018-05-04

To investigate the association between alerts from a national hospital mortality surveillance system and subsequent trends in relative risk of mortality. There is increasing interest in performance monitoring in the NHS. Since 2007, Imperial College London has generated monthly mortality alerts, based on statistical process control charts and using routinely collected hospital administrative data, for all English acute NHS hospital trusts. The impact of this system has not yet been studied. We investigated alerts sent to Acute National Health Service hospital trusts in England in 2011-2013. We examined risk-adjusted mortality (relative risk) for all monitored diagnosis and procedure groups at a hospital trust level for 12 months prior to an alert and 23 months post alert. We used an interrupted time series design with a 9-month lag to estimate a trend prior to a mortality alert and the change in trend after, using generalised estimating equations. On average there was a 5% monthly increase in relative risk of mortality during the 12 months prior to an alert (95% CI 4% to 5%). Mortality risk fell, on average by 61% (95% CI 56% to 65%), during the 9-month period immediately following an alert, then levelled to a slow decline, reaching on average the level of expected mortality within 18 months of the alert. Our results suggest an association between an alert notification and a reduction in the risk of mortality, although with less lag time than expected. It is difficult to determine any causal association. A proportion of alerts may be triggered by random variation alone and subsequent falls could simply reflect regression to the mean. Findings could also indicate that some hospitals are monitoring their own mortality statistics or other performance information, taking action prior to alert notification. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Autonomy, Trust, and Respect.

PubMed

Nys, Thomas

2016-02-01

This article seeks to explore and analyze the relationship between autonomy and trust, and to show how these findings could be relevant to medical ethics. First, I will argue that the way in which so-called "relational autonomy theories" tie the notions of autonomy and trust together is not entirely satisfying Then, I will introduce the so-called Encapsulated Interest Account as developed by Russell Hardin. This will bring out the importance of the reasons for trust. What good reasons do we have for trusting someone? I will criticize Hardin's business model as insufficiently robust, especially in the context of health care, and then turn to another source of trust, namely, love. It may seem that trust-through-love is much better suited for the vulnerability that is often involved in health care, but I will also show that it has its own deficiencies. Good health care should therefore pay attention to both models of trust, and I will offer some tentative remarks on how to do this. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Chinese community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system

PubMed Central

2013-01-01

Background Although the Chinese government put a lot of effort into promoting the community patient’s life satisfaction, there still lacked the holistic and systematic approaches to promote the community patient’s life satisfaction in various regions of China. On the basis of the literature, it was found that both the community patient’s assessment of community medical service and trust in community health delivery system were important considerations when the community patient comprehensively evaluated community medical service to generate life satisfaction. So this study was set up to test whether and to what extent the community patient’s assessments of various major aspects of community medical service/various major aspects of the community patient’s trust in community health delivery system influenced life satisfaction in whole China/in various regions of China. Methods In order to explore the situation of China’s community health delivery system before 2009 and provide a reference for China’s community health delivery system reform, the data that could comprehensively and accurately reflect the community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system in various regions of China was needed, so this study collaborated with the National Bureau of Statistics of China to carry out a large-scale 2008 national community resident household survey (N = 3,306) for the first time in China. And the specified ordered probit models were established to analyze the dataset from this household survey. Results Among major aspects of community medical service, the medical cost (particularly in developed regions), the doctor-patient communication (particularly in developed regions), the medical facility and hospital environment (particularly in developed regions), and the medical treatment process (particularly in underdeveloped regions) were all key considerations (p<0.05 for t statistics) in generating the community patient’s life satisfaction. Among major aspects of the community patient’s trust in community health delivery system, trust in doctor (particularly in underdeveloped regions), trust in prescription (particularly in underdeveloped regions), and trust in recommended medical examination (particularly in underdeveloped regions) were all important considerations (p<0.10 for t statistics) in generating the community patient’s life satisfaction. Conclusion The reduction of medical cost (particularly in developed regions), the improvement of doctor-patient communication (particularly in developed regions), the promotion of medical facility and hospital environment (particularly in developed regions), the improvement of medical treatment process (particularly in underdeveloped regions), the promotion of trust in doctor (particularly in underdeveloped regions), the promotion of trust in prescription (particularly in underdeveloped regions), and the promotion of trust in recommended medical examination (particularly in underdeveloped regions) could help promote the community patient’s life satisfaction. PMID:23406216

Making Me Feel Comfortable: Developing Trust in the Nurse for Mexican Americans.

PubMed

Jones, Sharon M

2015-11-01

Trust (confianza) is an important component of patient-centered care and culturally competent care and a major element in the Hispanic culture. The aim of this study was to conceptualize the process of the development of interpersonal trust by hospitalized patients in their nurses. Using the grounded theory method, English-speaking Mexican American patients (N = 22) were interviewed. The core category was Making Me Feel Comfortable. The cyclical process included a beginning stage (Having Needs, Relying on the Nurse), middle stage (Coming Across to Me, Taking Care of Me, Connecting), and end point (Feeling Confianza) with two outcomes (Confiding in the Nurse, Taking Away the Negative). Anytime there was a negative element during the middle stage, this element halted any further development of trust with the nurse. Unique findings were related to Hispanic cultural values of familism and personalismo. The findings have implications which impact patient safety and quality care. © The Author(s) 2014.

Predictors of Maternal Trust in Doctors About Advice on Infant Care Practices: The SAFE Study.

PubMed

Hwang, Sunah S; Rybin, Denis V; Kerr, Stephen M; Heeren, Timothy C; Colson, Eve R; Corwin, Michael J

To determine predictors of maternal trust in doctors about advice on infant care practices. Using probability sampling methods, we recruited mothers from 32 US maternity hospitals. Mothers completed a survey 2 to 6 months postpartum that included questions about maternal trust in doctors regarding 6 infant care practices and physician characteristics (doctor asked mother's opinion, doctor is qualified, infant sees 1 main doctor who is/is not of the same ethnicity/race). Prevalence estimates and 95% confidence intervals were calculated for maternal trust in physician advice for each infant care practice. Multivariate logistic regression was used to calculate the independent association of maternal and physician characteristics and trust for each infant care practice, controlling for sociodemographic characteristics. Of the 3983 mothers enrolled from January 2011 to March 2014, 3297 (83%) completed the follow-up survey. Maternal trust in the doctor varied according to infant care practice with highest trust for vaccination (89%) and lowest trust for pacifier use (56%). In the adjusted analyses, for all infant care practices, mothers were more likely to trust their doctors if they reported that the doctors were qualified (adjusted odds ratio [AOR], >3.0 for all practices) or if the doctor had asked their opinion (AOR, 1.76-2.43). For mothers who reported seeing 1 main doctor, white mothers were more likely to trust physicians for almost all infant care practices if they reported the doctor was the same race (AOR, 1.54-2.19). Physician characteristics and ways of communication were significantly associated with maternal trust in doctors about advice on infant care practices. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

A trust-based recommendation method using network diffusion processes

NASA Astrophysics Data System (ADS)

Chen, Ling-Jiao; Gao, Jian

2018-09-01

A variety of rating-based recommendation methods have been extensively studied including the well-known collaborative filtering approaches and some network diffusion-based methods, however, social trust relations are not sufficiently considered when making recommendations. In this paper, we contribute to the literature by proposing a trust-based recommendation method, named CosRA+T, after integrating the information of trust relations into the resource-redistribution process. Specifically, a tunable parameter is used to scale the resources received by trusted users before the redistribution back to the objects. Interestingly, we find an optimal scaling parameter for the proposed CosRA+T method to achieve its best recommendation accuracy, and the optimal value seems to be universal under several evaluation metrics across different datasets. Moreover, results of extensive experiments on the two real-world rating datasets with trust relations, Epinions and FriendFeed, suggest that CosRA+T has a remarkable improvement in overall accuracy, diversity and novelty. Our work takes a step towards designing better recommendation algorithms by employing multiple resources of social network information.

Hospitals Known for Nursing Excellence Associated with Better Hospital Experience for Patients.

PubMed

Stimpfel, Amy Witkoski; Sloane, Douglas M; McHugh, Matthew D; Aiken, Linda H

2016-06-01

To examine the relationship between Magnet recognition, an indicator of nursing excellence, and patients' experience with their hospitalization reported in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This secondary analysis includes cross-sectional data from the 2010 HCAHPS survey, the American Hospital Association, and the American Nurses Credentialing Center. We conducted a retrospective observational study. Using common hospital identifiers, we created a matched set of 212 Magnet hospitals and 212 non-Magnet hospitals. Patients in Magnet hospitals gave their hospitals higher overall ratings, were more likely to recommend their hospital, and reported more positive care experiences with nurse communication. Magnet recognition is associated with better patient care experiences, which may positively enhance reimbursement for hospitals. © Health Research and Educational Trust.

The Guy’s and St Thomas’s NHS Foundation Trust @home service: an overview of a new service

PubMed Central

Lee, Geraldine A.; Titchener, Karen

2017-01-01

Hospital in the home is a relatively new concept within the UK healthcare system. The Guy’s and St Thomas’s NHS Foundation Trust (GSTT) @home service ‘Bringing hospital care to your home’ was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients’ place of residence by facilitating rapid discharge from hospital. The service is designed for 260–280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health. The main criteria for referrals are adults, living within Lambeth or Southwark with an acute onset of illness often with acute exacerbations of chronic conditions. Care is delivered using 25 clinical pathways using integrated care teams, including those for respiratory disease, heart failure and palliative care services. Recently, the service extended to include overnight palliative care. As care shifts from hospital to the community, it is envisaged that these types of programmes will become an essential component of care provision. This paper describes the service and presents initial service evaluation data. PMID:28356923

The Guy's and St Thomas's NHS Foundation Trust @home service: an overview of a new service.

PubMed

Lee, Geraldine A; Titchener, Karen

2017-03-01

Hospital in the home is a relatively new concept within the UK healthcare system. The Guy's and St Thomas's NHS Foundation Trust (GSTT) @home service 'Bringing hospital care to your home' was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients' place of residence by facilitating rapid discharge from hospital. The service is designed for 260-280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health. The main criteria for referrals are adults, living within Lambeth or Southwark with an acute onset of illness often with acute exacerbations of chronic conditions. Care is delivered using 25 clinical pathways using integrated care teams, including those for respiratory disease, heart failure and palliative care services. Recently, the service extended to include overnight palliative care. As care shifts from hospital to the community, it is envisaged that these types of programmes will become an essential component of care provision. This paper describes the service and presents initial service evaluation data.

Academic disidentification in Black college students: The role of teacher trust and gender.

PubMed

McClain, Shannon; Cokley, Kevin

2017-01-01

Research has identified academic disidentification as a phenomenon that appears to uniquely impact Black male students. However, few empirical studies examine what underlies such gender differences. This study examined whether students' teacher trust is a factor underlying academic disidentification in Black college students and whether this is moderated by gender. Academic disidentification was investigated by examining the strength of the relation between a student's view of his or her academic abilities in comparison to peers (i.e., academic self-concept [ASC]) and the student's academic outcomes (i.e., grade point average [GPA]). Attribution theory was used as a lens to test a hypothesized multigroup path model that linked age to teacher trust and ASC, and ASC to GPA through teacher trust. Alternative models were also tested. Participants were 319 Black students (120 males and 199 females) recruited from a large, southwestern, predominantly White university. Results revealed the hypothesized model fit the data reasonably well, whereas the alternative models resulted in a poorer fit. The final model supported our hypothesis that the relation between ASC and GPA is partially mediated by teacher trust and this relation was moderated by gender, such that the indirect effect was significantly stronger for males than females. Several significant differences were also found across gender for direct paths. These findings suggest college students' trust of faculty may be particularly important for Black males and is likely a contributing factor to academic disidentification. Practical implications for university professionals' facilitation of Black college students' academic development are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

An educational conference in a general hospital.

PubMed

Caldwell, Gordon

2011-12-01

Western Sussex Hospitals National Health Service (NHS) Trust comprises the District General Hospitals of Worthing and Chichester. Both hospitals have successful postgraduate medical education centres, providing training for junior doctors and continuing professional development for senior doctors. Until now, there have been limited multi-professional teaching and learning activities available. The two hospitals have recently merged. The education executive felt that workplace learning had become undervalued since the implementation of Modernising Medical Careers in the UK. The executive wanted to provide a multi-professional conference on Workplace Learning, both to support the merger and to promote the value of workplace and multi-professional learning. The conference topic covering the 'how' of workplace learning was innovative. Many educational conferences concentrate on the organisation and evaluation of classroom learning, rather than on how learning can be facilitated in the workplace during ordinary working practice. It was also innovative to ensure that the presenters were representative of the multi-professional workforce. The presentations were limited to 8 minutes each to promote high-impact short presentations. The talks were recorded for publishing on the trust's intranet and the internet. A committed team in a district general hospital can provide a high-quality educational conference with wide appeal. Local health care professionals can produce short high-impact presentations. The use of modern information technology and audio-visual systems can make the presentations available to both local and worldwide audiences. © Blackwell Publishing Ltd 2011.

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

PubMed

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

Managed competition that works.

PubMed

Caper, P

1993-05-19

President Clinton has advocated managed competition within a global budget as a long-term strategy for simultaneously controlling health care costs and expanding access to medical care to all Americans. This proposal is intended to show how these two seemingly conflicting goals can be simultaneously accomplished. Managed competition, as it has been conceptualized to date, is primarily a strategy for reforming the system of providing health services. To work, it must be joined with a strategy for reforming our system of financing and paying for those services and of limiting overall system capacity. "Managed Competition That Works" is a proposal that would create a single trust-funded national system of health insurance, implemented through a system of vouchers to individuals. Global budgeting would be accomplished through establishment of the voucher's value each year. The trust fund would pay health plans for all medical care by capitation, but health plans would be free to negotiate a variety of payment arrangements with physicians, hospitals, and other providers. All plans would be required to offer a standard package of benefits, but would have great flexibility in offering benefits beyond the scope of the standard package, if those benefits replace high-cost with lower-cost services or permit the plan to compete more effectively for market share. This proposal would establish firm but acceptable national budget limits; provide universal, comprehensive, and uniform insurance coverage; eliminate cost shifting; encourage competition; reward efficiency-improving innovation; greatly reduce the need for centralized micromanagement of medical care; and retain local determination and a somewhat reduced level of consumer choice. Although this proposal is written as a national plan, trust funds could be implemented at the state level, if problems associated with portability of benefits among states could be solved.

Factors that influence patient response to requests to change to a unified restrictive formulary.

PubMed

Smetana, Gerald W; Davis, Roger B; Phillips, Russell S

2004-12-01

To determine factors that influence patient willingness to accept a medication change to a unified, restrictive formulary. Prospective cohort study. University-affiliated hospital-based primary care internal medicine practice. Two hundred ninety-seven members of a managed care plan who had received a prescription for a nonformulary medication in the previous 4 months and whose primary care physician approved a conversion to a formulary medication. Clinical nurses invited patients to change to a formulary medication at the time of a telephone refill request based on a standard script. The overall conversion rate to the formulary medication was 59.8%. Seventy-four percent of patients who requested a refill by telephone converted to the formulary (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.02 to 4.72). Patient age (OR, 1.03; CI, 1.01 to 1.05) and male gender (OR, 2.00; CI, 1.09 to 3.67) were each significant correlates of conversion. After adjustment in a multivariable model, only telephone refill request (adjusted OR, 2.31; CI, 1.07 to 4.97) and age (adjusted OR, 1.03; CI, 1.01 to 1.06) remained significant. Among the patients who made a telephone refill request, those who converted were more likely to completely trust their physician's judgment (P=.04) and to trust their physician to put their health over cost concerns (P=.05). Formulary conversion reduced costs beginning 3 months after the conversion date. A protocol for encouraging conversion to a unified formulary at the point of a telephone refill request increases formulary compliance rates and reduces medication costs. Patients who decline to convert medications are less likely to trust their physician.

Incidence rates of hospital-acquired urinary tract and bloodstream infections generated by automated compilation of electronically available healthcare data.

PubMed

Redder, J D; Leth, R A; Møller, J K

2015-11-01

Monitoring of hospital-acquired infection (HAI) by automated compilation of registry data may address the disadvantages of laborious, costly and potentially subjective and often random sampling of data by manual surveillance. To evaluate a system for automated monitoring of hospital-acquired urinary tract (HA-UTI) and bloodstream infections (HA-BSI) and to report incidence rates over a five-year period in a Danish hospital trust. Based primarily on electronically available data relating to microbiology results and antibiotic prescriptions, the automated monitoring of HA-UTIs and HA-BSIs was validated against data from six previous point-prevalence surveys (PPS) from 2010 to 2013 and data from a manual assessment (HA-UTI only) of one department of internal medicine from January 2010. Incidence rates (infections per 1000 bed-days) from 2010 to 2014 were calculated. Compared with the PPSs, the automated monitoring showed a sensitivity of 88% in detecting UTI in general, 78% in detecting HA-UTI, and 100% in detecting BSI in general. The monthly incidence rates varied between 4.14 and 6.61 per 1000 bed-days for HA-UTI and between 0.09 and 1.25 per 1000 bed-days for HA-BSI. Replacing PPSs with automated monitoring of HAIs may provide better and more objective data and constitute a promising foundation for individual patient risk analyses and epidemiological studies. Automated monitoring may be universally applicable in hospitals with electronic databases comprising microbiological findings, admission data, and antibiotic prescriptions. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Extent and Distribution of Old Forest Conditions on DNR-Managed State Trust Lands in Eastern Washington

Treesearch

Jerry F. Franklin; Miles Hemstrom; Robert Van Pelt; Joe Buchanan; Sabra Hull; Rex Crawford; Steve Curry; Walt Obermeyer

2007-01-01

An inventory was conducted of old forests on state trust lands in Eastern Washington managed by the Washington State Department of Natural Resources (DNR), in response to legislative direction (ESSB 6384, Section 189,2006). This inventory was conducted with guidance from an independent science panel, chaired by Jerry Franklin of the University of Washington. As...

Forging a new legacy of trust in research with Alaska Native college students using CBPR.

PubMed

Lopez, Ellen D S; Sharma, Dinghy Kristine B; Mekiana, Deborah; Ctibor, Alaina

2012-01-01

Disparities in the rates of matriculation and graduation are of concern to Alaska Native (AN) students and the universities committed to their academic success. Efforts to reduce attrition require a keen understanding of the factors that impact quality of life (QOL) at college. Yet, a long-standing legacy of mistrust towards research poses challenges to conducting inquiry among AN students. We introduced a partnership between the University of Alaska Fairbank's Rural Student Services (RSS) and the Center for Alaska Native Health Research (CANHR) within which we conducted the "What makes life good?" study aimed towards developing a QOL measure for AN students. Equally important was building a legacy of research trust among AN partners. We describe Phase I of a 2-phase study that employed a sequential mixed methods approach. Discussed are facilitators, challenges and lessons learned while striving to adhere to the principles of community-based participatory research (CBPR). Phase I included formative focus groups and QOL measurement development. The research involved the interplay among activities that were co-developed with the goal of enhancing trust and research capacity. Emphasis was placed on ensuring that data collection and analyses were student driven. All partners resided at the same university. However, trust and collaboration could not be assumed. Working within a collaborative framework, our partnership achieved the aim of developing a culturally informed QOL measure, while also creating an empowering experience for all partners who became co-investigators in a process that might normally be regarded with mistrust.

Implementing new care models: learning from the Greater Manchester demonstrator pilot experience.

PubMed

Elvey, Rebecca; Bailey, Simon; Checkland, Kath; McBride, Anne; Parkin, Stephen; Rothwell, Katy; Hodgson, Damian

2018-06-19

Current health policy focuses on improving accessibility, increasing integration and shifting resources from hospitals to community and primary care. Initiatives aimed at achieving these policy aims have supported the implementation of various 'new models of care', including general practice offering 'additional availability' appointments during evenings and at weekends. In Greater Manchester, six 'demonstrator sites' were funded: four sites delivered additional availability appointments, other services included case management and rapid response. The aim of this paper is to explore the factors influencing the implementation of services within a programme designed to improve access to primary care. The paper consists of a qualitative process evaluation undertaken within provider organisations, including general practices, hospitals and care homes. Semi-structured interviews, with the data subjected to thematic analysis. Ninety-one people participated in interviews. Six key factors were identified as important for the establishment and running of the demonstrators: information technology; information governance; workforce and organisational development; communications and engagement; supporting infrastructure; federations and alliances. These factors brought to light challenges in the attempt to provide new or modify existing services. Underpinning all factors was the issue of trust; there was consensus amongst our participants that trusting relationships, particularly between general practices, were vital for collaboration. It was also crucial that general practices trusted in the integrity of anyone external who was to work with the practice, particularly if they were to access data on the practice computer system. A dialogical approach was required, which enabled staff to see themselves as active rather than passive participants. The research highlights various challenges presented by the context within which extended access is implemented. Trust was the fundamental underlying issue; there was consensus amongst participants that trusting relationships were vital for effective collaboration in primary care.

Students' trust judgements in online health information seeking.

PubMed

Rowley, Jennifer; Johnson, Frances; Sbaffi, Laura

2015-12-01

As one of the most active groups of Internet users, students and other young people are active users of digital health information. Yet, research into young people's evaluation of health information is limited, and no previous studies have focused on trust formation. In addition, prior studies on adults' use of digital information do not reach a consensus regarding the key factors in trust formation. This study seeks to address this gap. A questionnaire-based survey was used to collect data from undergraduate students studying a variety of disciplines in one UK university. The Trust in Online Health Information Scale is proposed, and it includes the following dimensions: authority, style, content, usefulness, brand, ease of use, recommendation, credibility, and verification. In addition, inspection of responses to specific items/questions provides further insights into aspects of the information that were of specific importance in influencing trust judgements. © The Author(s) 2014.

A pragmatic observational feasibility study on integrated treatment for musculoskeletal disorders: Design and protocol.

PubMed

Hu, Xiao-yang; Hughes, John; Fisher, Peter; Lorenc, Ava; Purtell, Rachel; Park, A-La; Robinson, Nicola

2016-02-01

Musculoskeletal disorders (MSD) comprise a wide range of conditions, associated with an enormous pain and impaired mobility, and are affecting people's lives and work. Management of musculoskeletal disorders typically involves a multidisciplinary team approach. Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies, though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service (NHS) setting. To determine the feasibility of all aspects of a pragmatic observational study designed: (1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK; (2) to determine the acceptability of the study design and research process to patients; (3) to explore patients' expectation and experience of receiving integrated treatments. This is an observational feasibility study, with 1-year recruitment and 1-year follow-up, conducted in Royal London Hospital for Integrated Medicine, University College London Hospital Trust, UK. All eligible patients with MSDs newly referred to the hospital were included in the study. Interventions are integrated packages of care (conventional and complementary) as currently provided in the hospital. SF-36™ Health Survey, short form Brief Pain Inventory, Visual Analogue Scale, and modified Client Service Receipt Inventory will be assessed at 4/5 time points. Semi-structured interview/focus group will be carried out before treatment, and 1 year after commence of treatment. We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital. It will inform the design of a future trial including recruitment, retention, suitability of the outcome measures and patients experiences.

Daily remote monitoring of implantable cardioverter-defibrillators: insights from the pooled patient-level data from three randomized controlled trials (IN-TIME, ECOST, TRUST).

PubMed

Hindricks, Gerhard; Varma, Niraj; Kacet, Salem; Lewalter, Thorsten; Søgaard, Peter; Guédon-Moreau, Laurence; Proff, Jochen; Gerds, Thomas A; Anker, Stefan D; Torp-Pedersen, Christian

2017-06-07

Remote monitoring of implantable cardioverter-defibrillators may improve clinical outcome. A recent meta-analysis of three randomized controlled trials (TRUST, ECOST, IN-TIME) using a specific remote monitoring system with daily transmissions [Biotronik Home Monitoring (HM)] demonstrated improved survival. We performed a patient-level analysis to verify this result with appropriate time-to-event statistics and to investigate further clinical endpoints. Individual data of the TRUST, ECOST, and IN-TIME patients were pooled to calculate absolute risks of endpoints at 1-year follow-up for HM vs. conventional follow-up. All-cause mortality analysis involved all three trials (2405 patients). Other endpoints involved two trials, ECOST and IN-TIME (1078 patients), in which an independent blinded endpoint committee adjudicated the underlying causes of hospitalizations and deaths. The absolute risk of death at 1 year was reduced by 1.9% in the HM group (95% CI: 0.1-3.8%; P = 0.037), equivalent to a risk ratio of 0.62. Also the combined endpoint of all-cause mortality or hospitalization for worsening heart failure (WHF) was significantly reduced (by 5.6%; P = 0.007; risk ratio 0.64). The composite endpoint of all-cause mortality or cardiovascular (CV) hospitalization tended to be reduced by a similar degree (4.1%; P = 0.13; risk ratio 0.85) but without statistical significance. In a pooled analysis of the three trials, HM reduced all-cause mortality and the composite endpoint of all-cause mortality or WHF hospitalization. The similar magnitudes of absolute risk reductions for WHF and CV endpoints suggest that the benefit of HM is driven by the prevention of heart failure exacerbation.

Modernising patient clothing: a Florence Nightingale Foundation project.

PubMed

Fitzgerald, Christine

2017-04-27

Christine Fitzgerald, Matron at The Hillingdon Hospitals NHS Foundation Trust (currently on secondment) discusses a project to boost patient self-esteem and dignity through the clothing provided for them to wear.

Developing from within: ensuring the ambulatory emergency care workforce is fit for purpose.

PubMed

Thurgate, Claire; Holmes, Sue

2015-11-01

Emergency healthcare provision is changing, and services need to respond to evolving health economies while providing safe, effective, patient-centred care. Ambulatory care is developing to meet these needs, but workforce planners need to ensure that staff are fit for purpose. To address this, one trust, in partnership with a local university, designed a bespoke in-house, work-based learning package on ambulatory care, which was delivered to registered nurses by practice experts. This article describes the project and discusses the evaluation, which highlighted the benefits of this way of learning for the nurses, the trust and the university, and identified some areas that require development.

Academic Assets: University Fundraising--An Update

ERIC Educational Resources Information Center

Sutton Trust, 2014

2014-01-01

This report compares the fundraising activities of universities in the United Kingdom and the United States--continuing on from two previous Sutton Trust reports published in 2003 and 2006--and looks at the extent of fundraising and the size of endowment funds held by individual universities on both sides of the Atlantic. Key findings in this…

Evaluating Respondent-Driven Sampling as an Implementation Tool For Universal Coverage of Antiretroviral Studies among Men who have Sex with Men Living with HIV

PubMed Central

Baral, Stefan D.; Ketende, Sosthenes; Schwartz, Sheree; Orazulike, Ifeanyi; Ugoh, Kelechi; Peel, Sheila; Ake, Julie; Blattner, William; Charurat, Manhattan

2015-01-01

Introduction The TRUST model based on experimental and observational data posits that integration of HIV prevention and universal coverage of antiretroviral treatment (UCT) at a trusted community venue provides a framework for achieving effective reduction in HIV-related morbidity and mortality among men who have sex with men (MSM) living with HIV as well as reducing HIV incidence. The analyses presented here evaluate the utility of respondent-driven sampling (RDS) as an implementation tool for engaging MSM in the TRUST intervention. Methods The TRUST integrated prevention and treatment model was established at a trusted community center serving MSM in Abuja Nigeria. Five seeds have resulted in 3–26 waves of accrual between March, 2013 and August, 2014 with results presented here characterizing HIV burden and engagement in HIV care for 722 men across study recruitment waves. For analytic purposes, the waves were collapsed into five groups; four equally spaced (0–4, 5–9, 10–14, 15–19) and one ranging from the 20 to the 26th wave with significance assessed using Pearson’s chi-squared test. Results In earlier waves, MSM were more likely to have reported testing for HIV (82.9% in waves 0–4, 47.7% in waves 20–26, p<0.01). In addition, biologically-confirmed HIV prevalence decreased from an average of 59.1 to 42.9% (p<0.05) in later waves. In earlier waves, about 80% of participants correctly reported their HIV status as compared to less than 25% in the later waves (p<0.01). Lastly, participants reporting being on ART decreased from 50% to 22.2 % in later waves (p<0.01). Conclusions Implementation science studies focused on demonstrating impact of universal HIV-treatment programs among people living with HIV necessitate different accrual methods than those focused on preventing HIV acquisition. Here, RDS was shown to be an efficient method for reaching marginalized populations of MSM living with HIV in Nigeria and engaging them in universal HIV treatment services. PMID:25723974

Evaluating respondent-driven sampling as an implementation tool for universal coverage of antiretroviral studies among men who have sex with men living with HIV.

PubMed

Baral, Stefan D; Ketende, Sosthenes; Schwartz, Sheree; Orazulike, Ifeanyi; Ugoh, Kelechi; Peel, Sheila A; Ake, Julie; Blattner, William; Charurat, Manhattan

2015-03-01

The TRUST model based on experimental and observational data posits that integration of HIV prevention and universal coverage of antiretroviral treatment at a trusted community venue provides a framework for achieving effective reduction in HIV-related morbidity and mortality among men who have sex with men (MSM) living with HIV, as well as reducing HIV incidence. The analyses presented here evaluate the utility of respondent-driven sampling as an implementation tool for engaging MSM in the TRUST intervention. The TRUST integrated prevention and treatment model was established at a trusted community center serving MSM in Abuja, Nigeria. Five seeds have resulted in 3-26 waves of accrual between March 2013 and August 2014, with results presented here characterizing HIV burden and engagement in HIV care for 722 men across study recruitment waves. For analytic purposes, the waves were collapsed into 5 groups: 4 equally spaced (0-4, 5-9, 10-14, and 15-19) and 1 ranging from the 20th to the 26th wave with significance assessed using Pearson χ2 test. In earlier waves, MSM were more likely to have reported testing for HIV (82.9% in waves 0-4, 47.7% in waves 20-26; P < 0.01). In addition, biologically confirmed HIV prevalence decreased from an average of 59.1% to 42.9% (P < 0.05) in later waves. In earlier waves, about 80% of participants correctly reported their HIV status as compared with less than 25% in the later waves (P < 0.01). Finally, participants reporting being on ART decreased from 50% to 22.2% in later waves (P < 0.01). Implementation science studies focused on demonstrating impact of universal HIV treatment programs among people living with HIV necessitate different accrual methods than those focused on preventing HIV acquisition. Here, respondent-driven sampling was shown to be an efficient method for reaching marginalized populations of MSM living with HIV in Nigeria, and engaging them in universal HIV treatment services.

The Canterbury Charity Hospital: an update (2010-2012) and effects of the earthquakes.

PubMed

Bagshaw, Philip F; Maimbo-M'siska, Miriam; Nicholls, M Gary; Shaw, Carl G; Allardyce, Randall A; Bagshaw, Susan N; McNabb, Angela L; Johnson, Stuart S; Frampton, Christopher M; Stokes, Brian W

2013-11-22

To update activities of the Canterbury Charity Hospital (CCH) and its Trust over the 3 years 2010-2012, during which the devastating Christchurch earthquakes occurred. Patients' treatments, establishment of new services, expansion of the CCH, staffing and finances were reviewed. Previously established services including general surgery continued as before, some services such as ophthalmology declined, and new services were established including colonoscopy, dentistry and some gynaecological procedures; counselling was provided following the earthquakes. Teaching and research endeavours increased. An adjacent property was purchased and renovated to accommodate the expansion. The Trust became financially self-sustaining in 2010; annual running costs of $340,000/year were maintained but were anticipated to increase soon. Of the money generously donated by the community to the Trust, 82% went directly to patient care. Although not formally recorded, hundreds of appointment request were rejected because of service unavailability or unmet referral criteria. This 3-year review highlights substantial, undocumented unmet healthcare needs in the region, which were exacerbated by the 2010/2011 earthquakes. We contend that the level of unmet healthcare in Canterbury and throughout the country should be regularly documented to inform planning of public healthcare services.

Three-year audit and cost assessment of open abdominal aortic aneurysm repair in a district general hospital.

PubMed

El Kafsi, J; Wake, J; Lintott, P; Northeast, A; McLaren, A

2009-11-01

The aims of this study were to audit the outcome of elective open abdominal aortic aneurysm (AAA) repair in a district general hospital, as well as investigate the true costs for this procedure in relation to the national tariff. A database is maintained on AAA surgery in the trust. Data were supplemented by drawing information from blood bank and clinical notes. Patients with symptomatic or emergency aneurysms were excluded. Data from January 2005 to December 2007 were obtained on demographics, morbidity, 30-day mortality and blood usage. Costs were obtained from the trust finance department. Between January 2005 and December 2007, 79 elective AAA procedures were undertaken. Median age was 75 years (range, 52-85 years), median aneurysm size was 63 mm (range, 42-105 mm) and median ITU stay was 3 days (range, 1-41 days). Major morbidity rate was 20.3% (16 of 79 patients) and 30-day mortality overall was 5.1% (4 of 79 patients). Average cost per case was pound15,012.91 (range, pound4,040.03- pound82,158.00), when National Tariff is pound6,722.00 ( pound5,649.00 x local Market Forces Factor of 1.19). Loss per case for our trust was pound8,290.91 with a total annual loss of pound218,299.56. Morbidity and mortality in this district general hospital compare well with national studies; however, the total cost is far in excess of the national tariff.

The American Hospital in Moscow: A Lesson in International Cooperation, 1917-23.

PubMed

Grant, Susan

2015-10-01

In its examination of American Medical Aid to Russia, this article shows how the best of intentions can have the potential to go horribly awry. It argues that the competing binary forces of international collaboration and goodwill versus political tensions and uncertainty combined to create an environment wherein actors and agents inhabited an ever changing and unpredictable international stage. Could American philanthropic organisations and individuals overcome political volatility, financial restrictions and ideological barriers? Just what would it take to establish an American hospital in Moscow, the Bolshevik seat of power? The attempt to establish the hospital proved to be an exercise in patience, persistence and prudence (although not always in equal measure). This article shows that international cooperation, while undoubtedly complicated, was certainly possible. The flow of information, materiel and personnel between the United States, Germany and Russia proved that good intentions, trust and a will to help others were valued. The history of American Medical Aid to Russia also demonstrates that the Quaker role of facilitator and interlocutor was vital in establishing a relationship of trust between Soviet Russia and the United States. This article discusses the difficulties that philanthropic organisations faced when navigating the choppy international waters of the early 1920s and highlights the rewards of successfully doing this. It argues that basic human relationships and trust were just as, if not sometimes more, important than ideology in determining the tenor of early US-Soviet relations.

The American Hospital in Moscow: A Lesson in International Cooperation, 1917–23

PubMed Central

Grant, Susan

2015-01-01

In its examination of American Medical Aid to Russia, this article shows how the best of intentions can have the potential to go horribly awry. It argues that the competing binary forces of international collaboration and goodwill versus political tensions and uncertainty combined to create an environment wherein actors and agents inhabited an ever changing and unpredictable international stage. Could American philanthropic organisations and individuals overcome political volatility, financial restrictions and ideological barriers? Just what would it take to establish an American hospital in Moscow, the Bolshevik seat of power? The attempt to establish the hospital proved to be an exercise in patience, persistence and prudence (although not always in equal measure). This article shows that international cooperation, while undoubtedly complicated, was certainly possible. The flow of information, materiel and personnel between the United States, Germany and Russia proved that good intentions, trust and a will to help others were valued. The history of American Medical Aid to Russia also demonstrates that the Quaker role of facilitator and interlocutor was vital in establishing a relationship of trust between Soviet Russia and the United States. This article discusses the difficulties that philanthropic organisations faced when navigating the choppy international waters of the early 1920s and highlights the rewards of successfully doing this. It argues that basic human relationships and trust were just as, if not sometimes more, important than ideology in determining the tenor of early US–Soviet relations. PMID:26352304

Application of teledentistry in oral medicine in a community dental service, N. Ireland.

PubMed

Bradley, M; Black, P; Noble, S; Thompson, R; Lamey, P J

2010-10-23

Currently, patients with oral medicine conditions from all areas of Northern Ireland are referred by dentists and doctors to a small number of specialist services: predominantly, the Regional Oral Medicine Consultant at the School of Dentistry, Belfast. On receipt of the referral the consultant makes an assessment of the urgency of the case and the patient is placed on a waiting list. Until the recent implementation of waiting list initiatives (Elective Access Protocol, Department of Health, N. Ireland, 2006), patients remained on the waiting list for long periods of time. Analysis of these patient profiles highlights that many need both multiple treatment and review appointments of their chronic conditions, and consequently remain in the hospital system for significant periods of time. This increases the waiting time for these services. The idea of using teledentistry to triage referrals, and its potential as a tool to support locally based treatment, poses an alternative approach to the management of oral medicine referrals. It may be of particular interest to practitioners in rural locations where distance from the regional centre is significant. In 2005, to test this theory, a prototype teledentistry system was set up as part of a service improvement scheme by the Community Dental Service of the Homefirst Legacy Trust (now Northern Trust) in partnership with the Oral Medicine Department at the School of Dentistry, Royal Group of Hospitals Legacy Trust (now Belfast Trust). This paper describes the feasibility study.

New Liberian President Seeks to Rehabilitate Country's Education System: Finding Teachers Still Country's Main Hurdle

ERIC Educational Resources Information Center

Powell, Tracie

2007-01-01

Troubled by the difficulties of training teachers in Liberia, President Ellen Johnson Sirleaf says she hopes to attract them from U.S. colleges and universities. Sirleaf envisions the Liberian Education Trust as a way to help repair a country devastated by two civil wars. The trust seeks to raise money so that the West African country can build 50…

The Influence of Social Support on the Prosocial Behavior of College Students: The Mediating Effect Based on Interpersonal Trust

ERIC Educational Resources Information Center

Guo, Yuan

2017-01-01

A sample of 720 college students from 10 different universities at the Guangzhou Higher Education Mega Center are investigated using the Social Support Scale, the Prosocial Behavior Scale, and the Interpersonal Trust Scale. Data are analyzed using SPSS20.0 and Amos7.0. Results show that the subjective support and support utilization of college…

TrustGuard: A Containment Architecture with Verified Output

DTIC Science & Technology

2017-01-01

that the TrustGuard system has minimal performance decline, despite restrictions such as high communication latency and limited available bandwidth...design are the availability of high bandwidth and low delays between the host and the monitoring chip. 3-D integration provides an alternate way of...TRUSTGUARD: A CONTAINMENT ARCHITECTURE WITH VERIFIED OUTPUT SOUMYADEEP GHOSH A DISSERTATION PRESENTED TO THE FACULTY OF PRINCETON UNIVERSITY IN

Universal Lessons Learned by a Gastroenterologist from a Deaf and Mute Patient: The Importance of Nonverbal Communication and Establishing Patient Rapport and Trust

ERIC Educational Resources Information Center

Cappel, Mitchell S.

2009-01-01

Deaf and mute patients may require minimal extra attention to establish trust and allay anxieties before minor medical maneuvers such as rectal examination. An "extreme" case is reported of the consequences from failure to accomplish this. A generally cooperative deaf and mute patient struggled and suffered a rectal tear and perforation during…

Social Networking Sites: College Students' Patterns of Use and Concerns for Privacy and Trust by Gender, Ethnicity, and Employment Status

ERIC Educational Resources Information Center

Kyei-Blankson, Lydia; Iyer, Kamakshi S.; Subramanian, Lavanya

2016-01-01

Social Networking Sites (SNSs) are web-based facilities that allow for social interaction, sharing, communication and collaboration in today's world. In the current study, patterns of use of social media among students at a public Midwestern university are examined. In addition, students were surveyed regarding concerns for privacy and trust and…

A Longitudinal Study of the Predictors of Perceived Procedural Justice in Australian University Staff.

PubMed

Pignata, Silvia; Winefield, Anthony H; Provis, Chris; Boyd, Carolyn M

2016-01-01

This study examined the factors that predict employees' perceptions of procedural justice in university settings. The paper also reviews the ethical aspects of justice and psychological contracts within employment relationships. The study examined the predictors of perceived procedural justice in a two-wave longitudinal sample of 945 employees from 13 universities by applying the Job Demands-Resources theoretical model of stress. The proposed predictors were classified into two categories: Job demands of work pressure and work-home conflict; and job resources of job security, autonomy, trust in senior management, and trust in supervisor. The predictor model also examined job satisfaction and affective organizational commitment, demographic (age, gender, tenure, role) and individual characteristics (negative affectivity, job involvement) as well as Time 1 (T1) perceptions of procedural justice to ensure that tests were rigorous. A series of hierarchical multiple regression analyses found that job satisfaction at T1 was the strongest predictor of perceived procedural justice at Time 2. Employees' trust in senior management, and their length of tenure also positively predicted justice perceptions. There were also differences between academic and non-academic staff groups, as non-academic employees' level of job satisfaction, trust in senior management, and their length of organizational tenure predicted procedural justice perceptions, whereas for academics, only job satisfaction predicted perceived justice. For the "all staff" category, job satisfaction was a dominant and enduring predictor of justice, and employees' trust in senior management also predicted justice. Results highlight the importance of workplace factors in enhancing fair procedures to encourage reciprocity from employees. As perceived procedural justice is also conceptually linked to the psychological contract between employees-employers, it is possible that employees' levels of job satisfaction and perceptions of trust in senior management, relative to other work attitudinal outcomes, may be more effective for improving the broader working environment, and promoting staff morale. This study adds to research on applied business ethics as it focuses on the ethical aspects of perceived procedural justice and highlights the importance of workplace factors in enhancing fair procedures in organizational policy to encourage reciprocity and promote healthy organizational environments.

A Longitudinal Study of the Predictors of Perceived Procedural Justice in Australian University Staff

PubMed Central

Pignata, Silvia; Winefield, Anthony H.; Provis, Chris; Boyd, Carolyn M.

2016-01-01

Purpose: This study examined the factors that predict employees' perceptions of procedural justice in university settings. The paper also reviews the ethical aspects of justice and psychological contracts within employment relationships. Design/Methodology/Approach: The study examined the predictors of perceived procedural justice in a two-wave longitudinal sample of 945 employees from 13 universities by applying the Job Demands-Resources theoretical model of stress. The proposed predictors were classified into two categories: Job demands of work pressure and work-home conflict; and job resources of job security, autonomy, trust in senior management, and trust in supervisor. The predictor model also examined job satisfaction and affective organizational commitment, demographic (age, gender, tenure, role) and individual characteristics (negative affectivity, job involvement) as well as Time 1 (T1) perceptions of procedural justice to ensure that tests were rigorous. Findings: A series of hierarchical multiple regression analyses found that job satisfaction at T1 was the strongest predictor of perceived procedural justice at Time 2. Employees' trust in senior management, and their length of tenure also positively predicted justice perceptions. There were also differences between academic and non-academic staff groups, as non-academic employees' level of job satisfaction, trust in senior management, and their length of organizational tenure predicted procedural justice perceptions, whereas for academics, only job satisfaction predicted perceived justice. For the “all staff” category, job satisfaction was a dominant and enduring predictor of justice, and employees' trust in senior management also predicted justice. Research limitations/implications: Results highlight the importance of workplace factors in enhancing fair procedures to encourage reciprocity from employees. As perceived procedural justice is also conceptually linked to the psychological contract between employees-employers, it is possible that employees' levels of job satisfaction and perceptions of trust in senior management, relative to other work attitudinal outcomes, may be more effective for improving the broader working environment, and promoting staff morale. Originality/value: This study adds to research on applied business ethics as it focuses on the ethical aspects of perceived procedural justice and highlights the importance of workplace factors in enhancing fair procedures in organizational policy to encourage reciprocity and promote healthy organizational environments. PMID:27610093

NHS Trusts' clinical research activity and overall CQC performance - Is there a correlation?

PubMed

Jonker, L; Fisher, S J

2015-11-01

Since the late 2000's, the creation of the National Institute for Health Research (NIHR) has transformed clinical research activity in the United Kingdom. This study sought to establish if there is a link between clinical research activity and overall NHS Trust performance. Retrospective cohort study. Data for NHS Trust performance were obtained from public databases, namely the Care Quality Commission (CQC) 2013 risk rating for overall performance, and 2012-13 NIHR records for clinical research activity. Applying Spearman's rank analysis, none of the Trust categories showed a correlation with CQC risk rating: small hospitals, r = -0.062 (P = 0.76; n = 27); medium, r = -0.224 (P = 0.13; n = 47); large, r = -0.008 (P = 0.96; n = 57); academic, r = -0.18 (P = 0.41; n = 24). Similar results were observed when CQC risk rating was compared with the number of different clinical research studies conducted per Trust. The degree of NIHR National Portfolio clinical research activity is not significantly related to CQC risk rating, used as an indicator of overall NHS Trust performance. Other studies have previously shown that increased research activity correlates with improved mortality rates, one component of CQC risk rating scores. Alternative tools may have to be explored to evaluate the impact of clinical research on NHS Trusts and its patients. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Effects of nurses' emotional intelligence on their organizational citizenship behavior, with mediating effects of leader trust and value congruence.

PubMed

Lim, So-Hee; Han, Sang-Sook; Joo, Yun-Su

2018-02-20

To investigate the causal relationship between nurses' emotional intelligence and their organizational citizenship behavior and the possible mediating effects of leader trust and value congruence. The participants were 348 nurses who were working in a general hospital in a metropolitan area. The data were collected from December 16, 2012 to February 20, 2013. The hypothetical model of emotional intelligence, organizational citizenship behavior, leader trust, and value congruence was fitted to the actual data via structural equation modeling. The leaders' emotional intelligence had a direct positive effect on leader trust and value congruence; however, the nurses' own emotional intelligence had a negative effect on these two variables. Furthermore, leader trust had a direct positive effect on organizational citizenship behavior; value congruence had no such relationship. The nurses' emotional intelligence had a partial, indirect effect on organizational citizenship behavior via leader trust. In a nursing organization, it is necessary to build a system, such as mentoring, to be able to exchange emotions actively among the members in order to enhance emotional intelligence and have the same values between leaders and members throughout open communication. Therefore, nurse managers can contribute greatly to the enhancement of organizational performance by promoting members' organizational citizenship behavior through improving their relationships with them and gaining their trust, while concurrently making efforts to further develop their emotional intelligence. © 2018 Japan Academy of Nursing Science.

Community member and faith leader perspectives on the process of building trusting relationships between communities and researchers.

PubMed

Lakes, Kimberley D; Vaughan, Elaine; Pham, Jennifer; Tran, Tuyet; Jones, Marissa; Baker, Dean; Swanson, James M; Olshansky, Ellen

2014-02-01

In the first phase of this research, we conducted, audio-recorded, and transcribed seven focus groups with more than 50 English- or Spanish-speaking women of childbearing age. Qualitative analysis revealed the following themes: (1) expectation that participation would involve relationships based on trust that is built over time and impacted by cultural factors; (2) perceived characteristics of research staff that would help facilitate the development of trusting relationships; (3) perceptions about the location of the visits that may affect trust; (4) perceptions of a research study and trust for the institution conducting the study may affect trust; (5) connecting the study to larger communities, including faith communities, could affect trust and willingness to participate. In the second phase of this research, we conducted, recorded, transcribed, and analyzed interviews with leaders from diverse faith communities to explore the potential for research partnerships between researchers and faith communities. In addition to confirming themes identified in focus groups, faith leaders described an openness to research partnerships between the university and faith communities and considerations for the formation of these partnerships. Faith leaders noted the importance of finding common ground with researchers, establishing and maintaining trusting relationships, and committing to open, bidirectional communication. © 2014 Wiley Periodicals, Inc.

Community Member and Faith Leader Perspectives on the Process of Building Trusting Relationships between Communities and Researchers

PubMed Central

Vaughan, Elaine; Pham, Jennifer; Tran, Tuyet; Jones, Marissa; Baker, Dean; Swanson, James M.; Olshansky, Ellen

2014-01-01

Abstract In the first phase of this research, we conducted, audio‐recorded, and transcribed seven focus groups with more than 50 English‐ or Spanish‐speaking women of childbearing age. Qualitative analysis revealed the following themes: (1) expectation that participation would involve relationships based on trust that is built over time and impacted by cultural factors; (2) perceived characteristics of research staff that would help facilitate the development of trusting relationships; (3) perceptions about the location of the visits that may affect trust; (4) perceptions of a research study and trust for the institution conducting the study may affect trust; (5) connecting the study to larger communities, including faith communities, could affect trust and willingness to participate. In the second phase of this research, we conducted, recorded, transcribed, and analyzed interviews with leaders from diverse faith communities to explore the potential for research partnerships between researchers and faith communities. In addition to confirming themes identified in focus groups, faith leaders described an openness to research partnerships between the university and faith communities and considerations for the formation of these partnerships. Faith leaders noted the importance of finding common ground with researchers, establishing and maintaining trusting relationships, and committing to open, bidirectional communication. PMID:24405695

Significance of User Participation in a Hospital Information System Success: Insights From a Case Study.

PubMed

Saleem, Naveed; Steel, Douglas; Gercek, Gokhan; Chandra, Ashish

User participation in the development of a system is universally prescribed as an effective strategy to ensure the success of the resultant system. However, the existing literature on the merits of user participation only provides equivocal evidence. Various analyses of this literature point out that this equivocal evidence may be due to inconsistent operational measures of the user participation and system success constructs. Planned organizational change and participative decision making, the underlying paradigms of user participation construct, suggest that the development of some information systems may require blending of users' system-related functional expertise and developers' technical expertise to ensure system success. These paradigms also maintain that in case of well-defined, structured information systems user participation should enhance the likelihood of system success through better user understanding of the need for the system and system content and objectives, user trust, and a sense of system ownership. This research also described a case study involving the development and implementation of a medical records system for a neonatal intensive care unit in a large hospital in Texas. The case study provides evidence that in systems that require incorporation of user functional expertise user participation will enhance the likelihood of system success.

Clinical management. Where medicine meets management. Senior moments.

PubMed

Young, John; Sturdy, Deborah

2004-06-10

Most general hospital users are older people. Standard 4 of the national service framework for older people aims to transform the whole hospital experience for this group. Trusts have yet to grasp the fundamentals of this approach, despite the fact that it will help them achieve improvements such as access targets. Investment in staff training and education is needed to achieve the necessary cultural change.

Secure and Trustable Electronic Medical Records Sharing using Blockchain.

PubMed

Dubovitskaya, Alevtina; Xu, Zhigang; Ryu, Samuel; Schumacher, Michael; Wang, Fusheng

2017-01-01

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost.

Secure and Trustable Electronic Medical Records Sharing using Blockchain

PubMed Central

Dubovitskaya, Alevtina; Xu, Zhigang; Ryu, Samuel; Schumacher, Michael; Wang, Fusheng

2017-01-01

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain. In this paper, we present our perspectives on blockchain based healthcare data management, in particular, for EMR data sharing between healthcare providers and for research studies. We propose a framework on managing and sharing EMR data for cancer patient care. In collaboration with Stony Brook University Hospital, we implemented our framework in a prototype that ensures privacy, security, availability, and fine-grained access control over EMR data. The proposed work can significantly reduce the turnaround time for EMR sharing, improve decision making for medical care, and reduce the overall cost. PMID:29854130

ENT manifestations of alkaptonuria: report on a case series.

PubMed

Steven, R A; Kinshuck, A J; McCormick, M S; Ranganath, L R

2015-10-01

Alkaptonuria is an inborn error of metabolism. It is a multisystem disease with characteristic ENT manifestations. This paper reports, for the first time, the ENT findings in a cohort of alkaptonuria patients. Patients attending the National Centre for Alkaptonuria (Royal Liverpool and Broadgreen University Hospitals NHS Trust) underwent a full ENT assessment. Eighteen of the 20 patients (90 per cent) had an ENT sign or symptom. These included discolouration of the pinna, cerumen, nasal septum and pharynx. Discolouration of cerumen may occur before 30 years of age and may therefore be an important early clinical sign. Further audiological assessment of patients is needed to clarify if an association exists between alkaptonuria and hearing loss. Alkaptonuria is a condition that could present to the otolaryngologist. Successful early diagnosis and referral to a specialist centre is essential so that patients can be offered disease-modifying therapy.

Accreditation of medical laboratories in Croatia--experiences of the Institute of Clinical Chemistry, University Hospital "Merkur", Zagreb.

PubMed

Flegar-Mestrić, Zlata; Nazor, Aida; Perkov, Sonja; Surina, Branka; Kardum-Paro, Mirjana Mariana; Siftar, Zoran; Sikirica, Mirjana; Sokolić, Ivica; Ozvald, Ivan; Vidas, Zeljko

2010-03-01

Since 2003 when the international norm for implementation of quality management in medical laboratories (EN ISO 15189, Medical laboratories--Particular requirements for quality and competence) was established and accepted, accreditation has become practical, generally accepted method of quality management and confirmation of technical competence of medical laboratories in the whole world. This norm has been translated into Croatian and accepted by the Croatian Institute for Norms as Croatian norm. Accreditation is carried out on voluntary basis by the Croatian Accreditation Agency that has up to now accredited two clinical medical biochemical laboratories in the Republic of Croatia. Advantages of accredited laboratory lie in its documented management system, constant improvement and training, reliability of test results, establishing users' trust in laboratory services, test results comparability and interlaboratory (international) test results acceptance by adopting the concept of metrological traceability in laboratory medicine.

From DRGs to deregulation: New Jersey takes the road less traveled.

PubMed

Berliner, H S; Delgado, S

1993-01-01

Following a 1992 court ruling that declared New Jersey's system of financing uncompensated care unconstitutional, the state radically changed its 12-year-old hospital payment system that pioneered the use of diagnostic-related groups (DRGs). In its place, New Jersey lawmakers approved a package of reforms that lets hospitals set their own charges and collect bad debts, uses the state's unemployment insurance trust fund to pay for charity care, and reforms the individual and small group insurance markets. Immediate results of the law include new subsidies for inner-city hospitals, lower bond ratings, and hospital layoffs.

77 FR 67827 - Meeting of the Secretarial Commission on Indian Trust Administration and Reform

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-14

..., on the University of Washington campus to meet with young adults and college students on their ideas... p.m. to 9 p.m. on the University of Washington campus to meet with young adults and college students...

Performance points. The reform club.

PubMed

Edwards, Nick

2004-03-18

The improvement Partnership for Hospitals programme is the vanguard of Modernization Agency work. It is based on statistical process control to eliminate variations in performance, especially in elective service. All starred trusts will join IPH by next April.

Metabolic manipulation in chronic heart failure: study protocol for a randomised controlled trial.

PubMed

Beadle, Roger M; Williams, Lynne K; Abozguia, Khaild; Patel, Kiran; Leon, Francisco Leyva; Yousef, Zaheer; Wagenmakers, Anton; Frenneaux, Michael P

2011-06-06

Heart failure is a major cause of morbidity and mortality in society. Current medical therapy centres on neurohormonal modulation with angiotensin converting enzyme inhibitors and β-blockers. There is growing evidence for the use of metabolic manipulating agents as adjunctive therapy in patients with heart failure. We aim to determine the effect of perhexiline on cardiac energetics and alterations in substrate utilisation in patients with non-ischaemic dilated cardiomyopathy. A multi-centre, prospective, randomised double-blind, placebo-controlled trial of 50 subjects with non-ischaemic dilated cardiomyopathy recruited from University Hospital Birmingham NHS Foundation Trust and Cardiff and Vale NHS Trust. Baseline investigations include magnetic resonance spectroscopy to assess cardiac energetic status, echocardiography to assess left ventricular function and assessment of symptomatic status. Subjects are then randomised to receive 200 mg perhexiline maleate or placebo daily for 4 weeks with serum drug level monitoring. All baseline investigations will be repeated at the end of the treatment period. A subgroup of patients will undergo invasive investigations with right and left heart catheterisation to calculate respiratory quotient, and mechanical efficiency. The primary endpoint is an improvement in the phosphocreatine to adenosine triphosphate ratio at 4 weeks. Secondary end points are: i) respiratory quotient; ii) mechanical efficiency; iii) change in left ventricular (LV) function. ClinicalTrials.gov: NCT00841139 ISRCTN: ISRCTN72887836.

An intelligent algorithm for identification of optimum mix of demographic features for trust in medical centers in Iran.

PubMed

Yazdanparast, R; Zadeh, S Abdolhossein; Dadras, D; Azadeh, A

2018-06-01

Healthcare quality is affected by various factors including trust. Patients' trust to healthcare providers is one of the most important factors for treatment outcomes. The presented study identifies optimum mixture of patient demographic features with respect to trust in three large and busy medical centers in Tehran, Iran. The presented algorithm is composed of adaptive neuro-fuzzy inference system and statistical methods. It is used to deal with data and environmental uncertainty. The required data are collected from three large hospitals using standard questionnaires. The reliability and validity of the collected data is evaluated using Cronbach's Alpha, factor analysis and statistical tests. The results of this study indicate that middle age patients with low level of education and moderate illness severity and young patients with high level of education, moderate illness severity and moderate to weak financial status have the highest trust to the considered medical centers. To the best of our knowledge this the first study that investigates patient demographic features using adaptive neuro-fuzzy inference system in healthcare sector. Second, it is a practical approach for continuous improvement of trust features in medical centers. Third, it deals with the existing uncertainty through the unique neuro-fuzzy approach. Copyright © 2018 Elsevier B.V. All rights reserved.

Trust in Supervisor and Job Engagement: Mediating Effects of Psychological Safety and Felt Obligation.

PubMed

Basit, Ameer A

2017-11-17

In the social context of job engagement, the role of trust in supervisor in predicting engagement of employees has received attention in research. Very limited research, however, has investigated the mechanisms mediating this dynamic relationship. To address this important gap in knowledge, the aim of this study was to examine psychological safety and felt obligation as two psychological mechanisms mediating the effect of trust in supervisor on job engagement. Drawing from job engagement and social exchange theories, the mediating roles of psychological safety and felt obligation in the trust-engagement relationship were empirically investigated in the Malaysian context. Using self-report questionnaires, data were collected from 337 nurses employed in a public hospital located near Kuala Lumpur, Malaysia. Results fully supported the proposed serial multiple mediator model. Trust in supervisor was indirectly related to job engagement via psychological safety followed by felt obligation. This study provides empirical evidence that trust in supervisor makes employees feel psychologically safe to employ and express their selves in their job roles. This satisfaction of the psychological safety need is interpreted by employees as an important socioemotional benefit that, in turn, makes them feel obligated to pay back to their organization through their enhanced level of job engagement. Implications for theory and practice were discussed.

Engines of Inequality: Diminishing Equity in the Nation's Premier Public Universities

ERIC Educational Resources Information Center

Gerald, Danette; Haycock, Kati

2006-01-01

The nation's 50 flagship universities serve disproportionately fewer low-income and minority students than in the past, according to this fifth report in the Education Trust's series on college results. Students in the entering and graduating classes at these schools look less and less like the state populations those universities were created to…

'Trust my doctor, trust my pancreas': trust as an emergent quality of social practice.

PubMed

Cohn, Simon

2015-06-11

Growing attention is being paid to the importance of trust, and its corollaries such as mistrust and distrust, in health service and the central place they have in assessments of quality of care. Although initially focussing on doctor-patient relationships, more recent literature has broadened its remit to include trust held in more abstract entities, such as organisations and institutions. There has consequently been growing interest to develop rigorous and universal measures of trust. Drawing on illustrative ethnographic material from observational research in a UK diabetes clinic, this paper supports an approach that foregrounds social practice and resists conceiving trust as solely a psychological state that can be divorced from its context. Beyond exploring the less-than-conscious nature of trust, the interpretations attend to the extent to which trust practices are distributed across a range of actors. Data from clinical encounters reveal the extent to which matters of trust can emerge from the relationships between people, and sometimes people and things, as a result of a wide range of pragmatic concerns, and hence can usefully be conceived of as an extended property of a situation rather than a person. Trust is rarely explicitly articulated, but remains a subtle feature of experience that is frequently ineffable. A practice approach highlights some of the problems with adopting a general psychological or intellectualist conception of trust. In particular, assuming it is a sufficiently stable internal state that can be stored or measured not only transforms a diffuse and often ephemeral quality into a durable thing, but ultimately presents it as a generic state that has meaning independent of the specific relationships and context that achieve it. Emphasising the context-specific nature of trust practices does not dismiss the potential of matters of trust, when they emerge, to be transposed to other contexts. But it does highlight how, on each occasion, trust as a relational quality is ways 'done' or 'achieved' anew.

Forging a new legacy of trust in research with Alaska Native college students using CBPR

PubMed Central

Lopez, Ellen D.S.; Sharma, Dinghy Kristine B.; Mekiana, Deborah; Ctibor, Alaina

2012-01-01

Objectives Disparities in the rates of matriculation and graduation are of concern to Alaska Native (AN) students and the universities committed to their academic success. Efforts to reduce attrition require a keen understanding of the factors that impact quality of life (QOL) at college. Yet, a long-standing legacy of mistrust towards research poses challenges to conducting inquiry among AN students. We introduced a partnership between the University of Alaska Fairbank's Rural Student Services (RSS) and the Center for Alaska Native Health Research (CANHR) within which we conducted the “What makes life good?” study aimed towards developing a QOL measure for AN students. Equally important was building a legacy of research trust among AN partners. Study design We describe Phase I of a 2-phase study that employed a sequential mixed methods approach. Discussed are facilitators, challenges and lessons learned while striving to adhere to the principles of community-based participatory research (CBPR). Methods Phase I included formative focus groups and QOL measurement development. The research involved the interplay among activities that were co-developed with the goal of enhancing trust and research capacity. Emphasis was placed on ensuring that data collection and analyses were student driven. Conclusions All partners resided at the same university. However, trust and collaboration could not be assumed. Working within a collaborative framework, our partnership achieved the aim of developing a culturally informed QOL measure, while also creating an empowering experience for all partners who became co-investigators in a process that might normally be regarded with mistrust. PMID:23019564

The ties that bind: an integrative framework of physician-hospital alignment

PubMed Central

2011-01-01

Background Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Discussion Empirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Summary Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives. PMID:21324128

The ties that bind: an integrative framework of physician-hospital alignment.

PubMed

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2011-02-15

Alignment between physicians and hospitals is of major importance to the health care sector. Two distinct approaches to align the medical staff with the hospital have characterized previous research. The first approach, economic integration, is rooted in the economic literature, in which alignment is realized by financial means. The second approach, noneconomic integration, represents a sociological perspective emphasizing the cooperative nature of their relationship. Empirical studies and management theory (agency theory and social exchange theory) are used to increase holistic understanding of physician hospital alignment. On the one hand, noneconomic integration is identified as a means to realize a cooperative relationship. On the other hand, economic integration is studied as a way to align financial incentives. The framework is developed around two key antecedent factors which play an important role in aligning the medical staff. First, provider financial risk bearing is identified as a driving force towards closer integration. Second, organizational trust is believed to be important in explaining the causal relation between noneconomic and economic integration. Hospital financial risk bearing creates a greater need for closer cooperation with the medical staff and alignment of financial incentives. Noneconomic integration lies at the very basis of alignment. It contributes directly to alignment through the norm of reciprocity and indirectly by building trust with the medical staff, laying the foundation for alignment of financial incentives.

Incorporating the Last Four Digits of Social Security Numbers Substantially Improves Linking Patient Data from De-identified Hospital Claims Databases.

PubMed

Naessens, James M; Visscher, Sue L; Peterson, Stephanie M; Swanson, Kristi M; Johnson, Matthew G; Rahman, Parvez A; Schindler, Joe; Sonneborn, Mark; Fry, Donald E; Pine, Michael

2015-08-01

Assess algorithms for linking patients across de-identified databases without compromising confidentiality. Hospital discharges from 11 Mayo Clinic hospitals during January 2008-September 2012 (assessment and validation data). Minnesota death certificates and hospital discharges from 2009 to 2012 for entire state (application data). Cross-sectional assessment of sensitivity and positive predictive value (PPV) for four linking algorithms tested by identifying readmissions and posthospital mortality on the assessment data with application to statewide data. De-identified claims included patient gender, birthdate, and zip code. Assessment records were matched with institutional sources containing unique identifiers and the last four digits of Social Security number (SSNL4). Gender, birthdate, and five-digit zip code identified readmissions with a sensitivity of 98.0 percent and a PPV of 97.7 percent and identified postdischarge mortality with 84.4 percent sensitivity and 98.9 percent PPV. Inclusion of SSNL4 produced nearly perfect identification of readmissions and deaths. When applied statewide, regions bordering states with unavailable hospital discharge data had lower rates. Addition of SSNL4 to administrative data, accompanied by appropriate data use and data release policies, can enable trusted repositories to link data with nearly perfect accuracy without compromising patient confidentiality. States maintaining centralized de-identified databases should add SSNL4 to data specifications. © Health Research and Educational Trust.

NHS politics. Winging it.

PubMed

Dewar, Steve; Chantler, Cyril

2002-03-14

At present, NHS managers are highly constrained, suffering excessive regulation and central control. More autonomy for trusts would mean fewer directives and less performance management. Giving trusts a new organisational form, such as a public interest company or foundation hospital, might be reinvigorating and would not involve further reorganisation. These new freedoms should be accompanied by new accountabilities, not solely to politicians but to independent NHS regulators, local communities and patients. Devolved power and greater patient choice could produce a more responsive NHS. Its potential needs to be explored through experimentation and evaluation.

The Influence of Education on Public Trust and Consent Preferences With Residual Newborn Screening Dried Blood spots.

PubMed

Rothwell, Erin; Wong, Bob; Anderson, Rebecca A; Botkin, Jeffrey R

2016-07-01

The objectives of this study were to evaluate the impact of educational interventions during prenatal care on public trust for newborn screening and consent preferences for the retention and use of leftover newborn screening dried blood spots. Women who were 30 to 36 weeks pregnant were recruited, and outcomes were measured by telephone survey 2 to 4 weeks postpartum (n = 901). Approximately 40% of the sample chose the opt-out approach but those who watched educational interventions delivered during prenatal care were significantly associated with higher levels of trust and support for an opt-out consent approach. Providing education during prenatal care about newborn screening and the storage and use of leftover dried blood spots along with brochure-based education provided in the hospital when the baby is born is associated with improved trust for the program and support for research with the leftover blood spots. © The Author(s) 2016.

Author Correction: Segregation of mitochondrial DNA heteroplasmy through a developmental genetic bottleneck in human embryos.

PubMed

Floros, Vasileios I; Pyle, Angela; Dietmann, Sabine; Wei, Wei; Tang, Walfred W C; Irie, Naoko; Payne, Brendan; Capalbo, Antonio; Noli, Laila; Coxhead, Jonathan; Hudson, Gavin; Crosier, Moira; Strahl, Henrik; Khalaf, Yacoub; Saitou, Mitinori; Ilic, Dusko; Surani, M Azim; Chinnery, Patrick F

2018-04-19

In the version of this Letter originally published, an author error led to the affiliations for Brendan Payne, Jonathan Coxhead and Gavin Hudson being incorrect. The correct affiliations are: Brendan Payne: 3 Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK. 6 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; this is a new affiliation 6 and subsequent existing affiliations have been renumbered. Jonathan Coxhead: 11 Genomic Core Facility, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK; this is a new affiliation 11 and subsequent existing affiliations have been renumbered. Gavin Hudson: 3 Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK. In addition, in Fig. 2d, the numbers on the x-axis of the left plot were incorrectly labelled as negative; they should have been positive. These errors have now been corrected in all online versions of the Letter.

Community outreach library services in the UK: a case study of Wirral Hospital NHS Trust (WHNT).

PubMed

Dowse, Frances Maria; Sen, Barbara

2007-09-01

The study evaluates the Community Outreach Library Service at Wirral Hospital National Health Service Trust (WHNT). It considers the information seeking behaviour and information needs of primary care staff, and service effectiveness in meeting those needs. A literature review established the current context and areas of best practice. The investigative case study used postal questionnaires to 250 primary care staff and an interview with the Community Outreach Librarian. Themes emerged from the literature regarding information seeking behaviour, information needs, and meeting user needs through effective service delivery. Outreach services have value in terms of improving information skills and providing services at point of need. Time is a major constraint for both users and service providers. Investment is needed from appropriate funding sources to support the provision and marketing of outreach library services. Librarians benefit from sharing best practice. The continued evaluation of outreach library services is recommended.

Hospital Trusts productivity in the English NHS: Uncovering possible drivers of productivity variations.

PubMed

Aragon Aragon, María Jose; Castelli, Adriana; Gaughan, James

2017-01-01

Health care systems in OECD countries are increasingly facing economic challenges and funding pressures. These normally demand interventions (political, financial and organisational) aimed at improving the efficiency of the health system as a whole and its single components. In 2009, the English NHS Chief Executive, Sir David Nicholson, warned that a potential funding gap of £20 billion should be met by extensive efficiency savings by March 2015. Our study investigates possible drivers of differential Trust performance (productivity) for the financial years 2010/11-2012/13. Following accounting practice, we define Productivity as the ratio of Outputs over Inputs. We analyse variation in both Total Factor and Labour Productivity using ordinary least squares regressions. We explicitly included in our analysis factors of differential performance highlighted in the Nicholson challenge as the sources were the efficiency savings should come from. Explanatory variables include efficiency in resource use measures, Trust and patient characteristics, and quality of care. We find that larger Trusts and Foundation Trusts are associated with lower productivity, as are those treating a greater proportion of both older and/or younger patients. Surprisingly treating more patients in their last year of life is associated with higher Labour Productivity.

Washing uniforms at home: adherence to hospital policy.

PubMed

Riley, Kate; Laird, Katie; Williams, John

2015-02-20

Infection control is a priority for all hospitals to reduce the spread of healthcare-associated infections (HCAIs). Textiles especially uniforms, are a possible route of HCAI transmission. There are protocols to ensure hospital laundry services meet accepted standards, however healthcare uniforms are laundered by staff at home and variations in practice occur. A questionnaire was used to conduct a service evaluation at four hospitals in different NHS trusts to determine how closely healthcare staff followed hospital guidelines on laundering and aftercare of uniforms at home. Responses showed that not all staff followed these guidelines; 44% of staff washed their uniforms below the recommended temperature of 60°C, which presents a potential route for cross-contamination and infection.

Universities Run for, by, and with the Faculty, Students and Staff: Alternatives to the Neoliberal Destruction of Higher Education

ERIC Educational Resources Information Center

Wright, Susan; Greenwood, Davydd J.

2017-01-01

After analysing the organisational pathologies and societal ills created by the neoliberalisation of universities, the article engages in an organisational critique of the pseudo-business model currently in use. It poses as a solution the re-creation of universities as trusts, with a model of beneficiary ownership, a matrix form of organisation…

Understanding the impact of commercialization on public support for scientific research: is it about the funding source or the organization conducting the research.

PubMed

Critchley, Christine R; Nicol, Dianne

2011-05-01

This research examines the influence of commercialization on support for scientific research. It compares the effects of the funding source with the type of organization on public support for stem cell research. Using a national Australian telephone survey (n = 1000), the results reveal that support drops significantly when scientific research is funded by private rather than public interests, and even more so when it is conducted in a private company rather than a public university. Respondents' preference for university research was enhanced if they trusted universities, distrusted major companies and believed that the research would be beneficial. A preference for public funding was also associated with lower trust in companies and a belief that the research would benefit people. Implications of these results are discussed in relation to the challenge of maintaining public support in an increasingly commercialized research environment.

Patient Perceptions of Wearable Face-Mounted Computing Technology and the Effect on the Doctor-Patient Relationship

PubMed Central

Press, Valerie G.; Meltzer, David O.; Arora, Vineet M.

2016-01-01

Summary Summary Background Wearable face-mounted computers such as Google Glass™, Microsoft HoloLens™, and Oculus’ Rift®, are increasingly being tested in hospital care. These devices challenge social etiquette, raise privacy issues, and may disrupt the intimacy of the doctor patient relationship. We aimed to determine patients’ perception of and their privacy concerns with an archetype of wearable face-mounted computer devices, Google Glass. Methods Hospitalized inpatients were asked about their familiarity with Glass, how comfortable they would be and if they would be concerned about privacy if their physician wore Glass, if the use of Glass would affect their trust in their physician, and if they would want their physician to wear Glass if it improved their care. Results Most (73%) respondents were unfamiliar with Glass, though 64% would be comfortable if their doctor wore Glass. Under half (46%) of respondents were concerned about privacy with the use of Glass. Seventy-six percent (76%) of respondents stated their doctor wearing Glass would not affect their trust in their doctor. Patients concerned about their privacy were less likely to trust their doctor if their doctor wore Glass (17% vs. 0%, p<0.01). Sixty-five percent (65%) of respondents would want their doctor to wear Glass if it improved their care. Conclusion Most patients appear open to and would want their doctor to use face-mounted wearable computers such as Glass, even when unfamiliar with this technology. While some patients expressed concerns about privacy, patients were much less concerned about wearable technologies affecting the trust they have in their physician. PMID:27730249

Self-rostering can improve work-life balance and staff retention in the NHS.

PubMed

Barrett, Renee; Holme, Annie

2018-03-08

Renee Barrett, Staff Nurse, ITU, Great Ormond Street Hospital NHS Trust, renee.barrett@gosh.nhs.uk , and Annie Holme, Lecturer, King's College London, look at how e-rostering can benefit health organisations and staff.

Establishing an inflammatory bowel disease service.

PubMed

Pearson, Catherine

Specialist nurses make a valuable contribution to the care of the individual with inflammatory bowel disease yet there are still relatively few of these nurses in post. This article discusses the development of the role within the Bolton Hospitals NHS Trust.

The proposed Nelson Mandela Children's Hospital, Johannesburg: providing the best care for children in the developing world.

PubMed

Bolton, Keith

2011-01-01

Construction will soon commence on the Nelson Mandela Children's Hospital (NMCH) in Johannesburg, South Africa. The Hospital will have 250-300 beds and will provide tertiary and quaternary care to children in specific Centers of Excellence. Admission to this referral facility will be based entirely on medical needs. The disciplines that are catered for include Paediatric surgery, oncology, nephrology, cardiology, intensive care and imaging. The NMCH will be South Africa's first "Private Hospital - Not for Gain". Funding for capital expenditure is currently being raised by the Trust. Operational expenditure will come from the Department of Health, private insurers and neighbouring governments.

[Emergency eye care in French university hospitals].

PubMed

Bourges, J-L

2018-03-01

The patient's request for urgent care in ophthalmology (PRUCO) at health care centers is constantly growing. In France, university hospitals are managing 75% of these cases. We sought to quantify PRUCO referred to French university hospital emergency units as well as to approach the structure and the territorial distribution of emergency eye care provided by French university hospitals. We conducted a quick cross-sectional survey sent to the 32 metropolitan and overseas French university hospitals. It inquired for each hospital whether emergency eye care units were available, whether ophthalmologists were on duty or on call overnight and how many PRUCO were managed in 2016. The 32 university hospitals completed the survey. A total of 398650 PRUCO were managed in French university hospitals in 2016. The emergency unit was exclusively dedicated to eye care for 70% of the hospitals, with 47% (15/32) of them employing an ophthalmologist on duty overnight. Every hospital but one had at least one ophthalmologist on call. The city of Paris set aside, university hospitals took care of an annual mean of 9000 PRUCO (min=500; max=32,250). The 32 French university hospitals are actively responding to patient's requests for urgent care in ophthalmology with very heterogeneous patient volumes and organizational systems. Half of them employ ophthalmologists on duty. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

26 CFR 1.673(b)-1 - Income payable to charitable beneficiaries before amendment by Tax Reform Act of 1969).

Code of Federal Regulations, 2010 CFR

2010-04-01

... irrevocably payable to University A for 1 year and then to University B for the next year; or if income of a... trust income payable to University C for the first 3 years because of the application of section 673(b... returned to G within 10 years, G would not be taxable under section 673 on income payable to University C...

[Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital].

PubMed

Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes

2018-05-01

Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, p<0.01). Nurses of both hospitals had sufficient opportunity to reconcile work and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective workload and stress factors reported by physicians at the University Hospital were significantly higher than those by doctors at the municipal hospital. © Georg Thieme Verlag KG Stuttgart · New York.

Research Activity and the Association with Mortality

PubMed Central

Ozdemir, Baris A.; Karthikesalingam, Alan; Sinha, Sidhartha; Poloniecki, Jan D.; Hinchliffe, Robert J.; Thompson, Matt M.; Gower, Jonathan D.; Boaz, Annette; Holt, Peter J. E.

2015-01-01

Introduction The aims of this study were to describe the key features of acute NHS Trusts with different levels of research activity and to investigate associations between research activity and clinical outcomes. Methods National Institute for Health Research (NIHR) Comprehensive Clinical Research Network (CCRN) funding and number of patients recruited to NIHR Clinical Research Network (CRN) portfolio studies for each NHS Trusts were used as markers of research activity. Patient-level data for adult non-elective admissions were extracted from the English Hospital Episode Statistics (2005-10). Risk-adjusted mortality associations between Trust structures, research activity and, clinical outcomes were investigated. Results Low mortality Trusts received greater levels of funding and recruited more patients adjusted for size of Trust (n = 35, 2,349 £/bed [95% CI 1,855–2,843], 5.9 patients/bed [2.7–9.0]) than Trusts with expected (n = 63, 1,110 £/bed, [864–1,357] p<0.0001, 2.6 patients/bed [1.7–3.5] p<0.0169) or, high (n = 42, 930 £/bed [683–1,177] p = 0.0001, 1.8 patients/bed [1.4–2.1] p<0.0005) mortality rates. The most research active Trusts were those with more doctors, nurses, critical care beds, operating theatres and, made greater use of radiology. Multifactorial analysis demonstrated better survival in the top funding and patient recruitment tertiles (lowest vs. highest (odds ratio & 95% CI: funding 1.050 [1.033–1.068] p<0.0001, recruitment 1.069 [1.052–1.086] p<0.0001), middle vs. highest (funding 1.040 [1.024–1.055] p<0.0001, recruitment 1.085 [1.070–1.100] p<0.0001). Conclusions Research active Trusts appear to have key differences in composition than less research active Trusts. Research active Trusts had lower risk-adjusted mortality for acute admissions, which persisted after adjustment for staffing and other structural factors. PMID:25719608

[The first Mental Health Act in China 2013 : An historical step towards human rights].

PubMed

Zhao, X

2017-05-01

In the past, the mentally ill used to be relentlessly stigmatized and their basic needs grossly neglected in China. Only the coastal cities with their Western oriented universities provided Western type mental healthcare. In general, traditional Chinese medicine (TCM) embracing medicinal herbs and acupuncture was practiced. Mental hospitals were non-existent before 1889 and care of the chronically mentally ill rested with their families and the community; however, the prevalence and spectrum of mental disorders were similar to those in Western countries. After the establishment of the People's Republic of China old-fashioned mental hospitals were founded. The "Great Leap Forward" starting in 1958 envisaged the creation of a mental healthcare system based on Soviet Union standards. Psychiatry had a strong biological orientation, and psychotherapy did not exist. Psychology was rejected as not being science and was not taught at universities before 1978. With the Reform and Opening Policy in 1978 the education of psychology was stepped up. Psychology was introduced as an academic discipline in 1978 and psychotherapy and psychosomatic medicine were established in mental healthcare. The current mental healthcare in China resembles the standard in Germany before the "Psychiatrie-Enquete" (expert commission official report). With the Mental Health Act adopted in 2013 after 27 years of planning, China has laid the legal foundation for planning and establishing a humane system of mental healthcare. The Act safeguards patients' human and individual rights and increases trust in psychiatric institutions. It guarantees the right to optimal treatment and provides legal protection in cases of malpractice.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

PubMed Central

Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-01

Objective (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings. PMID:28115331

Improving Access to, Use of, and Outcomes from Public Health Programs: The Importance of Building and Maintaining Trust with Patients/Clients

PubMed Central

Ward, Paul Russell

2017-01-01

The central argument in this paper is that “public trust” is critical for developing and maintaining the health and wellbeing of individuals, communities, and societies. I argue that public health practitioners and policy makers need to take “public trust” seriously if they intend to improve both the public’s health and the engagement between members of the public and public health systems. Public health practitioners implement a range of services and interventions aimed at improving health but implicit a requirement for individuals to trust the practitioners and the services/interventions, before they engage with them. I then go on to provide an overview of the theory of trust within sociology and show why it is important to understand this theory in order to promote trust in public health services. I then draw on literature in three classic areas of public health—hospitals, cancer screening, and childhood immunization—to show why trust is vital in terms of understanding and potentially improving uptake of services. The case studies in this paper reveal that public health practitioners need to understand the centrality of building and maintaining trusting relationships with patients/clients because people who distrust public health services are less likely to use them, less likely to follow advice or recommendations, and more likely to have poorer health outcomes. PMID:28337430

The feasibility of a randomized controlled trial of esophagectomy for esophageal cancer - the ROMIO (Randomized Oesophagectomy: Minimally Invasive or Open) study: protocol for a randomized controlled trial

PubMed Central

2014-01-01

Background There is a need for evidence of the clinical effectiveness of minimally invasive surgery for the treatment of esophageal cancer, but randomized controlled trials in surgery are often difficult to conduct. The ROMIO (Randomized Open or Minimally Invasive Oesophagectomy) study will establish the feasibility of a main trial which will examine the clinical and cost-effectiveness of minimally invasive and open surgical procedures for the treatment of esophageal cancer. Methods/Design A pilot randomized controlled trial (RCT), in two centers (University Hospitals Bristol NHS Foundation Trust and Plymouth Hospitals NHS Trust) will examine numbers of incident and eligible patients who consent to participate in the ROMIO study. Interventions will include esophagectomy by: (1) open gastric mobilization and right thoracotomy, (2) laparoscopic gastric mobilization and right thoracotomy, and (3) totally minimally invasive surgery (in the Bristol center only). The primary outcomes of the feasibility study will be measures of recruitment, successful development of methods to monitor quality of surgery and fidelity to a surgical protocol, and development of a core outcome set to evaluate esophageal cancer surgery. The study will test patient-reported outcomes measures to assess recovery, methods to blind participants, assessments of surgical morbidity, and methods to capture cost and resource use. ROMIO will integrate methods to monitor and improve recruitment using audio recordings of consultations between recruiting surgeons, nurses, and patients to provide feedback for recruiting staff. Discussion The ROMIO study aims to establish efficient methods to undertake a main trial of minimally invasive surgery versus open surgery for esophageal cancer. Trial registration The pilot trial has Current Controlled Trials registration number ISRCTN59036820(25/02/2013) at http://www.controlled-trials.com; the ROMIO trial record at that site gives a link to the original version of the study protocol. PMID:24888266

UK–South Asian patients’ experiences of and satisfaction toward receiving information about biologics in rheumatoid arthritis

PubMed Central

Kumar, Kanta; Raizada, Sabrina R; Mallen, Christian D; Stack, Rebecca J

2018-01-01

Background Rheumatoid arthritis (RA) causes painful joint inflammation and is incurable, but treatments control RA. Drug regimens are complex, and patients often do not take their medication as expected. Poor medication adherence can lead to poorly controlled disease and worse patient outcomes. Biologics treatments are expensive and require full engagement from patients. We have previously shown that patients from Black ethnic minority backgrounds do not fully engage into treatment plan. This study explored the patients’ experiences in and satisfaction toward receiving information about biologics and future support preferences in South Asian patients with RA. Methods Twenty South Asian patients with RA from Royal Wolverhampton Hospitals NHS Trust and Central Manchester University Hospitals NHS Foundation Trust participated in individual semistructured interviews. Interviews were transcribed and data were analyzed by using thematic analysis approach. Results Four overarching themes describe the patients’ experience in and satisfaction toward receiving information on biologics: 1) current provision of information regarding the “biologics journey” and understanding of RA: in this theme, non-English-speaking patients expressed heightened anxiety about stepping up to biologics; 2) experience and perceptions of biologics: many patients were positive about the biologic experience; however, there were patient-perceived delays in getting on to the biologics; 3) factors influencing willingness to try biologics: in this theme, a number of factors were identified including seeking advice from doctors abroad; and 4) recommendations on the desired information to fully understand the use of biologics: some patients valued group discussions, while others suggested receiving RA and biologic information through a video interaction. Conclusion This novel study provides insight into South Asian RA patients’ experiences in and satisfaction toward receiving information about biologics. South Asian patients with RA reported a range of perceptions about biologics and support preferences, many of which may not be shared with the non-South Asian population. PMID:29670337

Microfibre barrier laundry adds value.

PubMed

Fryer, Kurt

2011-04-01

London's Guy's and St Thomas' NHS Foundation Trust has installed a complete barrier laundry system from Electrolux Professional at its St Thomas' Hospital location for specialist washing of an estimated 7,000 microfibre cloths and 5,000 microfibre mops each day from both the St Thomas' and Guy's Hospital sites. Since the installation, as Electrolux Professional national account manager Kurt Fryer reports, the "cost-effective" equipment's high performance has seen laundry staff achieve a significant increase in productivity.

United We Stand, Divided We Fall: Increasing Response Capability in Kentucky through Regionalization and Leadership

DTIC Science & Technology

2011-03-01

trust (Yang & Mossholder, 2010). In “Disaster and Emergency Management: Canadian Nurses ’ Perceptions of Preparedness on Hospital Front Lines,” the...authors examined nurses ’ perceptions in terms of their confidence rating of their level of preparedness, awareness of hospital plans, perceptions of...significant role in the ice storm response. Public health nurses worked in shelters; environmentalists were called upon to ensure that restaurants with

[Issues related to national university medical schools: focusing on the low wages of university hospital physicians].

PubMed

Takamuku, Masatoshi

2015-01-01

University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.

24 CFR 200.215 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Officer. (See § 200.224) (e) Principal. (1) An individual, joint venture, partnership, corporation, trust... a project as sponsor, owner, prime contractor, Turnkey Developer, management agent, nursing home... or contract of assistance; (2) a hospital, group practice facility or nursing home; (3) cooperative...

Corporate identity. Brand designs.

PubMed

Mathieson, Steve

2004-02-19

The past two years have seen a steadily more consistent brand identity for the NHS. Branding will become more important as foundation status and PCT commissioning makes acute hospitals more competitive. This has put pressure on some trusts that have their own strong identities.

A national quality incentive scheme to reduce antibiotic overuse in hospitals: evaluation of perceptions and impact.

PubMed

Islam, J; Ashiru-Oredope, D; Budd, E; Howard, P; Walker, A S; Hopkins, S; Llewelyn, M J

2018-06-01

In 2016/2017, a financially linked antibiotic prescribing quality improvement initiative Commissioning for Quality and Innovation (AMR-CQUIN) was introduced across acute hospitals in England. This aimed for >1% reductions in DDDs/1000 admissions of total antibiotics, piperacillin/tazobactam and carbapenems compared with 2013/2014 and improved review of empirical antibiotic prescriptions. To assess perceptions of staff leading antimicrobial stewardship activity regarding the AMR-CQUIN, the investments made by hospitals to achieve it and how these related to achieving reductions in antibiotic use. We invited antimicrobial stewardship leads at acute hospitals across England to complete a web-based survey. Antibiotic prescribing data were downloaded from the PHE Antimicrobial Resistance Local Indicators resource. Responses were received from 116/155 (75%) acute hospitals. Owing to yearly increases in antibiotic use, most trusts needed to make >5% reductions in antibiotic consumption to achieve the AMR-CQUIN goal of 1% reduction. Additional funding was made available at 23/113 (20%) trusts and, in 18 (78%), this was <10% of the AMR-CQUIN value. Nationally, the annual trend for increased antibiotic use reversed in 2016/2017. In 2014/2015, year-on-year changes were +3.7% (IQR -0.8%, +8.4%), +9.4% (+0.2%, +19.5%) and +5.8% (-6.2%, +18.2%) for total antibiotics, piperacillin/tazobactam and carbapenems, respectively, and +0.1% (-5.4%, +4.0%), -4.8% (-16.9%, +3.2%) and -8.0% (-20.2%, +4.0%) in 2016/2017. Hospitals where staff believed they could reduce antibiotic use were more likely to do so (P < 0.001). Introducing the AMR-CQUIN was associated with a reduction in antibiotic use. For individual hospitals, achieving the AMR-CQUIN was associated with favourable perceptions of staff and not availability of funding.

Use of Anthropomorphic Brand Mascots for Student Motivation and Engagement: A Promotional Case Study with Pablo the Penguin at the University of Portsmouth Library

ERIC Educational Resources Information Center

Bennett, David E.; Thompson, Paula

2016-01-01

A case study demonstrating how an online narrative featuring the adventures of a cuddly toy penguin, Pablo Penguin (@uoppenguin on Twitter) has been introduced at the University of Portsmouth Library to build trust and engagement between university students and library services and facilities. Evidence for the benefits of anthropomorphic brand…

A rigorous computational approach to linear response

NASA Astrophysics Data System (ADS)

Bahsoun, Wael; Galatolo, Stefano; Nisoli, Isaia; Niu, Xiaolong

2018-03-01

We present a general setting in which the formula describing the linear response of the physical measure of a perturbed system can be obtained. In this general setting we obtain an algorithm to rigorously compute the linear response. We apply our results to expanding circle maps. In particular, we present examples where we compute, up to a pre-specified error in the L∞ -norm, the response of expanding circle maps under stochastic and deterministic perturbations. Moreover, we present an example where we compute, up to a pre-specified error in the L 1-norm, the response of the intermittent family at the boundary; i.e. when the unperturbed system is the doubling map. This work was mainly conducted during a visit of SG to Loughborough University. WB and SG would like to thank The Leverhulme Trust for supporting mutual research visits through the Network Grant IN-2014-021. SG thanks the Department of Mathematical Sciences at Loughborough University for hospitality. WB thanks Dipartimento di Matematica, Universita di Pisa. The research of SG and IN is partially supported by EU Marie-Curie IRSES ‘Brazilian-European partnership in Dynamical Systems’ (FP7-PEOPLE-2012-IRSES 318999 BREUDS). IN was partially supported by CNPq and FAPERJ. IN would like to thank the Department of Mathematics at Uppsala University and the support of the KAW grant 2013.0315.

Charitable remainder trust strategies for health care organizations.

PubMed

Goeppele, H A

1998-01-01

While availability of tax-exempt financing and exemption from income and property taxes have been viewed as the primary benefits of tax exemption, an underutilized benefit is the eligibility to receive charitable contributions. This article, using acquisition of a medical practice as an example, demonstrates one way planned giving can benefit both the health care organization and its physicians, and how such giving programs can be tailored to individual donor needs. Rather than selling a medical practice directly to a hospital, both the physician and the tax-exempt health care organization realize greater benefits through the illustrated charitable remainder trust strategy.

Residency hospital type and career paths in Japan: an analysis of physician registration cohorts.

PubMed

Koike, Soichi; Kodama, Tomoko; Matsumoto, Shinya; Ide, Hiroo; Yasunaga, Hideo; Imamura, Tomoaki

2010-01-01

In 2004, a new postgraduate medical training system was introduced in Japan and a shift of new graduates from university hospitals to other postgraduate education hospitals happened. The aim of this study is to analyse the past trends on postgraduate medical education choices and subsequent career options to discuss possible outcomes of the current shift and policy implications. Data from the national physician survey from 1976 to 2006 were analysed. The proportion change of physicians started their career in university hospitals was calculated. The career paths for physicians by different residency type were presented. More than 90% of physicians experienced university hospital work at least once in their 20-year careers. In their first 10 years of their career, physicians who started their residency in a university hospital tended to spend more years working in university hospitals, and those who started in other post-graduate training hospitals tended to spend less in university hospitals. Then, these groups presented quite similar patterns in their career choices. University hospitals need to strengthen their function as continuing education and career development centres and to adopt a less paternalistic approach, as fewer residents start their career in university hospitals.

Providing Personalised Nutrition: Consumers' Trust and Preferences Regarding Sources of Information, Service Providers and Regulators, and Communication Channels.

PubMed

Poínhos, Rui; Oliveira, Bruno M P M; van der Lans, Ivo A; Fischer, Arnout R H; Berezowska, Aleksandra; Rankin, Audrey; Kuznesof, Sharron; Stewart-Knox, Barbara; Frewer, Lynn J; de Almeida, Maria D V

2017-01-01

Personalised nutrition has potential to revolutionise dietary health promotion if accepted by the general public. We studied trust and preferences regarding personalised nutrition services, how they influence intention to adopt these services, and cultural and social differences therein. A total of 9,381 participants were quota-sampled to be representative of each of 9 EU countries (Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK, and Norway) and surveyed by a questionnaire assessing their intention to adopt personalised nutrition, trust in service regulators and information sources, and preferences for service providers and information channels. Trust and preferences significantly predicted intention to adopt personalised nutrition. Higher trust in the local department of health care was associated with lower intention to adopt personalised nutrition. General practitioners were the most trusted of service regulators, except in Portugal, where consumer organisations and universities were most trusted. In all countries, family doctors were the most trusted information providers. Trust in the National Health Service as service regulator and information source showed high variability across countries. Despite its highest variability across countries, personal meeting was the preferred communication channel, except in Spain, where an automated internet service was preferred. General practitioners were the preferred service providers, except in Poland, where dietitians and nutritionists were preferred. The preference for dietitians and nutritionists as service providers highly varied across countries. These results may assist in informing local initiatives to encourage acceptance and adoption of country-specific tailored personalised nutrition services, therefore benefiting individual and public health. © 2017 S. Karger AG, Basel.

[Controlling and operation management in hospitals].

PubMed

Vagts, Dierk A

2010-03-01

The economical pressure on the health system and especially on hospitals is growing rapidly. Hence, economical knowledge for people in medical executive positions becomes imperative. In advanced and forward-looking hospitals controlling is gaining more and more weight, because it takes over a coordinative responsibility. Ideally controlling is navigating the teamwork of managers (CEOs) and medical executives by weighing medical necessities and economical framework. Controlling is contributing to evaluate an optimal efficiency of a hospital in a highly competitive surrounding by providing medical and economical data on a regular basis. A close, open-minded and trusting cooperation between all people, who are involved, is imperative. Hence, controlling in the proper meaning of the word can not flourish in dominant and hierarchic hospital structures. Georg Thieme Verlag Stuttgart * New York.

University hospitals as drivers of career success: an empirical study of the duration of promotion and promotion success of hospital physicians

PubMed Central

2014-01-01

Background German hospitals have a well-defined career structure for clinicians. In this hierarchical career system university hospital are stepping stones for career advancement. This longitudinal study investigates the impact of working in university hospitals on the career success of junior physicians and senior physicians. Methods Consideration of the career trajectories of 324 hospital physicians. Discrete-time event history analysis is used to study the influence of working in university hospitals on the chance of promotion from junior physician to senior physician and senior physician to chief physician. A comparison of medians provides information about the impact of working in university hospitals on the duration of promotion to senior and chief physician positions. Results Working in university hospitals has a negative impact for advancement to a senior physician position in terms of promotion duration (p = 0.005) and also in terms of promotion success, where a short time span of just 1–2 years in university hospitals has a negative effect (OR = 0.38, p < 0.01), while working there for a medium or long term has no significant effect. However, working in universities has a positive effect on the duration of promotion to a chief physician position (p = 0.079), and working in university hospitals for 3–4 years increases the chance of promotion to a chief physician position (OR = 4.02, p < 0.05), while working there > =7 years decreases this chance (OR = 0.27, p < 0.05). In addition, physicians have a higher chance of promotion to a chief physician position through career mobility when they come to the position from a university hospital. Conclusion Working at university hospitals has a career-enhancing effect for a senior physician with ambitions to become a chief physician. For junior physicians on the trajectory to a senior physician position, however, university hospitals are not drivers of career success. PMID:24755299

University hospitals as drivers of career success: an empirical study of the duration of promotion and promotion success of hospital physicians.

PubMed

Degen, Christiane; Kuntz, Ludwig

2014-04-23

German hospitals have a well-defined career structure for clinicians. In this hierarchical career system university hospital are stepping stones for career advancement. This longitudinal study investigates the impact of working in university hospitals on the career success of junior physicians and senior physicians. Consideration of the career trajectories of 324 hospital physicians. Discrete-time event history analysis is used to study the influence of working in university hospitals on the chance of promotion from junior physician to senior physician and senior physician to chief physician. A comparison of medians provides information about the impact of working in university hospitals on the duration of promotion to senior and chief physician positions. Working in university hospitals has a negative impact for advancement to a senior physician position in terms of promotion duration (p = 0.005) and also in terms of promotion success, where a short time span of just 1-2 years in university hospitals has a negative effect (OR = 0.38, p < 0.01), while working there for a medium or long term has no significant effect. However, working in universities has a positive effect on the duration of promotion to a chief physician position (p = 0.079), and working in university hospitals for 3-4 years increases the chance of promotion to a chief physician position (OR = 4.02, p < 0.05), while working there > =7 years decreases this chance (OR = 0.27, p < 0.05). In addition, physicians have a higher chance of promotion to a chief physician position through career mobility when they come to the position from a university hospital. Working at university hospitals has a career-enhancing effect for a senior physician with ambitions to become a chief physician. For junior physicians on the trajectory to a senior physician position, however, university hospitals are not drivers of career success.

A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances

PubMed Central

Mangnall, Louise A R; Dietrich, Thomas; Scholey, John M

2013-01-01

Objective: To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience. Design: Multicentre randomized controlled trial. Setting: Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire. Materials and methods: Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced. Results: Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001). Conclusions: Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond. PMID:24009318

Engineering waterborne Pseudomonas aeruginosa out of a critical care unit.

PubMed

Garvey, Mark I; Bradley, Craig W; Wilkinson, Martyn A C; Bradley, Christina; Holden, Elisabeth

2017-08-01

To describe engineering and holistic interventions on water outlets contaminated with Pseudomonas aeruginosa and the observed impact on clinical P. aeruginosa patient isolates in a large Intensive Care Unit (ICU). Descriptive study. Queen Elizabeth Hospital Birmingham (QEHB), part of University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, UK and provides clinical services to nearly 1 million patients every year. Breakpoint models were used to detect any significant changes in the cumulative yearly rates of clinical P. aeruginosa patient isolates from August 2013-December 2016 across QEHB. Water sampling undertaken on the ICU indicated 30% of the outlets were positive for P. aeruginosa at any one time. Molecular typing of patient and water isolates via Pulsed Field Gel Electrophoresis suggested there was a 30% transmission rate of P. aeruginosa from the water to patients on the ICU. From, February 2014, QEHB implemented engineering interventions, consisting of new tap outlets and PALL point-of-use filters; as well as holistic measures, from February 2016 including a revised tap cleaning method and appropriate disposal of patient waste water. Breakpoint models indicated the engineering and holistic interventions resulted in a significant (p<0.001) 50% reduction in the number of P. aeruginosa clinical patient isolates over a year. Here we demonstrate that the role of waterborne transmission of P. aeruginosa in an ICU cannot be overlooked. We suggest both holistic and environmental factors are important in reducing transmission. Copyright © 2017 Elsevier GmbH. All rights reserved.

Danish Universities in the Financial Crisis: Change and Trust

ERIC Educational Resources Information Center

Milthers, Pernille Meyn

2011-01-01

Universities have always been important to national economies, but since the financial crisis of 2007-08 they have become key economic actors. Because they supply highly skilled labour and undertake basic research that enable nations to engage in global competition, they are capable of boosting production and innovation. This article explores the…

Embracing the Exit: Assessment, Trust, and the Teaching of Writing

ERIC Educational Resources Information Center

Eng, Joseph

2006-01-01

Historically, the Composition Program at Eastern Washington University (EWU), a comprehensive university in Cheney, WA, required a single essay sample from each composition student as the final exit exam; in practice, a student passed or failed the course based on an in-class argumentative essay, written in three consecutive class periods. Such a…

Blurring the Boundaries: Reflecting on PDS Roles and Responsibilities through Multiple Lenses

ERIC Educational Resources Information Center

Larson, Lotta C.; Lickteig, Amanda D.; Sherbert, Vicki S.; Nauerth, Deborah A.

2014-01-01

It is well documented that successful Professional Development School (PDS) initiatives are contingent on trusting relationships between the university and school districts. Over the past 25 years, continual efforts have been made by the Kansas State University (KSU) PDS to minimize notions of status while maintaining mutually beneficial goals and…

The Mathematics and Computer Science Learning Center (MLC).

ERIC Educational Resources Information Center

Abraham, Solomon T.

The Mathematics and Computer Science Learning Center (MLC) was established in the Department of Mathematics at North Carolina Central University during the fall semester of the 1982-83 academic year. The initial operations of the MLC were supported by grants to the University from the Burroughs-Wellcome Company and the Kenan Charitable Trust Fund.…

Ensuring Latina/o College Student Success: A Data-Driven Approach

ERIC Educational Resources Information Center

Rivera, Eric M.; Monzon, Reynaldo I.

2013-01-01

Many colleges and universities are trying to understand the factors that contribute to Latina/o college student success. San Diego State University (SDSU) has been recognized by The Education Trust Report (2012) for having the highest increase in graduation rates, but most importantly, comparably to White students, increasing the graduation rates…

Teacher as Servant Leader

ERIC Educational Resources Information Center

Bowman, Richard F.

2005-01-01

Servant leadership as an idea or theme has a lineage as old as the scriptures. Yet, the principles that ground servant leadership mirror a universal ethic: humility, honesty, trust, empathy, healing, community, and service. On the other hand, servant leadership in the classroom speaks to the universal human longing to be known, to care, and to be…

Cultures of Trust: Effects of Avatar Faces and Reputation Scores on German and Arab Players in an Online Trust-Game

PubMed Central

Bente, Gary; Dratsch, Thomas; Kaspar, Kai; Häßler, Tabea; Bungard, Oliver; Al-Issa, Ahmad

2014-01-01

Reputation systems as well as seller depictions (photos; avatars) have been shown to reduce buyer uncertainty and to foster trust in online trading. With the emergence of globalized e-markets, it remains an urgent question whether these mechanisms, found to be effective for Western cultures, also apply to other cultures. Hypothesizing that members of collectivistic cultures in contrast to those of individualistic cultures would rely more on visual social cues (seller faces) than on factual information (reputation scores), we compared buying decisions of Arab and German participants in an experimental trust game. Photo-realistic avatars were used instead of photos to control facial features and expressions. The results revealed significant main effects for both reputation scores and avatar faces. Moreover, both variables significantly affected the purchase behavior of Arab as well as German buyers, suggesting cross-cultural universals in the processing of trust cues. The results have implications for future cross-cultural studies in e-commerce as well as the design of online markets and shared virtual environments. PMID:24901696

Cultures of trust: effects of avatar faces and reputation scores on German and Arab players in an online trust-game.

PubMed

Bente, Gary; Dratsch, Thomas; Kaspar, Kai; Häβler, Tabea; Bungard, Oliver; Al-Issa, Ahmad

2014-01-01

Reputation systems as well as seller depictions (photos; avatars) have been shown to reduce buyer uncertainty and to foster trust in online trading. With the emergence of globalized e-markets, it remains an urgent question whether these mechanisms, found to be effective for Western cultures, also apply to other cultures. Hypothesizing that members of collectivistic cultures in contrast to those of individualistic cultures would rely more on visual social cues (seller faces) than on factual information (reputation scores), we compared buying decisions of Arab and German participants in an experimental trust game. Photo-realistic avatars were used instead of photos to control facial features and expressions. The results revealed significant main effects for both reputation scores and avatar faces. Moreover, both variables significantly affected the purchase behavior of Arab as well as German buyers, suggesting cross-cultural universals in the processing of trust cues. The results have implications for future cross-cultural studies in e-commerce as well as the design of online markets and shared virtual environments.

Governing boards and profound organizational change in hospitals.

PubMed

Fennell, M L; Alexander, J A

1989-01-01

Over the past decade the importance of governing boards as policy-making setting and oversight units within organizations has increased dramatically. Although this is true for both corporate- and private-sector organizations (Bacon and Brown 1977; Gelman 1988), it is particularly relevant to the health sector. Hospital governing boards, long considered inconsequential in hospital management, have recently become subject to closer scrutiny. The role of governing boards in decisions affecting hospital strategy and hospital performance is once again a topic of some interest in boardrooms and hospital trade journals. Impressive evidence of the renewed interest in governance is provided by the funding of an instructional consortium by the S.K. Kellogg Foundation to help strengthen trusteeship and governing board decision making, and to improve education for health services managers in the area of governance. Members of the consortium include the Hospital Research and Educational Trust, the American Hospital Association, the American College of Healthcare Executives, and the Association for University Programs in Health Administration. Among the activities being undertaken by this consortium is the development of a self-assessment tool/methodology for boards, a bibliography and reference guide on effective governance for practicing trustees, research workshops for faculty in health administration programs, and a teaching guide on governance and trustee leadership. Despite this interest, the question with which we began this article persists. Do governing boards make a difference? In the course of our review of previous work on governance we found that, more often than not, that question has been transformed into: how do boards influence hospital performance? And very often that question has been further narrowed into: which board structure leads to better hospital performance? We have argued for a respecification of the initial question. Rather than pursuing a definition of the maximally performing governing board, we should perhaps shift our focus back to a fuller understanding of board structure and function, and its influence on hospital change. The model developed here combines four essential, and very basic, questions: 1. What are the basic dimensions that underlie structural variation in different types of governing boards? 2. How do these board types influence structural change in hospitals? 3. How is the effect of board influence on change itself likely to change over time as a function of the hospital's general pattern of growth, decline, stability, or instability?(ABSTRACT TRUNCATED AT 400 WORDS)

Parochial trust and cooperation across 17 societies

PubMed Central

Romano, Angelo; Balliet, Daniel; Liu, James H.

2017-01-01

International challenges such as climate change, poverty, and intergroup conflict require countries to cooperate to solve these complex problems. However, the political tide in many countries has shifted inward, with skepticism and reluctance to cooperate with other countries. Thus, cross-societal investigations are needed to test theory about trust and cooperation within and between groups. We conducted an experimental study in 17 countries designed to test several theories that explain why, who, and where people trust and cooperate more with ingroup members, compared with outgroup members. The experiment involved several interactions in the trust game, either as a trustor or trustee. We manipulated partner group membership in the trust game (ingroup, outgroup, or unknown) and if their reputation was at stake during the interaction. In addition to the standard finding that participants trust and cooperate more with ingroup than outgroup members, we obtained findings that reputational concerns play a decisive role for promoting trust and cooperation universally across societies. Furthermore, men discriminated more in favor of their ingroup than women. Individual differences in cooperative preferences, as measured by social value orientation, predicted cooperation with both ingroup and outgroup members. Finally, we did not find support for three theories about the cross-societal conditions that influence the degree of ingroup favoritism observed across societies (e.g., material security, religiosity, and pathogen stress). We discuss the implications for promoting cooperation within and between countries. PMID:29133403

Gossip.

PubMed

1994-07-13

• Oh, where will it all end? Cash-strapped NHS hospitals and trusts are apparently coming up with ever more ingenious ways of making money. A Danish nurse, over here for the recent Euroquan conference, was charged £100 for a study visit around Stanmore Hospital, the national bone place. Good to know that in these days of European unity we still manage to rip off the foreigners. One can only hope the money will go to a good cause, like re-building the crumbling ruin.

Factor selection for service quality evaluation: a hospital case study.

PubMed

Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

2017-02-13

Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

Overseas nurses in the National Health Service: a process of deskilling.

PubMed

O'Brien, Terri

2007-12-01

This paper shows that overseas nurses (OSN) recruited to UK hospital trusts become deskilled in technical aspects of clinical practice. Existing research reports that many newly recruited OSN are prevented from using technical skills acquired in training abroad, to the detriment of the National Health Service (NHS) and the concern of the nurses themselves. The author conducted case study work in three NHS hospital trusts in the northwest of England. The findings reported are part of a wider investigation into the assimilation(1) of OSN from the Philippines, India and Spain into NHS hospitals. Semi-structured interviews were undertaken with members of four groups of actors: managers, OSN, home nurses (HN) and mentors, which were analysed thematically. Results. The research confirms the finding that many OSN are prevented from using technical skills in the UK, but also suggests reasons why this is so. The finding of deskilling emerged strongly in all three cases and is singled out for discussion in this paper. The experience of OSN highlights ambiguity surrounding the role of the nurse in British hospitals. This arises partly because OSN tend to be recruited to the bottom grades of nursing in the NHS, where their technical skills are underused. Segmentation within the nursing hierarchy contributes to the conflicting messages and mismatch of expectations experienced by nurses at the ward level, regarding the role of the nurse.

Who's My Doctor? Using an Electronic Tool to Improve Team Member Identification on an Inpatient Pediatrics Team.

PubMed

Singh, Amit; Rhee, Kyung E; Brennan, Jesse J; Kuelbs, Cynthia; El-Kareh, Robert; Fisher, Erin S

2016-03-01

Increase parent/caregiver ability to correctly identify the attending in charge and define terminology of treatment team members (TTMs). We hypothesized that correct TTM identification would increase with use of an electronic communication tool. Secondary aims included assessing subjects' satisfaction with and trust of TTM and interest in computer activities during hospitalization. Two similar groups of parents/legal guardians/primary caregivers of children admitted to the Pediatric Hospital Medicine teaching service with an unplanned first admission were surveyed before (Phase 1) and after (Phase 2) implementation of a novel electronic medical record (EMR)-based tool with names, photos, and definitions of TTMs. Physicians were also surveyed only during Phase 1. Surveys assessed TTM identification, satisfaction, trust, and computer use. More subjects in Phase 2 correctly identified attending physicians by name (71% vs. 28%, P < .001) and correctly defined terms intern, resident, and attending (P ≤ .03) compared with Phase 1. Almost all subjects (>79%) and TTMs (>87%) reported that subjects' ability to identify TTMs moderately or strongly impacted satisfaction and trust. The majority of subjects expressed interest in using computers to understand TTMs in each phase. Subjects' ability to correctly identify attending physicians and define TTMs was significantly greater for those who used our tool. In our study, subjects reported that TTM identification impacted aspects of the TTM relationship, yet few could correctly identify TTMs before tool use. This pilot study showed early success in engaging subjects with the EMR in the hospital and suggests that families would engage in computer-based activities in this setting. Copyright © 2016 by the American Academy of Pediatrics.

Authentic leadership and nurses' voice behaviour and perceptions of care quality.

PubMed

Wong, Carol A; Spence Laschinger, Heather K; Cummings, Greta G

2010-11-01

The purpose of the present study was to test a theoretical model linking authentic leadership with staff nurses' trust in their manager, work engagement, voice behaviour and perceived unit care quality. Authentic leadership is a guide for effective leadership needed to build trust and healthier work environments because there is special attention given to honesty, integrity and high ethical standards in the development of leader-follower relationships. A non-experimental, predictive survey design was used to test the hypothesized model in a random sample of 280 (48% response rate) registered nurses working in acute care hospitals in Ontario. The final model fitted the data acceptably (χ(2)=17.24, d.f.=11, P=0.10, IFI=0.99, CFI=0.99, RMSEA=0.045). Authentic leadership significantly and positively influenced staff nurses' trust in their manager and work engagement which in turn predicted voice behaviour and perceived unit care quality. These findings suggest that authentic leadership and trust in the manager play a role in fostering trust, work engagement, voice behaviour and perceived quality of care. Nursing leaders can improve care quality and workplace conditions by paying attention to facilitating genuine and positive relationships with their staff. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Hospital Trusts productivity in the English NHS: Uncovering possible drivers of productivity variations

PubMed Central

Aragon Aragon, María Jose; Gaughan, James

2017-01-01

Background Health care systems in OECD countries are increasingly facing economic challenges and funding pressures. These normally demand interventions (political, financial and organisational) aimed at improving the efficiency of the health system as a whole and its single components. In 2009, the English NHS Chief Executive, Sir David Nicholson, warned that a potential funding gap of £20 billion should be met by extensive efficiency savings by March 2015. Our study investigates possible drivers of differential Trust performance (productivity) for the financial years 2010/11-2012/13. Methods Following accounting practice, we define Productivity as the ratio of Outputs over Inputs. We analyse variation in both Total Factor and Labour Productivity using ordinary least squares regressions. We explicitly included in our analysis factors of differential performance highlighted in the Nicholson challenge as the sources were the efficiency savings should come from. Explanatory variables include efficiency in resource use measures, Trust and patient characteristics, and quality of care. Results We find that larger Trusts and Foundation Trusts are associated with lower productivity, as are those treating a greater proportion of both older and/or younger patients. Surprisingly treating more patients in their last year of life is associated with higher Labour Productivity. PMID:28767731

Understanding African Americans' Views of the Trustworthiness of Physicians

PubMed Central

Jacobs, Elizabeth A; Rolle, Italia; Ferrans, Carol Estwing; Whitaker, Eric E; Warnecke, Richard B

2006-01-01

BACKGROUND Many scholars have written about the historical underpinnings and likely consequences of African Americans distrust in health care, yet little research has been done to understand if and how this distrust affects African Americans' current views of the trustworthiness of physicians. OBJECTIVE To better understand what trust and distrust in physicians means to African Americans. DESIGN Focus-group study, using an open-ended discussion guide. SETTING Large public hospital and community organization in Chicago, IL. PATIENTS Convenience sample of African-American adult men and women. MEASUREMENTS Each focus group was systematically coded using grounded theory analysis. The research team then identified themes that commonly arose across the 9 focus groups. RESULTS Participants indicated that trust is determined by the interpersonal and technical competence of physicians. Contributing factors to distrust in physicians include a lack of interpersonal and technical competence, perceived quest for profit and expectations of racism and experimentation during routine provision of health care. Trust appears to facilitate care-seeking behavior and promotes patient honesty and adherence. Distrust inhibits care-seeking, can result in a change in physician and may lead to nonadherence. CONCLUSIONS Unique factors contribute to trust and distrust in physicians among African-American patients. These factors should be considered in clinical practice to facilitate trust building and improve health care provided to African Americans. PMID:16808750

If you come from a well-known organisation, I will trust you: Exploring and understanding the community's attitudes towards healthcare research in Cambodia.

PubMed

Pol, Sreymom; Fox-Lewis, Shivani; Neou, Leakhena; Parker, Michael; Kingori, Patricia; Turner, Claudia

2018-01-01

To explore Cambodian community members' understanding of and attitudes towards healthcare research. This qualitative study generated data from semi-structured interviews and focus group discussions. This study was conducted at a non-governmental paediatric hospital and in nearby villages in Siem Reap province, Cambodia. A total of ten semi-structured interviews and four focus group discussions were conducted, involving 27 participants. Iterative data collection and analysis were performed concurrently. Data were analysed by thematic content analysis and the coding structure was developed using relevant literature. Participants did not have a clear understanding of what activities related to research compared with those for routine healthcare. Key attitudes towards research were responsibility and trust: personal (trust of the researcher directly) and institutional (trust of the institution as a whole). Villagers believe the village headman holds responsibility for community activities, while the village headman believes that this responsibility should be shared across all levels of the government system. It is essential for researchers to understand the structure and relationship within the community they wish to work with in order to develop trust among community participants. This aids effective communication and understanding among all parties, enabling high quality ethical research to be conducted.

A qualitative study of a blended therapy using problem solving therapy with a customised smartphone app in men who present to hospital with intentional self-harm.

PubMed

Mackie, Craig; Dunn, Nicole; MacLean, Sarah; Testa, Valerie; Heisel, Marnin; Hatcher, Simon

2017-11-01

Blended therapy describes the use of computerised therapy combined with face-to-face therapy to extend the depth, range and nature of the face-to-face therapy. We wanted to develop a treatment manual for a randomised trial of blended therapy combining face-to-face problem solving and a smartphone app in men who present to hospital with self-harm. To develop a treatment manual and to describe the experience of receiving and delivering a blended therapy. After completion of the blended therapy, semistructured qualitative interviews were conducted with participants to describe their experience of the treatment. Two independent coders analysed the material using a thematic, grounded theory approach. Seven men were enrolled in the study, and six completed the qualitative interviews. The two main themes identified were of trust and connection. Participants attended 85% of their appointments. In the treatment manual, we emphasised the themes of trust and connection by allowing time to discuss the app in the face-to-face to sessions, ensuring that therapists are familiar with the app and know how to respond to technical queries. Identification of trust and connection generates novel questions about the importance of the therapeutic alliance with technology rather than with people. Clinicians and app developers need to pay attention to the therapeutic relationship with technology as trust and good communication can be easily damaged, resulting in disengagement with the app. Blended therapy may result in increased adherence to face-to-face sessions. NCT02718248. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Impact of Proactive Nurse Participation in ICU Family Conferences: A Mixed-Method Study.

PubMed

Garrouste-Orgeas, Maité; Max, Adeline; Lerin, Talia; Grégoire, Charles; Ruckly, Stéphane; Kloeckner, Martin; Brochon, Sandie; Pichot, Emmanuelle; Simons, Clara; El-Mhadri, Myriame; Bruel, Cédric; Philippart, François; Fournier, Julien; Tiercelet, Kelly; Timsit, Jean-François; Misset, Benoit

2016-06-01

To investigate family perceptions of having a nurse participating in family conferences and to assess the psychologic well being of the same families after ICU discharge. Mixed-method design with a qualitative study embedded in a single-center randomized study. Twelve-bed medical-surgical ICU in a 460-bed tertiary hospital. One family member for each consecutive patient who received more than 48 hours of mechanical ventilation in the ICU. Planned proactive participation of a nurse in family conferences led by a physician. In the control group, conferences were led by a physician without a nurse. Of the 172 eligible family members, 100 (60.2%) were randomized; among them, 88 underwent semistructured interviews at ICU discharge and 86 completed the Peritraumatic Dissociative Experiences Questionnaire at ICU discharge and then the Hospital Anxiety Depression Questionnaire and the Impact of Event Scale (for posttraumatic stress-related symptoms) 3 months later. The intervention and control groups were not significantly different regarding the prevalence of posttraumatic stress-related symptoms (52.3 vs 50%, respectively; p = 0.83). Anxiety and depression subscale scores were significantly lower in the intervention group. The qualitative data indicated that the families valued the principle of the conference itself. Perceptions of nurse participation clustered into four main themes: trust that ICU teamwork was effective (50/88; 56.8%), trust that care was centered on the patient (33/88; 37.5%), trust in effective dissemination of information (15/88; 17%), and trust that every effort was made to relieve anxiety in family members (12/88; 13.6%). Families valued the conferences themselves and valued the proactive participation of a nurse. These positive perceptions were associated with significant anxiety or depression subscale scores but not with changes in posttraumatic stress-related symptoms.

[Mobbing: ten-year evaluation experience in a University Hospital].

PubMed

Monaco, Edoardo; Girardi, Paolo; Falaschi, Paolo; Ferracuti, Stefano; Martocchia, Antonio; Battaglia, Valentina; Capitanelli, Ilaria; Catarinozzi, Elena; Piccari, Ines; Rossi, Marina; Prestigiacomo, Claudio

2017-11-01

Bullying is a manifestation of occupational stress and can therefore be considered as a real "organizational pathology." Include the activities of the surgery dedicated to Mobbing, Unit of Occupational Medicine Sant'Andrea Hospital, which began operations in June 2001. In over ten years of operation (July 2012), the sample, consisting of 50.7% for men and 49.3% women, is heterogeneous in age. The schooling of the sample is medium-high as more than 82% have higher education level. The business sector is the service sector accounted for most (84%) than in industry (9%) and agriculture (2%). Of the 1545 patients seen, 1320 completed the diagnostic path, while 225 have stopped. 814 users have been certified for compatibility bullying (63% of cases) with a net reduction of the awards from 2007 onwards. Considerations are expressed about the possible intervention strategies: the presence of dedicated experts at the counters of listening and professionals as the trusted advisor, to which workers in distress can call on for advice and guidance on how to defend itself from, in accordance with the implemented for years at the Ministry of Health, the establishment of such figures as the manager rehability that in other European countries, are scheduled for some time in work organization. Copyright© by Aracne Editrice, Roma, Italy.

The association between subcultures and resistance to change--in a Swedish hospital clinic.

PubMed

Carlstrom, Eric; Olsson, Lars-Eric

2014-01-01

The purpose of this paper is to explore the different subcultures and the employees' preparedness for change at an orthopaedic clinic in a university hospital in Sweden. Surveys were sent out to 179 nurses and physicians. The survey included the two instruments Organisational Values Questionnaire and resistance to change (RTC) Scale. The results suggest a dominance of a human relations culture, i.e. flexibility, cohesion and trust, in the orthopaedic clinic. These characteristics seemed to decrease RTC. Opposite to this, planning, routines and goal setting appeared to increase change-resistant behaviour. By predicting potential obstacles in a certain context prior to a change process, resources can be used in a more optimal way. An instrument that pinpoints the culture of a particular healthcare setting may be a useful tool in order to anticipate the possible outcome of change. The rational goal/internal processes dimension exerted a stronger association with RTC than in earlier studies. Deeply rooted standards and routinised care models, governed by work schedules, could be an obstacle to introducing a care model based on the individual needs of the patient. There was, however, a surprisingly low RTC. The results are contrary to the accepted understanding of public organisations known to be slow to change.

Can a violation of investor trust lead to financial contagion in the market for tax-exempt hospital bonds?

PubMed

Bernet, Patrick M; Getzen, Thomas E

2008-03-01

Not-for-profit hospitals rely heavily on tax-exempt debt. Investor confidence in such instruments was shaken by the 1998 bankruptcy of the Allegheny Health and Education Research Foundation (AHERF), which was the largest U.S. not-for-profit failure up to that date and whose default was accompanied by claims of accounting irregularities. Such shocks can result in contagion whereby all hospitals are viewed as riskier. We test for the significance and duration of resulting contagion using an industry-specific model of interest cost determinants. Empirical tests indicate that contagion does occur, resulting in higher interest on new debt issues from other hospitals.

Beginning community engagement at a busy biomedical research programme: Experiences from the KEMRI CGMRC-Wellcome Trust Research Programme, Kilifi, Kenya

PubMed Central

Marsh, Vicki; Kamuya, Dorcas; Rowa, Yvonne; Gikonyo, Caroline; Molyneux, Sassy

2008-01-01

There is wide acknowledgement of the need for community engagement in biomedical research, particularly in international settings. Recent debates have described theoretical approaches to identifying situations where this is most critical and potential mechanisms to achieve it. However, there is relatively little published experience of community engagement in practice. A major component of the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme is centred on Kilifi District General Hospital and surrounding community of 240,000 local residents. Documented community perceptions of the research centre are generally positive, but many indicate a low understanding of research and therapeutic misconceptions of its activities. As in other settings, these misunderstandings have contributed to concerns and rumours, and potentially undermine ethical aspects of research and local trust in the institution. Through a series of consultative activities, a community engagement strategy has been developed in Kilifi to strengthen mutual understanding between community members and the Centre. One important component is the establishment of a representative local resident network in different geographic locations commonly involved in research, to supplement existing communication channels. Early implementation of the strategy has provided new and diverse opportunities for dialogue, interaction and partnership building. Through the complex social interactions inherent in the community engagement strategy, the centre aims to build context specific ethical relations with local residents and to strengthen understanding of how ethical principles can be applied in practice. Evaluations over time will assess the effectiveness and sustainability of these strategies, provide generalisable information for similar research settings, and contribute to debates on the universality of ethical principles for research. This paper aims to summarise the rationale for community engagement in research, drawing on published literature and local findings, to outline the process of community engagement in Kilifi and to describe issues emerging from its development and early implementation. PMID:18375028

International educational partnerships for doctors in training: a collaborative framework with the RCP.

PubMed

Thomson, George A; Foster, Matthew; Sheriff, Rezvi; Mendis, Lalitha; Fernando, Devaka J S; Blundell, Caroline; Worrall, Jeffrey; Black, Carol

2005-01-01

The UK offers excellent postgraduate medical education, and overseas doctors in training often covet a period of training in the UK. Some overseas training authorities make UK training mandatory prior to appointment as a consultant. Unfortunately, the organisation of such training often proves to be ad hoc, and may lack educational value. UK training faces challenges as a result of reduced hours of work, more structured and intensive educational needs, and pressures of increasing clinical demand. A plethora of new 'trust' posts have developed, often with limited educational value, creating a risk that training quality for overseas doctors is reduced. Against this background, such posts can be used to create international training partnerships such as that at Sherwood Forest Hospitals NHS Trust (SFHT), providing high-quality general and specialty training. Given the success of this strategy, it would be desirable for other UK trusts to provide similar schemes offering specialties not covered at SFHT.

Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study

PubMed Central

Fuller, Christopher; Savage, Joan; Cookson, Barry; Hayward, Andrew; Cooper, Ben; Duckworth, Georgia; Michie, Susan; Murray, Miranda; Jeanes, Annette; Roberts, J; Teare, Louise; Charlett, Andre

2012-01-01

Objective To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Design Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. Setting 187 acute trusts in England and Wales. Intervention Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004. Main outcome measures Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections). Results Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10 000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P<0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P<0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P=0.02) and C difficile infection (0.75, 0.67 to 0.84; P<0.0001). Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia (0.91, 0.83 to 0.99; P=0.03) and C difficile infection (0.80, 0.71 to 0.90; P=0.01), for at least two quarters after each visit. Conclusions The Cleanyourhands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections. National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections. PMID:22556101

Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.

PubMed

Stone, Sheldon Paul; Fuller, Christopher; Savage, Joan; Cookson, Barry; Hayward, Andrew; Cooper, Ben; Duckworth, Georgia; Michie, Susan; Murray, Miranda; Jeanes, Annette; Roberts, J; Teare, Louise; Charlett, Andre

2012-05-03

To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. 187 acute trusts in England and Wales. Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004. Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections). Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10,000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P < 0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P < 0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P = 0.02) and C difficile infection (0.75, 0.67 to 0.84; P < 0.0001). Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia (0.91, 0.83 to 0.99; P=0.03) and C difficile infection (0.80, 0.71 to 0.90; P=0.01), for at least two quarters after each visit. The Cleanyourhands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections. National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections.

Social capital and health in a national cohort of 82,482 Open University adults in Thailand.

PubMed

Yiengprugsawan, Vasoontara; Khamman, Suwanee; Seubsman, Sam-Ang; Lim, Lynette L-Y; Sleigh, Adrian C

2011-05-01

We report associations between social capital and health among 82,482 adults in a national cohort of Open University students residing throughout Thailand.After adjusting for covariates, poor self-assessed health was positively associated with low social trust (OR = 1.88; 95% CI 1.76-2.01) and low social support (OR = 1.79; 95% CI 1.63-1.95). In addition, poor psychological health was also associated with low social trust (OR = 2.52; 95% CI 2.41-2.64) and low social support (OR = 1.80; 95% CI 1.69-1.92). Females, elderly, unpartnered, low income, and urban residents were associated with poor health. Findings suggest ways to improve social capital and heath in Thailand and other middle-income countries.

An analysis of the delivery of anaesthetic training sessions in the United Kingdom.

PubMed

Green, A; Tatham, K C; Yentis, S M; Wilson, J; Cox, M

2017-11-01

We analysed data from the electronic rota system CLWRota, covering 2,689,962 anaesthetic sessions between 01/01/2014 and 31/12/2015, in 91 UK Trusts, in order to investigate trainees' supervision. There were 8209 trainee attachments analysed, during which 618,695 sessions were undertaken by trainees. The number of supervised sessions per week that trainees worked varied considerably (median (IQR [range]) 2.6 (1.6-3.6 [0-10]) for all grades combined), with senior trainees more likely than junior trainees to be supervised for fewer than the three sessions per week mandated by the Royal College of Anaesthetists. The number of supervised sessions was unrelated to Trusts' size, suggesting that trainees in smaller hospitals receive the same level of supervision as in larger teaching hospitals. Analysis of a dataset of this size should be a good reflection of the delivery of anaesthesia training in the UK. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Interpreter services in an inner city teaching hospital: a 6-year experience.

PubMed

Khwaja, Nadeem; Sharma, Saroj; Wong, Julian; Murray, David; Ghosh, Jonathan; Murphy, Michael O; Halka, Anastassi T; Walker, Michael G

2006-11-01

Being able to communicate effectively with patients is essential not only from a medicolegal standpoint but more importantly from clinical governance perspectives. Issues such as informed consent and patient choice within the NHS are currently being highlighted; for these to be available to patients, their language requirements are paramount. An audit was performed by the Linkworkers office at the Central Manchester & Manchester Children's Hospital NHS (CMMC) Trust on the total number of attendances and refusals per language in the period 1998-2003. In the CMMC Trust, Urdu/Punjabi, Bengali, Cantonese, Somali, Arabic and French represent the majority of the workload, comprising almost 80% of cases in 2003. In the same year, an increase in demand for languages of Eastern European countries became evident. Finding interpreters for these languages even via agencies can be extremely difficult. If the current trend continues, requirement for these services will increase exponentially. For this demand to be met adequately these issues must be kept at the forefront of NHS planning.

Evaluation of Return to Practice: the views of nurse returnees from three NHS Hospital Trusts.

PubMed

Barriball, K Louise; Coopamah, Vinoda; Roberts, Julia; Watts, Suzanne

2007-05-01

Exploration of the views and experiences of returnees on a Return to Practice programme based in three NHS Hospital Trusts. In the light of nursing shortages in Britain, there is an ongoing need to encourage nurses to re-enter the profession through Return to Practice programmes. In order to maximize returnees' participation in the nursing workforce; however, evaluation of the effectiveness of Return to Practice programmes is necessary. 17 returnees were recruited to the study completing self-report questionnaires at programme commencement and participating in focus group discussions on programme completion. Three key issues emerged from the data: the varied personal circumstances and professional histories of returnees; the challenge of providing adequate support in practice that reflected returnees' individual needs and aspirations and the importance of flexible employment opportunities to meet returnees' expectations of an appropriate work life balance. It is important that any schemes to attract nurses back to the profession are targeted at their specific needs.

Social capital and knowledge sharing: effects on patient safety.

PubMed

Chang, Chia-Wen; Huang, Heng-Chiang; Chiang, Chi-Yun; Hsu, Chiu-Ping; Chang, Chia-Chen

2012-08-01

This article is a report on a study that empirically examines the influence of social capital on knowledge sharing and the impact of knowledge sharing on patient safety. Knowledge sharing is linked to many desirable managerial outcomes, including learning and problem-solving, which are essential for patient safety. Rather than studying the tangible effects of rewards, this study examines whether social capital (including social interaction, trust and shared vision) directly supports individual knowledge sharing in an organization. This cross-sectional study analysed data collected through a questionnaire survey of nurses from a major medical centre in northern Taiwan. The data were collected over a 9-month period from 2008 to 2009. The data analysis was conducted using the Partial Least Squares Graph v3.0 program to evaluate the measurement properties and the structural relationships specified in the research model. Based on a large-scale survey, empirical results indicate that Registered Nurses' perceptions of trust and shared vision have statistically significant and direct effects on knowledge sharing. In addition, knowledge sharing is significantly and positively associated with patient safety. The findings suggest that hospital administrators should foster group trust and initiate a common vision among Registered Nurses. In addition, administrators and chief knowledge officers of hospitals should encourage positive intentions towards knowledge sharing. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

[Physician shortage in Japan: the new postgraduate medical education program and physicians as a human medical resource].

PubMed

Nomura, Kyoko

2011-01-01

Japan now faces a serious physician shortage. After introducing the new postgraduate medical education (PGME) system and doctor-to-facility matching system, residents shifted their teaching hospitals from university hospitals to non-university hospitals. Because university hospitals had played a central role in allocating physicians to communities, the decrease in the number of physicians at university hospitals has driven this physician shortage. Japanese policymakers blame the new PGME for exacerbating this physician shortage and have tentatively agreed to reform the PGME to encourage residents to return to university hospitals. However, the PGME system should not be reformed only for political reasons; such a change requires a scientific basis. First, after the introduction of the new PGME, residents showed an improved clinical competence; therefore, it has accomplished its ultimate goal. Second, the residents' satisfaction level in terms of the residency system and clinical skills training was significantly higher at non-university hospitals than at university hospitals. This implies that training conditions at university hospitals are not as good as at non-university hospitals, which explains the decrease in the number of physicians at university hospitals. Third, in 2009, the Japanese government increased the maximum medical school enrollment to mitigate the physician shortage. However, a simple increase does not solve the problem of physician shortage unless it also addresses the problem of physician maldistribution. Fourth, the number of females entering medicine is increasing, and women constituted 30% of newly certified physicians in 2010. In this era of physician shortage, female physicians are highly recommended as a human medical resource.

A national survey of inpatient medication systems in English NHS hospitals

PubMed Central

2014-01-01

Background Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap. Methods The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011). Results One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards/overalls were routinely used during nurses’ drug rounds on at least one ward in 59% of hospitals. Conclusions Inter- and intra-hospital variations in medication systems and processes exist, even within the English NHS; future research should focus on investigating their potential effects on nurses’ workflow and MAEs, and developing NHS-wide interventions to reduce MAEs. PMID:24572075

A national survey of inpatient medication systems in English NHS hospitals.

PubMed

McLeod, Monsey; Ahmed, Zamzam; Barber, Nick; Franklin, Bryony Dean

2014-02-27

Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap. The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011). One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients' own drugs (89%) and 'one-stop dispensing' medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. "Do not disturb" tabards/overalls were routinely used during nurses' drug rounds on at least one ward in 59% of hospitals. Inter- and intra-hospital variations in medication systems and processes exist, even within the English NHS; future research should focus on investigating their potential effects on nurses' workflow and MAEs, and developing NHS-wide interventions to reduce MAEs.

Historical Perspectives on the Crisis of the University

ERIC Educational Resources Information Center

Schapira, Michael

2014-01-01

The beginning of the 21th century has not been a particularly stable period for the university, at least if you trust the steady stream of books, articles, jeremiads and statements from public officials lamenting its fallen status and calling for bold reforms. Such a state of affairs has allowed critics and reformers alike to axiomatically evoke…

A Nordstrom Experience: Jennifer Duvernay--Arizona State University, Tempe

ERIC Educational Resources Information Center

Library Journal, 2005

2005-01-01

Jennifer Duvernay, a science reference librarian at Arizona State University (ASU), feels it is very important to make sure that the information shopping experience is completely satisfying. "I'd like our students to choose to come to us because they have good experiences with us, trust us, and like us, despite [the availability of] plenty of…

Complementary and alternative medicine use in a pediatric neurology clinic.

PubMed

Aburahma, Samah K; Khader, Yousef S; Alzoubi, Karem; Sawalha, Noor

2010-08-01

To evaluate the frequency and determinants of complementary and alternative medicine (CAM) use in children attending a pediatric neurology clinic in North Jordan, a parent completed questionnaire survey of children attending the pediatric neurology clinic at King Abdullah University Hospital from March to July 2008 was conducted. A review of 176 completed questionnaires showed that 99 parents (56%) had used CAM for their child's specific neurological illness. The most common modalities were prayer/reciting the Quran (77%), religious healers (30%), massage with olive oil (32%), and consumption of honey products (29%). The most common reason was religious beliefs in 68%. None reported lack of trust in conventional medicine as the reason behind seeking CAM. Factors significantly associated with CAM use were speech delay, belief in its usefulness, father's age more than 30 years, and mothers with education less than high school. CAM had a supplementary role in relation to traditional western medicine use. Copyright 2010 Elsevier Ltd. All rights reserved.

Trusts' forward-thinking approach recognised.

PubMed

Herring, Phillip

2017-05-01

It is often said that the quality of the parking experience at a hospital or other healthcare facility makes one of the most lasting impressions on visitors. HEJ editor, Jonathan Baillie, spoke to Phillip Herring, managing director at Indigo, the UK arm of one of Europe's leading 'bespoke parking solution' providers, to discover how, harnessing first-class customer service, the latest technology, and the ability to offer anything from simple car park management to 30-year Design Build Finance Operate (DBFO) packages, the company is looking to extend a UK healthcare parking contract portfolio which already sees it work with 11 NHS Trusts across England, Scotland, and Wales.

Cancelled surgeries and payment by results in the English National Health Service.

PubMed

McIntosh, Bryan; Cookson, Graham; Jones, Simon

2012-04-01

To model the frequency of 'last minute' cancellations of planned elective procedures in the English NHS with respect to the patient and provider factors that led to these cancellations. A dataset of 5,288,604 elective patients spell in the English NHS from January 1st, 2007 to December 31st, 2007 was extracted from the Hospital Episode Statistics. A binary dependent variable indicating whether or not a patient had a Health Resource Group coded as S22--'Planned elective procedure not carried out'--was modeled using a probit regression estimated via maximum likelihood including patient, case and hospital level covariates. Longer waiting times and being admitted on a Monday were associated with a greater rate of cancelled procedures. Male patients, patients from lower socio-economic groups and older patients had higher rates of cancelled procedures. There was significant variation in cancellation rates between hospitals; Foundation Trusts and private facilities had the lowest cancellation rates. Further research is needed on why Foundation Trusts exhibit lower cancellation rates. Hospitals with relatively high cancellation rates should be encouraged to tackle this problem. Further evidence is needed on whether hospitals are more likely to cancel operations where the procedure tariff is lower than the S22 tariff as this creates a perverse incentive to cancel. Understanding the underlying causes of why male, older and patients from lower socio-economic groups are more likely to have their operations cancelled is important to inform the appropriate policy response. This research suggests that interventions designed to reduce cancellation rates should be targeted to high-cancellation groups.

A Randomized Controlled Trial of a CPR Decision Support Video for Patients Admitted to the General Medicine Service.

PubMed

Merino, Aimee M; Greiner, Ryan; Hartwig, Kristopher

2017-09-01

Patient preferences regarding cardiopulmonary resuscitation (CPR) are important, especially during hospitalization when a patient's health is changing. Yet many patients are not adequately informed or involved in the decision-making process. We examined the effect of an informational video about CPR on hospitalized patients' code status choices. This was a prospective, randomized trial conducted at the Minneapolis Veterans Affairs Health Care System in Minnesota. We enrolled 119 patients, hospitalized on the general medicine service, and at least 65 years old. The majority were men (97%) with a mean age of 75. A video described code status choices: full code (CPR and intubation if required), do not resuscitate (DNR), and do not resuscitate/do not intubate (DNR/DNI). Participants were randomized to watch the video (n = 59) or usual care (n = 60). The primary outcome was participants' code status preferences. Secondary outcomes included a questionnaire designed to evaluate participants' trust in their healthcare team and knowledge and perceptions about CPR. Participants who viewed the video were less likely to choose full code (37%) compared to participants in the usual care group (71%) and more likely to choose DNR/DNI (56% in the video group vs. 17% in the control group) ( < 0.00001). We did not see a difference in trust in their healthcare team or knowledge and perceptions about CPR as assessed by our questionnaire. Hospitalized patients who watched a video about CPR and code status choices were less likely to choose full code and more likely to choose DNR/DNI. © 2017 Society of Hospital Medicine

Using pH testing to confirm nasogastric tube position.

PubMed

Earley, Tracy

In 2004 the MHRA published a directive for all hospitals in the UK to use pH paper in place of litmus paper when testing position of nasogastric tubes (NGT). This article illustrates one trust's implementation of this process of change in order to achieve compliance.

Effect of a Computerized Provider Order Entry (CPOE) System on Medication Orders at a Community Hospital and University Hospital

PubMed Central

Wess, Mark L.; Embi, Peter J.; Besier, James L.; Lowry, Chad H.; Anderson, Paul F.; Besier, James C.; Thelen, Geriann; Hegner, Catherine

2007-01-01

Computerized Provider Order Entry (CPOE) has been demonstrated to improve the medication ordering process, but most published studies have been performed at academic hospitals. Little is known about the effects of CPOE at community hospitals. With a pre-post study design, we assessed the effects of a CPOE system on the medication ordering process at both a community and university hospital. The time from provider ordering to pharmacist verification decreased by two hours with CPOE at the community hospital (p<0.0001) and by one hour at the university hospital (p<0.0001). The rate of medication clarifications requiring signature was 2.80 percent pre-CPOE and 0.40 percent with CPOE (p<0.0001) at the community hospital. The university hospital was 2.76 percent pre-CPOE and 0.46 percent with CPOE (p<0.0001). CPOE improved medication order processing at both community and university hospitals. These findings add to the limited literature on CPOE in community hospitals. PMID:18693946

Relationship between nurses' organizational trust levels and their organizational citizenship behaviors.

PubMed

Altuntas, Serap; Baykal, Ulku

2010-06-01

This research used a descriptive and explorative design to determine the levels of nurses' organizational trust and organizational citizenship and to investigate relationships between the levels of organizational trust and organizational citizenship behaviors. Nurses who had completed their orientation from a total of 11 hospitals with bed capacities of 100 and located in the European district of Istanbul were included in the sample for this study. Formal, written applications and approval of the ethical committee were obtained from concerned institutions before proceeding with the data collection step. The Organizational Trust Inventory and the Organizational Citizenship Level Scale, a questionnaire form including five questions regarding nurses' personal characteristics, were used in data collection. Data collection tools were distributed to 900 nurses in total, and usable data were obtained from 482 nurses. Number and percentage calculations and Pearson correlation analysis were used to assess research data. The results of the present research showed that nurses had a higher than average level of trust in their managers and coworkers and they trusted more in their managers and coworkers than their institutions. The Organizational Citizenship Level Scale indicated that the behavior most frequently demonstrated by the nurses was conscientiousness, followed by courtesy and civic virtue, whereas sportsmanship was displayed to an average extent. An analysis of relationships between nurses' level of organizational trust and their organizational citizenship behaviors revealed that nurses who trust in their managers, institutions, and coworkers demonstrated the organizational citizenship behaviors of conscientiousness, civic virtue, courtesy, and altruism more frequently. The findings attained in this study indicated that the organizational trust the staff had in their institutions, managers, and coworkers influenced the organizational citizenship behaviors of conscientiousness, civic virtue, altruism, and courtesy, whereas it had no effect on sportsmanship behavior. Nurse managers should introduce studies to improve their subordinates' organizational trust to ensure that they develop organizational citizenship behaviors, and they should support them in this process. These topics for nursing services will provide guidance to managers, particularly to managers of nursing services, in establishing processes to predict nurses' organizational commitment, job satisfaction, performance, intention to leave, and other relevant issues.

Actuarial status of the old-age and survivors insurance and disability insurance trust funds.

PubMed

Ballantyne, H C

1982-06-01

The 1982 Annual Report of the Board of Trustees of the Old-Age and Survivors Insurance (OASI) and Disability Insurance (DI) Trust Funds indicates sever financial problems in both the short and the long range. The short-range financial status is significantly worse than was estimated last year, after enactment of the 1981 legislation, because of continuing unfavorable economic conditions. The estimated long-range deficit is the same as the deficit that was estimated last year before the 1981 legislation and is therefore somewhat worse than was estimated immediately after enactment of the legislation. Under present law, which authorizes temporary interfund borrowing amount the OASI, DI, and Hospital Insurance (HI) Trust Funds, the OASI Trust Fund would become unable to pay benefits on time by July 1983. The assets of the DI Trust Fund, on the other hand, are expected to grow rapidly in both the short and long range. If the assets of both the OASI and DI Trust Funds were combined, however, the two funds would still become unable to pay benefits on time by the latter half of 1983, based on all four sets of economic and demographic assumptions in the 1982 report. Even if the temporary interfund borrowing authority in present law were extended, the combined assets of the OASI, DI, and HI Trust Funds would become insufficient to pay benefits on time by 1984, based on the two less favorable sets of assumptions in the 1982 report. Based on the other two, more favorable, sets of assumptions, the three combined funds could pay benefits on time through the 1980's but there would be little or no margin of safety to permit timely payment of benefits if economic conditions are even slightly less favorable.

Amnioinfusion in very early preterm prelabor rupture of membranes (AMIPROM): pregnancy, neonatal and maternal outcomes in a randomized controlled pilot study.

PubMed

Roberts, D; Vause, S; Martin, W; Green, P; Walkinshaw, S; Bricker, L; Beardsmore, C; Shaw, N; McKay, A; Skotny, G; Williamson, P; Alfirevic, Z

2014-05-01

To assess short- and long-term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial. This was a prospective non-blinded randomized controlled trial with randomization stratified for pregnancies in which the membranes ruptured between 16 + 0 and 19 + 6 weeks' gestation and 20 + 0 and 23 + 6 weeks' gestation to minimize the risk of random imbalance in gestational age distribution between randomized groups. Intention-to-treat analysis was used. The study was conducted in four UK hospital-based fetal medicine units (Liverpool Women's NHS Trust, St Mary's Hospital Manchester, Birmingham Women's NHS Foundation Trust and Wirral University Hospitals Trust). The participants were women with confirmed preterm prelabor rupture of membranes at 16 + 0 to 24 + 0 weeks' gestation. Women with multiple pregnancy, fetal abnormality or obstetric indication for immediate delivery were excluded. Participants were randomly allocated to either serial weekly transabdominal amnioinfusions if the deepest pool of amniotic fluid was < 2 cm or expectant management until 37 weeks' gestation. Short-term maternal, pregnancy and neonatal and long-term outcomes for the child were studied. Long-term respiratory morbidity was assessed using validated respiratory questionnaires at 6, 12 and 18 months of age and infant lung function test at around 12 months of age. Neurodevelopment was assessed using the Bayley Scales of Infant Development, second edition (BSID-II) at corrected age of 2 years. Fifty-eight women were randomized to the study. Two babies were excluded from the analysis because of termination of pregnancy for lethal anomaly, leaving 56 participants (28 assigned to serial amnioinfusion and 28 to expectant management) recruited between 2002 and 2009. There was no significant difference in perinatal mortality (19/28 vs 19/28; relative risk (RR) 1.0 (95% CI, 0.70-1.43)) and maternal or neonatal morbidity. The overall chance of surviving without long-term respiratory or neurodevelopmental disability was 4/56 (7.1%); 4/28 (14.3%) in the amnioinfusion group and 0/28 in the expectant group (RR 9.0 (95% CI, 0.51-159.70)). This pilot study found no major differences in maternal, perinatal or pregnancy outcomes. The study was not designed to show a difference between the groups and the number of survivors was too small to draw any conclusions about long-term outcomes. It does, however, signal that a larger definitive study to evaluate amnioinfusion for improvement in healthy survival is needed. The pilot suggests that, with appropriate funding, such a study is feasible. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

Neurocultural evidence that ideal affect match promotes giving.

PubMed

Park, BoKyung; Blevins, Elizabeth; Knutson, Brian; Tsai, Jeanne L

2017-07-01

Why do people give to strangers? We propose that people trust and give more to those whose emotional expressions match how they ideally want to feel ("ideal affect match"). European Americans and Koreans played multiple trials of the Dictator Game with recipients who varied in emotional expression (excited, calm), race (White, Asian) and sex (male, female). Consistent with their culture's valued affect, European Americans trusted and gave more to excited than calm recipients, whereas Koreans trusted and gave more to calm than excited recipients. These findings held regardless of recipient race and sex. We then used fMRI to probe potential affective and mentalizing mechanisms. Increased activity in the nucleus accumbens (associated with reward anticipation) predicted giving, as did decreased activity in the right temporo-parietal junction (rTPJ; associated with reduced belief prediction error). Ideal affect match decreased rTPJ activity, suggesting that people may trust and give more to strangers whom they perceive to share their affective values. © The Author (2017). Published by Oxford University Press.

State University of New York Stony Brook University Hospital: Selected Expenditure Controls. Report 92-S-66.

ERIC Educational Resources Information Center

New York State Office of the Comptroller, Albany. Div. of Management Audit.

An audit was done of selected expenditure controls at the State University of New York (SUNY) at Stony Brook University Hospital particularly payroll costs and procurement practices. The Hospital reported an operating loss of $24 million in 1992. The audit reviewed Hospital management and staff and applicable policies and procedures as well as…

Assessing advertising content in a hospital advertising campaign: An application of Puto and Wells (1984) measure of informational and transformational advertising content.

PubMed

Menon, Mohan K; Goodnight, Janelle M; Wayne, Robin J

2006-01-01

The following is a report of a study designed to measure advertising content based on the cognitive and affective elements of informational (i.e., information processing) and transformational (i.e., experiential) content using the measure of advertising informational and transformational content developed by Puto and Wells (1984). A university hospital advertising campaign designed to be high in transformational content did not appear to affect perceived quality of local university hospitals relative to private hospitals or increase the likelihood of choosing a university hospital in the future. Further, experiences with university hospitals that seemed to be in direct contrast to the content of the advertisements based on subject perceptions affected how university hospital advertisements were perceived in terms of content. Conclusions and implications for hospital advertising campaigns are discussed.

Combinations of social participation and trust, and association with health status-an Australian perspective.

PubMed

Williams, Susan L; Ronan, Kevin

2014-12-01

A limited number of studies have examined the 'miniaturization of community' model which is based on belief that 'new' individualistic, and narrower forms of social participation, do not promote generalized trust in others. Little is known about miniaturization of community and self-reported health, physical health and psychological health in Australia. Data from a 2009 computer-assisted-telephone-interview survey was used to investigate generalized trust, social participation and health-related quality of life in a regional Australian population (n = 1273; mean age 51.2 years). Logistic regression analyses were performed to investigate the associations between generalized trust, social participation and poor self-reported health (global self-rated, psychological and physical), and included four social participation/trust categories. A majority (67%) reported high generalized trust of others, 54% were categorized as high social participators. Miniaturization of community was a risk factor for poor self-rated psychological health across genders, and a risk factor for poor self-rated health for males. For women, low social participation (irrespective of trust level) was associated with poor self-reported health. Given current and previous findings, there is a need for further research in a range of contexts which explores the underlying concept of miniaturization of community, that is, the changes in social participation and social networks which may negatively impact community health. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Parochial trust and cooperation across 17 societies.

PubMed

Romano, Angelo; Balliet, Daniel; Yamagishi, Toshio; Liu, James H

2017-11-28

International challenges such as climate change, poverty, and intergroup conflict require countries to cooperate to solve these complex problems. However, the political tide in many countries has shifted inward, with skepticism and reluctance to cooperate with other countries. Thus, cross-societal investigations are needed to test theory about trust and cooperation within and between groups. We conducted an experimental study in 17 countries designed to test several theories that explain why, who, and where people trust and cooperate more with ingroup members, compared with outgroup members. The experiment involved several interactions in the trust game, either as a trustor or trustee. We manipulated partner group membership in the trust game (ingroup, outgroup, or unknown) and if their reputation was at stake during the interaction. In addition to the standard finding that participants trust and cooperate more with ingroup than outgroup members, we obtained findings that reputational concerns play a decisive role for promoting trust and cooperation universally across societies. Furthermore, men discriminated more in favor of their ingroup than women. Individual differences in cooperative preferences, as measured by social value orientation, predicted cooperation with both ingroup and outgroup members. Finally, we did not find support for three theories about the cross-societal conditions that influence the degree of ingroup favoritism observed across societies (e.g., material security, religiosity, and pathogen stress). We discuss the implications for promoting cooperation within and between countries. Copyright © 2017 the Author(s). Published by PNAS.

Financial Analysis of National University Hospitals in Korea.

PubMed

Lee, Munjae

2015-10-01

This paper provides information for decision making of the managers and the staff of national university hospitals. In order to conduct a financial analysis of national university hospitals, this study uses reports on the final accounts of 10 university hospitals from 2008 to 2011. The results of comparing 2008 and 2011 showed that there was a general decrease in total assets, an increase in liabilities, and a decrease in total medical revenues, with a continuous deficit in many hospitals. Moreover, as national university hospitals have low debt dependence, their management conditions generally seem satisfactory. However, some individual hospitals suffer severe financial difficulties and thus depend on short-term debts, which generally aggravate the profit and loss structure. Various indicators show that the financial state and business performance of national university hospitals have been deteriorating. These research findings will be used as important basic data for managers who make direct decisions in this uncertain business environment or by researchers who analyze the medical industry to enable informed decision-making and optimized execution. Furthermore, this study is expected to contribute to raising government awareness of the need to foster and support the national university hospital industry.

Financial Analysis of National University Hospitals in Korea

PubMed Central

Lee, Munjae

2015-01-01

Objectives This paper provides information for decision making of the managers and the staff of national university hospitals. Methods In order to conduct a financial analysis of national university hospitals, this study uses reports on the final accounts of 10 university hospitals from 2008 to 2011. Results The results of comparing 2008 and 2011 showed that there was a general decrease in total assets, an increase in liabilities, and a decrease in total medical revenues, with a continuous deficit in many hospitals. Moreover, as national university hospitals have low debt dependence, their management conditions generally seem satisfactory. However, some individual hospitals suffer severe financial difficulties and thus depend on short-term debts, which generally aggravate the profit and loss structure. Various indicators show that the financial state and business performance of national university hospitals have been deteriorating. Conclusion These research findings will be used as important basic data for managers who make direct decisions in this uncertain business environment or by researchers who analyze the medical industry to enable informed decision-making and optimized execution. Furthermore, this study is expected to contribute to raising government awareness of the need to foster and support the national university hospital industry. PMID:26730356

[International collaboration to develop a nurse practitioner master's program].

PubMed

Tang, Woung-Ru

2007-12-01

Because of the shortage of resident doctors and in order to raise standards, hospitals and medical centers have trained their own nurse practitioners (NPs). Given the absence of standard training criteria and an unevenness of faculty quality, however, many NPs play the role of medical substitute, which is far from the independent role performed by NPs in foreign countries. It is therefore necessary to include NP training within higher education. The Graduate Institute of Nursing at Chang Gung University established the first NP in-service training program in 2003 through international collaboration, with the purpose of cultivating advanced clinical nursing talents. The program emphasizes the importance of clinical reasoning and practical training, in order to enable students to perform the multiple roles of treatment and caring undertaken by NPs. Experts in advanced nursing and clinical medicine from Taiwan and abroad were invited to serve as lecturers. The students also had the opportunity to take NP courses at Oregon Health and Science University (USA) and participate in clinical visits. The results have been widely praised. International collaboration is built upon the mutual trust of the parties, and its success is determined by the measures that it involves, as well as by the global vision and competence of participants. This paper shares the advantages and disadvantages of the NP master's program through international collaboration.

Where is the trust in the peer review dynamic?

NASA Astrophysics Data System (ADS)

Ucko, Daniel

The motto of the Royal Society is ``nullius in verba'', which translates roughly as ``take nobody's word for it'', and this motto is furthermore emblematic of the conduct of science. We want facts and not opinions, verified results and not conjecture. From the time that we first started communicating scientific results, it has been recognized that scientific claims must be verified by someone who is not the maker of those claims, and who furthermore has no stake in the matter, in other words, a claim needs to be evaluated objectively. Peer review as a method of evaluation can be thought of as akin to an experiment, where the review process tests the hypothesis of a submitted paper. Peer review is however also a social process with human actors: authors, referees, and editors. As a process, peer review depends on trust, but in what way does that manifest? There are many agents in peer review: in addition to the human actors, there is also the institution that is the journal, as well as the publisher (e.g. APS) that stands behind the journal. People can also have trust in the very concept of peer review. If we accept as a proposition that publications are witnesses to science in the same way that people who attend scientific demonstrations are witnesses of an experiment, then how much do we trust this witness? A few further questions arise: If referees (and sometimes authors) are anonymous, what does this do to the mechanisms of trust? Is trust only possible between human agents, or can you trust a process or a journal in a similar way to trusting a certain car brand? Is an absence of trust the same as distrust? Is trust rational, or cognitive, or is it a practice? In this paper I will attempt to locate the trust and ask how trust is earned, and, conversely, how it can be lost, using peer review as example. I have a joint affiliation with Stony Brook University and APS and would like both listed, in that order, in the abstract.

Using SERVQUAL and Kano research techniques in a patient service quality survey.

PubMed

Christoglou, Konstantinos; Vassiliadis, Chris; Sigalas, Ioakim

2006-01-01

This article presents the results of a service quality study. After an introduction to the SERVQUAL and the Kano research techniques, a Kano analysis of 75 patients from the General Hospital of Katerini in Greece is presented. The service quality criterion used satisfaction and dissatisfaction indices. The Kano statistical analysis process results strengthened the hypothesis of previous research regarding the importance of personal knowledge, the courtesy of the hospital employees and their ability to convey trust and confidence (assurance dimension). Managerial suggestions are made regarding the best way of acting and approaching hospital patients based on the basic SERVQUAL model.

Autonomy and performance in the public sector: the experience of English NHS hospitals.

PubMed

Verzulli, Rossella; Jacobs, Rowena; Goddard, Maria

2018-05-01

Since 2004, English NHS hospitals have been given the opportunity to acquire a more autonomous status known as a Foundation Trust (FT), whereby regulations and restrictions over financial, management, and organizational matters were reduced in order to create incentives to deliver higher-quality services in the most efficient way. Using difference-in-difference models, we test whether achieving greater autonomy (FT status) improved hospital performance, as proxied by measures of financial management, quality of care, and staff satisfaction. Results provide little evidence that the FT policy per se has made any difference to the performance of hospitals in most of these domains. Our findings have implications for health policy and inform the trend towards granting greater autonomy to public-sector organizations.

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis.

PubMed

Iwami, Michiyo; Ahmad, Raheelah; Castro-Sánchez, Enrique; Birgand, Gabriel; Johnson, Alan P; Holmes, Alison

2017-01-23

(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). 3 senior managers from 5 hospitals for qualitative interviews. As primary outcome measures, a 'Red-Amber-Green' (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A management approach that drives actions strategically: balanced scorecard in a mental health trust case study.

PubMed

Schmidt, Stefan; Bateman, Ian; Breinlinger-O'Reilly, Jochen; Smith, Peter

2006-01-01

Achieving excellence is a current preoccupation in U.K. public health organisations. This article aims to use a case study to explain how a mental health trust delivers excellent performance using a balanced scorecard (BSC) management approach. Reports a project to implement a BSC approach in the South West Yorkshire Mental Health NHS Trust to achieve its "excellence" objectives. The authors were participants in the project. The design of the pilot project was informed theoretically by the work of Kaplan and Norton and practically by in-house discussions on a strategy to achieve excellence. Explains the process of building a BSC strategy step-by-step. Discusses how the vision and strategies of a mental health trust can be translated into tangible measures, which are the basis for actions that are driven strategically. There are many possibilities for a BSC management approach and this case study is specific to mental health trusts in the UK, although it is believed that the case has a universally applicable modus operandi. This article will help healthcare managers to evaluate the benefits of a BSC management approach. This article explains how actions can be structured in connection with a BSC management approach.

Opsite Plus in the managment of low to moderate exuding wounds.

PubMed

Fear, M

This article discusses the use of OpSite Plus (formerly known as OpSite Post-Op) in the community setting. This semipermeable film dressing with an absorbent pad was evaluated by the community hospital and by practice and district nurses within Plymouth's NHS Primary Care Trust.

Treatment Approaches for Presurgical Anxiety: A Health Care Concern.

ERIC Educational Resources Information Center

Keogh, Nancy Jones; And Others

To test the differential effectiveness of preoperative instruction (factual information, emotional expression, and trust relationship), mastery modeling, and coping modeling, 100 children, aged 7-12, were studied. Subjects from two hospitals were randomly assigned to four experimental groups and one control group: alone (the control group, N=20);…

'Commitment' secures rooftop SSD contract.

PubMed

Davies, John

2010-01-01

John Davies, operations manager of multi-disciplinary mechanical and electrical and construction contractor cfes, describes a "turnkey" project that the company is undertaking for the Yeovil District Hospital (YDH) NHS Foundation Trust, involving both the design and construction of a new sterile services department, and substantial input into the facility's subsequent operation and management.

Organizational culture and its relationship with hospital performance in public hospitals in China.

PubMed

Zhou, Ping; Bundorf, Kate; Le Chang, Ji; Huang, Jin Xin; Xue, Di

2011-12-01

To measure perceptions of organizational culture among employees of public hospitals in China and to determine whether perceptions are associated with hospital performance. Hospital, employee, and patient surveys from 87 Chinese public hospitals conducted during 2009. Developed and administered a tool to assess organizational culture in Chinese public hospitals. Used factor analysis to create measures of organizational culture. Analyzed the relationships between employee type and perceptions of culture and between perceptions of culture and hospital performance using multivariate models. Employees perceived the culture of Chinese public hospitals as stronger in internal rules and regulations, and weaker in empowerment. Hospitals in which employees perceived that the culture emphasized cost control were more profitable and had higher rates of outpatient visits and bed days per physician per day but also had lower levels of patient satisfaction. Hospitals with cultures perceived as customer-focused had longer length of stay but lower patient satisfaction. Managers in Chinese public hospitals should consider whether the culture of their organization will enable them to respond effectively to their changing environment. © Health Research and Educational Trust.

Trust in Times of Challenge: Exploring the Relationships of Faculty and Administrators at Small, Private Under Resourced Colleges and Universities

ERIC Educational Resources Information Center

Hoppes, Cherron R.

2009-01-01

In an era of declining resources, higher education institutions are marshalling efforts to respond and remain sustainable. For small private college and universities with non-selective admissions criteria and limited resources, this is a particularly challenging period. The relationships between faculty and administrators play a key role in how…

Higher Education and the Public Trust: Improving Stature in Colleges and Universities. ASHE-ERIC Higher Education Report No. 6.

ERIC Educational Resources Information Center

Alfred, Richard L.; Weissman, Julie

Institutional stature, its development and determination, and strategies for its enhancement in colleges and universities are discussed. Focus is on the fundamental dimensions of stature, how it is affected by the external environment, and what colleges can do to improve it. Chapters are as follow: "Definition and Dimensions of Stature" (higher…

26 CFR 1.642(c)-3 - Adjustments and other special rules for determining unlimited charitable contributions deduction.

Code of Federal Regulations, 2014 CFR

2014-04-01

... distributed to M University, an organization described in section 501(c)(3) which is exempt from taxation... University, an organization described in section 501(c)(3) which is exempt from taxation under section 501(a...'s death the remainder of the trust is to be distributed to M Church. During the taxable year 1972...

26 CFR 1.642(c)-3 - Adjustments and other special rules for determining unlimited charitable contributions deduction.

Code of Federal Regulations, 2013 CFR

2013-04-01

... distributed to M University, an organization described in section 501(c)(3) which is exempt from taxation... University, an organization described in section 501(c)(3) which is exempt from taxation under section 501(a...'s death the remainder of the trust is to be distributed to M Church. During the taxable year 1972...

Continuity, Support, Togetherness and Trust: Findings from an Evaluation of a University-Administered Early Professional Development Programme for Teachers in England

ERIC Educational Resources Information Center

McIntyre, Joanna; Hobson, Andrew J.; Mitchell, Nick

2009-01-01

This article discusses the evaluation of a unique university-based early professional development (EPD) programme in England that enabled newly and recently qualified teachers to have continued contact with their initial teacher preparation provider. The programme was designed to enhance the induction, EPD and retention of beginning teachers of…

The Diffusion of Light and Education: Meeting the Challenges of Higher Education in Virginia

ERIC Educational Resources Information Center

Poliakoff, Michael; Alacbay, Armand

2012-01-01

In an uncertain environment, it is imperative that leaders of colleges and universities ensure that money spent on higher education--whether that money comes from students, parents, donors, or taxpayers--is being invested wisely. How well do colleges and universities in the Commonwealth of Virginia live up to the public trust? How do they compare…

Coordinated Collection Development via CD-ROM. A Pilot Project Granted by LSCA Title III Funds to Crosby Library, Gonzaga University. Final Narrative Report.

ERIC Educational Resources Information Center

Peterson, Elaine; Carr, Mary M.

Three colleges in the state of Washington--Gonzaga College (Crosby Library), Whitworth College, and Eastern Washington University--received grants from the Fred Meyer Charitable Trust and the Library Services and Construction Act to facilitate coordinated collection development in the areas of education and business/economics, so that their…

Specific Remedy for Specific Problem: Measuring Service Quality in South African Higher Education

ERIC Educational Resources Information Center

de Jager, Johan; Gbadamosi, Gbolahan

2010-01-01

This study commences a process of developing a scale for the measurement of service quality in higher education in South Africa and also examines the relationship between the measures of service quality on the one hand and some other related variables such as intention to leave the university, trust in management of the university and the overall…

EDUCATION: Gates Gives Cambridge a Rival to Rhodes.

PubMed

Cohen, J

2000-10-20

Thanks to a new $210 million trust announced on 11 October by the Bill & Melinda Gates Foundation, Cambridge University is launching a new high-visibility scholars' program, which each year will fund at least 225 students from outside the United Kingdom. The university will select Gates Cambridge Scholars based on merit, not need, focusing on academic ability and leadership potential.

Brand trust and image: effects on customer satisfaction.

PubMed

Khodadad Hosseini, Sayed Hamid; Behboudi, Leila

2017-08-14

Purpose The purpose of this paper is to investigate brand trust and brand image effects on healthcare service users. Nowadays, managers and health activists are showing increased tendency to marketing and branding to attract and satisfy customers. Design/methodology/approach The current study's design is based on a conceptual model examining brand trust and brand image effects on customer satisfaction. Data obtained from 240 questionnaires (310 respondents) were analyzed using path analysis. Findings Results revealed that the most effective items bearing the highest influence on customer satisfaction and on benefiting from healthcare services include brand image, staff sincerity to its patients, interactions with physicians and rapport. Research limitations/implications This study needs to be conducted in different hospitals and with different patients, which would lead to the model's expansion and its influence on the patient satisfaction. Originality/value Being the first study that simultaneously addresses brand trust and brand image effects on customer satisfaction, this research provides in-depth insights into healthcare marketing. Moreover, identifying significant components associated with healthcare branding helps managers and healthcare activists to create and protect their brands and, consequently, leading to an increased profitability resulting from the enhanced consumer satisfaction. Additionally, it would probably facilitate purchasing processes during the service selection.

Social capital among healthcare professionals: A prospective study of its importance for job satisfaction, work engagement and engagement in clinical improvements.

PubMed

Strömgren, Marcus; Eriksson, Andrea; Bergman, David; Dellve, Lotta

2016-01-01

Social capital can be an important resource to facilitate the needed improvements in quality of care and efficiency in hospitals. To assess the importance of social capital (recognition, vertical trust, horizontal trust and reciprocity) for job satisfaction, work engagement and engagement in clinical improvements. A prospective cohort design was used. Intensive care units and emergency, surgical and medical units at five Swedish hospitals with ongoing development of their processes of care. Healthcare professionals (physicians, registered nurses, assistant nurses) at five Swedish midsize hospitals. The participants answered a questionnaire at two occasions, NN=1602 at baseline and NN=1548 at one-year follow-up. Mean hospital response rate was 53% at baseline and 59% at follow-up. Univariate, multivariate and logistic regression analyses were performed, and the prospective analysis was based on 477 respondents. Social capital was associated with healthcare professionals' general work engagement and job satisfaction. Analysis showed positive associations between all measured aspects of social capital and engagement in clinical improvements of patient safety and quality of care. The prospective analysis showed that increased social capital predicted increased job satisfaction, work engagement and engagement in clinical improvements of patient safety. Social capital is strongly related to job satisfaction and active engagement with clinical improvements. The findings contribute to a deeper knowledge of social capital as a predictive factor that influences patient safety and health among healthcare staff. Copyright © 2015 Elsevier Ltd. All rights reserved.

Elective surgical patients' narratives of hospitalization: the co-construction of safety.

PubMed

Doherty, Carole; Saunders, Mark N K

2013-12-01

This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n=72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of 'chaos' and 'suffering' emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient-clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consumers' use of HCAHPS ratings and word-of-mouth in hospital choice.

PubMed

Huppertz, John W; Carlson, Jay P

2010-12-01

To investigate the impact of the HCAHPS report of patient experiences and word-of-mouth narratives on consumers' hospital choice. Online consumer research panel of U.S. adults ages 18 and older. In an experiment, 309 consumers were randomly assigned to see positive or negative information about a hospital in two modalities: HCAHPS graphs and a relative's narrative e-mail. Then they indicated their intentions to choose the hospital for elective surgery. A simple, one-paragraph e-mail and 10 HCAHPS graphs had similar impacts on consumers' hospital choice. When information was inconsistent between the HCAHPS data and e-mail narrative, one modality attenuated the other's effect on hospital choice. The findings illustrate the power of anecdotal narratives, suggesting that policy makers should consider how HCAHPS data can be affected by word-of-mouth communication. © Health Research and Educational Trust.

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.

PubMed

Sheldon, Trevor A; Cullum, Nicky; Dawson, Diane; Lankshear, Annette; Lowson, Karin; Watt, Ian; West, Peter; Wright, Dianne; Wright, John

2004-10-30

To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). Interrupted time series analysis, review of case notes, survey, and interviews. Acute and primary care trusts in England and Wales. All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context.

The impact of commercialisation and genetic data sharing arrangements on public trust and the intention to participate in biobank research.

PubMed

Critchley, Christine; Nicol, Dianne; Otlowski, Margaret

2015-01-01

The necessity for biobanks to share their resources with third parties poses potential risks to public trust and the intention to participate in genetic research. We explore the effects of data sharing and the type of third-party access (public vs. private) on public trust and, in turn, the intention to participate in biobank research. An experimental design was used to assess a national sample of 1,701 Australians via a computer-assisted telephone interview. The results revealed that trust and the intention to participate significantly decreased in relation to private compared to public biobanks, and when access to third-party researchers was allowed compared to when it was not. Somewhat surprisingly, no differences were found in relation to the third party being international compared to Australian, but trust and the intention to participate were significantly eroded when private third parties were allowed access. Those with a university education were particularly distrustful of private biobanks and biobanks that allowed access, while those who were more aware of genetic databases appeared more confident with biobanks sharing with private-sector third parties. The pattern of results suggests that public awareness of the need for biobanks to share their resources widely needs to be increased to maintain public trust and support. © 2015 S. Karger AG, Basel.

Smart information system for gachon university gil hospital.

PubMed

Park, Dong Kyun; Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-03-01

In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

Smart Information System for Gachon University Gil Hospital

PubMed Central

Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-01-01

Objectives In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. Methods This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. Results The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Conclusions Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future. PMID:22509476

The Balanced Budget Act of 1997 and U.S. hospital operations.

PubMed

Bazzoli, Gloria J; Lindrooth, Richard C; Hasnain-Wynia, Romana; Needleman, Jack

The Balanced Budget Act (BBA) of 1997 initiated several changes to Medicare payment policy in an effort to slow the growth of hospital Medicare payments and ensure the future of the Medicare Hospital Insurance Trust Fund. Although subsequent federal legislation relaxed some original proposals, restored funds were limited and directed to specific types of hospitals. In addition, these Medicare policy changes came at a time when hospitals faced private sector payment constraints. This paper assesses the short-term effects of the BBA on operations of nonprofit hospitals in the United States and compares these effects to those observed in the early 1980s during implementation of the Medicare prospective payment system (PPS). We found that some operational changes instituted by hospitals facing financial pressures from the BBA were similar to those observed for hospitals that faced pressure from Medicare PPS, including efforts to contain Medicare cost growth, to expand outpatient service provision, and to contain hospital staffing. However, during PPS implementation hospitals experienced declining inpatient use and growing profit margins, whereas post-BBA hospitals experienced growing inpatient use and declining margins.

Characteristics of the divested HCA and AMI hospitals.

PubMed

McCue, M J; Clement, J P

1992-04-01

The primary aim of this study was to compare and contrast the predivestiture managerial and market characteristics of the following: Divested and nondivested hospitals of Hospital Corporation of America (HCA) and American Medical International (AMI). The findings indicated that HCA hospitals with 1) lower occupancy rates, 2) less growth in revenues, 3) higher debt to total asset position, 4) fewer beds, 5) less growth in their elderly populations, and 6) less growth in their markets' per capita incomes had a higher probability of being divested into HealthTrust. The results for the AMI model were similar to those for the HCA model. AMI hospitals with 1) fewer beds, 2) less growth in their markets' per capita incomes, 3) lower salary expenses per discharge, 4) lower occupancy rates, and 5) increased growth in populations had a higher probability of being divested into EPIC.

Incidence, care quality and outcomes of patients with acute kidney injury in admitted hospital care.

PubMed

Medcalf, J F; Davies, C; Hollinshead, J; Matthews, B; O'Donoghue, D

2016-12-01

Acute kidney injury (AKI) is common in acute hospital admission and associated with worse patient outcomes. To measure incidence, care quality and outcome of AKI in admitted hospital care. Forty-six of 168 acute NHS healthcare trusts in UK caring for 2 million acute hospital admissions per annum collected information on adults identified with AKI stage 3 (3-fold rise in serum creatinine or creatinine >354 µmol/l) through routine biochemical testing over a 5-month period in 2012. Information was collected on patient and care characteristics. Primary outcomes were survival and recovery of kidney function at 1 month. A total of 15 647 patients were identified with biochemical AKI stage 3. Case note reviews were available for 7726 patients. In 80%, biochemical AKI stage 3 was confirmed clinically. Among this group, median age was 75 years, median length of stay was 12 days and the overall mortality within 1 month was 38%. Significant factors in a multivariable model predicting survival included age and some causes of AKI. Dipstick urinalysis, medication review, discussion with a nephrologist and acceptance for transfer to a renal unit were also associated with higher survival, but not early review by a senior doctor, acceptance for transfer to critical care or requirement for renal replacement therapy. Eighteen percent of people did not have their kidney function checked 1 month after the episode had resolved. This large study of in-hospital AKI supports the efficacy of biochemical detection of AKI in common usage. AKI mortality remains substantial, length of stay comparable with single-centre studies, and much of the variation is poorly explained (model Cox and Snell R 2  =   0.131) from current predictors. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Improving patient safety and healthcare quality: examples of good practice.

PubMed

Tingle, John

2017-07-27

John Tingle, Reader in Health Law at Nottingham Trent University, discusses a recent report by the Care Quality Commission that showcases eight NHS trusts that have improved their patient safety and healthcare quality.

[From the concept of guilt to the value-free notification of errors in medicine. Risks, errors and patient safety].

PubMed

Haller, U; Welti, S; Haenggi, D; Fink, D

2005-06-01

The number of liability cases but also the size of individual claims due to alleged treatment errors are increasing steadily. Spectacular sentences, especially in the USA, encourage this trend. Wherever human beings work, errors happen. The health care system is particularly susceptible and shows a high potential for errors. Therefore risk management has to be given top priority in hospitals. Preparing the introduction of critical incident reporting (CIR) as the means to notify errors is time-consuming and calls for a change in attitude because in many places the necessary base of trust has to be created first. CIR is not made to find the guilty and punish them but to uncover the origins of errors in order to eliminate them. The Department of Anesthesiology of the University Hospital of Basel has developed an electronic error notification system, which, in collaboration with the Swiss Medical Association, allows each specialist society to participate electronically in a CIR system (CIRS) in order to create the largest database possible and thereby to allow statements concerning the extent and type of error sources in medicine. After a pilot project in 2000-2004, the Swiss Society of Gynecology and Obstetrics is now progressively introducing the 'CIRS Medical' of the Swiss Medical Association. In our country, such programs are vulnerable to judicial intervention due to the lack of explicit legal guarantees of protection. High-quality data registration and skillful counseling are all the more important. Hospital directors and managers are called upon to examine those incidents which are based on errors inherent in the system.

Cost efficiency of university hospitals in the Nordic countries: a cross-country analysis.

PubMed

Medin, Emma; Anthun, Kjartan S; Häkkinen, Unto; Kittelsen, Sverre A C; Linna, Miika; Magnussen, Jon; Olsen, Kim; Rehnberg, Clas

2011-12-01

This paper estimates cost efficiency scores using the bootstrap bias-corrected procedure, including variables for teaching and research, for the performance of university hospitals in the Nordic countries. Previous research has shown that hospital provision of research and education interferes with patient care routines and inflates the costs of health care services, turning university hospitals into outliers in comparative productivity and efficiency analyses. The organisation of patient care, medical education and clinical research as well as available data at the university hospital level are highly similar in the Nordic countries, creating a data set of comparable decision-making units suitable for a cross-country cost efficiency analysis. The results demonstrate significant differences in university hospital cost efficiency when variables for teaching and research are entered into the analysis, both between and within the Nordic countries. The results of a second-stage analysis show that the most important explanatory variables are geographical location of the hospital and the share of discharges with a high case weight. However, a substantial amount of the variation in cost efficiency at the university hospital level remains unexplained.

A comprehensive audit of nursing record keeping practice.

PubMed

Griffiths, Paul; Debbage, Samantha; Smith, Alison

Good quality record keeping is essential to safe and effective patient care. To ensure that high standards of record keeping are maintained, regular clinical audit should be undertaken. This article describes an audit and re-audit of nursing record keeping at Sheffield Teaching Hospital NHS Foundation Trust. The article demonstrates improving audit data in 2005 and 2006 and describes how audit and the resulting recommendations and action plans can result in real improvements in the quality of record keeping. The keys to success in this ongoing audit programme are identified as stakeholder involvement, support from the senior nurses in the organization and the use of the data for both local and trust-wide purposes.

Managing the complexity of nurse shortages: a case study of bank and agency staffing in an acute care Trust in Wales, UK.

PubMed

Massey, Lynn; Esain, Ann; Wallis, Marianne

2009-07-01

Managing nurse shortages is a major challenge in Trusts today given the worldwide shortage of nurses. To fill the gap created by a lack of permanent staff UK government agencies have increasingly used bank and agency staff. Managing this type of staffing effectively and efficiently, in the context of shrinking healthcare funds, is a major challenge in providing safe and quality healthcare. To analyse bank and agency nursing staffing patterns and factors that impact on these patterns. Case study within the largest hospital in one Welsh Integrated Healthcare Trust. De-identified bank and agency staffing electronic and manual database records and focus group interview with bank and agency office staff. A predictable bank and agency staffing pattern was found, wherein bank and agency nursing staff were used with increasing frequency towards the end of the week. Demand for bank and agency nursing staff occurred because of: hospital practices that fund a fixed staff establishment for nursing units, while patient numbers and acuity are variable; poor forward planning; sickness, and absence due to professional development or staff training. There is a need for managers to reconsider management and recruitment policies, particularly in relation to using bank and agency staff. The complexity of staffing challenges managers to focus on predictability of workload needs and other factors that affect staffing requirements, such as: professional development, flexible working rosters to match the need and minimize sickness and turnover of staff.

The impact of leadership and quality climate on hospital performance.

PubMed

Shipton, Helen; Armstrong, Claire; West, Michael; Dawson, Jeremy

2008-12-01

To explore the relationship between leadership effectiveness and health-care trust performance, taking into account external quality measures and the number of patient complaints; also, to examine the role of care quality climate as a mediator. We developed scales for rating leadership effectiveness and care quality climate. We then drew upon UK national indices of health-care trust performance-Commission for Health Improvement star ratings, Clinical Governance Review ratings and the number of patient complaints per thousand. We conducted statistical analysis to examine any significant relationships between predictor and outcome variables. The study is based on 86 hospital trusts run by the National Health Service (NHS) in the UK. The data collection is part of an annual staff survey commissioned by the NHS to explore the quality of working life. A total of 17,949 employees were randomly surveyed (41% of the total sample). Leadership effectiveness is associated with higher Clinical Governance Review ratings and Commission for Health Improvement star ratings for our sample (beta = 0.42, P < 0.05; beta = 0.37, P < 0.05, respectively), and lower patient complaints (beta = -0.57, P < 0.05). In addition, 98% of the relationship between leadership and patient complaints is explained by care quality climate. Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area-patient complaints-may be a valid measure to consider when assessing leadership and quality in a health-care context.

A Model for Calculated Privacy and Trust in pHealth Ecosystems.

PubMed

Ruotsalainen, Pekka; Blobel, Bernd

2018-01-01

A pHealth ecosystem is a community of service users and providers. It is also a dynamic socio-technical system. One of its main goals is to help users to maintain their personal health status. Another goal is to give economic benefit to stakeholders which use personal health information existing in the ecosystem. In pHealth ecosystems, a huge amount of health related data is collected and used by service providers such as data extracted from the regulated health record and information related to personal characteristics, genetics, lifestyle and environment. In pHealth ecosystems, there are different kinds of service providers such as regulated health care service providers, unregulated health service providers, ICT service providers, researchers and industrial organizations. This fact together with the multidimensional personal health data used raises serious privacy concerns. Privacy is a necessary enabler for successful pHealth, but it is also an elastic concept without any universally agreed definition. Regardless of what kind of privacy model is used in dynamic socio-technical systems, it is difficult for a service user to know the privacy level of services in real life situations. As privacy and trust are interrelated concepts, the authors have developed a hybrid solution where knowledge got from regulatory privacy requirements and publicly available privacy related documents is used for calculation of service providers' specific initial privacy value. This value is then used as an estimate for the initial trust score. In this solution, total trust score is a combination of recommended trust, proposed trust and initial trust. Initial privacy level is a weighted arithmetic mean of knowledge and user selected weights. The total trust score for any service provider in the ecosystem can be calculated deploying either a beta trust model or the Fuzzy trust calculation method. The prosed solution is easy to use and to understand, and it can be also automated. It is possible to develop a computer application that calculates a situation-specific trust score, and to make it freely available on the Internet.

A qualitative study of the role of workplace and interpersonal trust in shaping service quality and responsiveness in Zambian primary health centres.

PubMed

Topp, Stephanie M; Chipukuma, Julien M

2016-03-01

Human decisions, actions and relationships that invoke trust are at the core of functional and productive health systems. Although widely studied in high-income settings, comparatively few studies have explored the influence of trust on health system performance in low- and middle-income countries. This study examines how workplace and inter-personal trust impact service quality and responsiveness in primary health services in Zambia. This multi-case study included four health centres selected for urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (two weeks/centre) and key informant interviews (14) that were recorded and transcribed verbatim. Case-based thematic analysis incorporated inductive and deductive coding. Findings demonstrated that providers had weak workplace trust influenced by a combination of poor working conditions, perceptions of low pay and experiences of inequitable or inefficient health centre management. Weak trust in health centre managers' organizational capacity and fairness contributed to resentment amongst many providers and promoted a culture of blame-shifting and one-upmanship that undermined teamwork and enabled disrespectful treatment of patients. Although patients expressed a high degree of trust in health workers' clinical capacity, repeated experiences of disrespectful or unresponsive care undermined patients' trust in health workers' service values and professionalism. Lack of patient-provider trust prompted some patients to circumvent clinic systems in an attempt to secure better or more timely care. Lack of resourcing and poor leadership were key factors leading to providers' weak workplace trust and contributed to often-poor quality services, driving a perverse cycle of negative patient-provider relations across the four sites. Findings highlight the importance of investing in both structural factors and organizational management to strengthen providers' trust in their employer(s) and colleagues, as an entry-point for developing both the capacity and a work culture oriented towards respectful and patient-centred care. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

The Influence of Social Capital on Nurse-Perceived Evidence-Based Practice Implementation in South Korea.

PubMed

Shin, Ji In; Lee, Eunjoo

2017-05-01

To examine the relationship between evidence-based practice (EBP) adoption and social capital in nurses and to determine how social capital affected EBP adoption in South Korea. A cross-sectional, correlational design was used. In total, 432 registered nurses from two university-affiliated teaching hospitals in South Korea completed the questionnaire, which included demographic items, the Developing Evidence-Based Practice Questionnaire, and the Social Capital Outcomes for Nurses scale. Data were analyzed using hierarchical regression to identify the predictors of EBP adoption. Nurses with higher social capital scores reported fewer perceived barriers to finding and reviewing evidence, and changing practice. Higher social capital scores were associated with higher levels of perceived facilitators of EBP adoption and skills appraisal in finding and reviewing evidence. Social capital was a significant predictor of EBP adoption. Nurses with greater opportunities to exchange and communicate their ideas freely are more likely to accept new evidence through diverse channels and trust-based relationships between nurses, which allows healthcare organizations to promote innovations such as EBP adoption. Therefore, social capital in nurses could serve as a driving force for EBP adoption and should provide a healthy foundation for changes in patient care practices. Nurses with higher social capital are tending to adopt EBP willingly. High trust enables nurses to facilitate and support change in practice. Therefore, to improve EBP adoption in patient care, it needs to be monitored that relationships between nurses are carefully structured and that they foster mutual interaction. © 2017 Sigma Theta Tau International.

Reflections on a community and university research collaboration.

PubMed

Mayo, Kevin; Tsey, Komla

2009-08-01

This paper reflects on the collaborative research relationship between university and community researchers. It identifies emergent themes expressed in the words of researchers and recommends strategies to assist with other research collaborations. Emergent themes included: Initial reticence by community members followed by positive experiences; the value of empowerment frameworks in research; building trust between community and university researchers; capacity building, management, and workloads; and community politics, misunderstandings and wealth disparity. The paper recommends strategies for successful research collaborations and identifies challenges to research collaborations.

Predictors of nursing home residents' time to hospitalization.

PubMed

O'Malley, A James; Caudry, Daryl J; Grabowski, David C

2011-02-01

To model the predictors of the time to first acute hospitalization for nursing home residents, and accounting for previous hospitalizations, model the predictors of time between subsequent hospitalizations. Merged file from New York State for the period 1998-2004 consisting of nursing home information from the minimum dataset and hospitalization information from the Statewide Planning and Research Cooperative System. Accelerated failure time models were used to estimate the model parameters and predict survival times. The models were fit to observations from 50 percent of the nursing homes and validated on the remaining observations. Pressure ulcers and facility-level deficiencies were associated with a decreased time to first hospitalization, while the presence of advance directives and facility staffing was associated with an increased time. These predictors of the time to first hospitalization model had effects of similar magnitude in predicting the time between subsequent hospitalizations. This study provides novel evidence suggesting modifiable patient and nursing home characteristics are associated with the time to first hospitalization and time to subsequent hospitalizations for nursing home residents. © Health Research and Educational Trust.

Factors determining patients’ intentions to use point-of-care testing medical devices for self-monitoring: the case of international normalized ratio self-testing

PubMed Central

Shah, Syed Ghulam Sarwar; Barnett, Julie; Kuljis, Jasna; Hone, Kate; Kaczmarski, Richard

2013-01-01

Purpose To identify factors that determine patients’ intentions to use point-of-care medical devices, ie, portable coagulometer devices for self-testing of the international normalized ratio (INR) required for ongoing monitoring of blood-coagulation intensity among patients on long-term oral anticoagulation therapy with vitamin K antagonists, eg, warfarin. Methods A cross-sectional study that applied the technology-acceptance model through a self-completed questionnaire, which was administered to a convenience sample of 125 outpatients attending outpatient anticoagulation services at a district general hospital in London, UK. Data were analyzed using descriptive statistics, factor analyses, and structural equation modeling. Results The participants were mainly male (64%) and aged ≥ 71 years (60%). All these patients were attending the hospital outpatient anticoagulation clinic for INR testing; only two patients were currently using INR self-testing, 84% of patients had no knowledge about INR self-testing using a portable coagulometer device, and 96% of patients were never offered the option of the INR self-testing. A significant structural equation model explaining 79% of the variance in patients’ intentions to use INR self-testing was observed. The significant predictors that directly affected patients’ intention to use INR self-testing were the perception of technology (β = 0.92, P < 0.001), trust in doctor (β = −0.24, P = 0.028), and affordability (β = 0.15, P = 0.016). In addition, the perception of technology was significantly affected by trust in doctor (β = 0.43, P = 0.002), age (β = −0.32, P < 0.001), and affordability (β = 0.23, P = 0.013); thereby, the intention to use INR self-testing was indirectly affected by trust in doctor (β = 0.40), age (β = −0.29), and affordability (β = 0.21) via the perception of technology. Conclusion Patients’ intentions to use portable coagulometers for INR self-testing are affected by patients’ perceptions about the INR testing device, the cost of device, trust in doctors/clinicians, and the age of the patient, which need to be considered prior to any intervention involving INR self-testing by patients. Manufacturers should focus on increasing the affordability of INR testing devices for patients’ self-testing and on the potential role of medical practitioners in supporting use of these medical devices as patients move from hospital to home testing. PMID:23300344

Trustworthy Research Institutions: The Challenging Case of Studying the Genetics of Intelligence.

PubMed

Johnston, Josephine; Banerjee, Mohini P; Geller, Gail

2015-01-01

It is simple enough to claim that academic research institutions ought to be trustworthy. Building the culture and taking the steps necessary to earn and preserve institutional trust are, however, complex processes. The experience motivating this special report--a request for the Center for Talented Youth at Johns Hopkins University to collaborate on research regarding the genetics of intelligence--illustrates how ensuring institutional trustworthiness can be in tension with a commitment to fostering research. In this essay, we explore the historical context for biomedical research institutions like Johns Hopkins that have worked to build local community trust. In so doing, we consider how the example under focus in this special report can lead to greater consideration of how research institutions balance fostering trust with their other commitments. © 2015 The Hastings Center.

On Trust: A Hard Look at Canadian Senior Officer Relationships During the Italian Campaign

DTIC Science & Technology

2015-05-01

as opposed to an individual who does not seem trustworthy to subordinates, is realistic. Soldiers are not robots —their needs, complex desires, fears...understaffed and struggling hospitals. “The next day, a contingent of British Nursing sisters arrived . . . they helped to an extent that would have been

Appreciating age diversity and German nurse well-being and commitment: co-worker trust as the mediator.

PubMed

Lehmann-Willenbrock, Nale; Lei, Zhike; Kauffeld, Simone

2012-06-01

Nursing practice faces the challenges of succeeding with a great diversity of customers and managing a diverse workforce with a wide range of age differences. While age diversity can lead to increased creativity and a greater richness of values and skills, it can also lead to value clashes, disrespect of each other's viewpoints, and increased conflict. As a result, nurses frequently experience stress, work-life imbalance, and a withdrawal from commitment. We propose the injection of positive diversity mindsets (age diversity appreciation) as one remedy. Specifically, we suggest that age diversity appreciation is positively related to nurses' well-being (stress and work-life balance), and also positively related to their team commitment. We further hypothesize that nurses' trust in co-workers mediates the hypothesized relationships. Our survey data of 138 nurses in a large hospital in Germany supported our hypotheses. We discuss both theoretical and managerial implications of our findings in the context of age diversity and nursing work outcomes in hospitals. © 2012 Blackwell Publishing Asia Pty Ltd.

Interpreter Services in An Inner City Teaching Hospital: A 6-Year Experience

PubMed Central

Khwaja, Nadeem; Sharma, Saroj; Wong, Julian; Murray, David; Ghosh, Jonathan; Murphy, Michael O; Halka, Anastassi T; Walker, Michael G

2006-01-01

INTRODUCTION Being able to communicate effectively with patients is essential not only from a medicolegal standpoint but more importantly from clinical governance perspectives. Issues such as informed consent and patient choice within the NHS are currently being highlighted; for these to be available to patients, their language requirements are paramount. PATIENTS AND METHODS An audit was performed by the Linkworkers office at the Central Manchester & Manchester Children's Hospital NHS (CMMC) Trust on the total number of attendances and refusals per language in the period 1998–2003. RESULTS In the CMMC Trust, Urdu/Punjabi, Bengali, Cantonese, Somali, Arabic and French represent the majority of the workload, comprising almost 80% of cases in 2003. In the same year, an increase in demand for languages of Eastern European countries became evident. Finding interpreters for these languages even via agencies can be extremely difficult. CONCLUSIONS If the current trend continues, requirement for these services will increase exponentially. For this demand to be met adequately these issues must be kept at the forefront of NHS planning. PMID:17132317

Paediatric Eye Services: How Much of the Workload Is Amblyopia-Related?

PubMed

Stewart, Catherine E; Shah, Shaheen; Wren, Siobhan; Roberts, Clare J

2016-09-01

The proportion of patients seen by the paediatric eye service that attend for reasons related to amblyopia has not been quantified. The purpose of this study was to quantify the proportion of patients seen in the paediatric eye service attending for reasons related to amblyopia. Records of all eye appointments of children attending the Hillingdon Hospitals NHS Foundation Trust and St Mary's Hospital Imperial College Healthcare NHS Trust over one month in 2009 were examined to determine the diagnosis and reason for attendance. Seven hundred and four patients had appointments booked at St Mary's and Hillingdon in March 2009. The fail-to-attend rates were not significantly different at the 2 sites (19% at St Mary's and 9% at Hillingdon; P=0.75). Of the 704 patients, 533 (St Mary's, 252 [75%]; Hillingdon, 281 [76%]) were attending for amblyopia-related reasons. Of the overall 982 booked appointments, 770 (79%) were amblyopia-related. Amblyopia diagnosis and management is clearly the most common cause of attendance to the paediatric eye service, accounting for over three-quarters of outpatient visits.

Knowledge Management Enablers and Process in Hospital Organizations.

PubMed

Lee, Hyun-Sook

2017-02-01

This research aimed to investigate the effects of knowledge management enablers, such as organizational structure, leadership, learning, information technology systems, trust, and collaboration, on the knowledge management process of creation, storage, sharing, and application. Using data from self-administered questionnaires in four Korean tertiary hospitals, this survey investigated the main organizational factors affecting the knowledge management process in these organizations. A total of 779 questionnaires were analyzed using SPSS 18.0 and AMOS 18.0. The results showed that organizational factors affect the knowledge management process differently in each hospital organization. From a managerial perspective, the implications of these factors for developing organizational strategies that encourage and foster the knowledge management process are discussed.

[Adverse events self-declaration system and influenza vaccination coverage of healthcare workers in a tertiary hospital].

PubMed

Velasco Munoz, Cesar; Sequera, Víctor-Guillermo; Vilajeliu, Alba; Aldea, Marta; Mena, Guillermo; Quesada, Sebastiana; Varela, Pilar; Olivé, Victoria; Bayas, José M; Trilla, Antoni

2016-02-19

During the influenza vaccination campaign 2011-2012 we established a self-declaration system of adverse events (AEs) in healthcare workers (HCW). The aim of this study is to describe the vaccinated population and analyse vaccination coverage and self-declared AEs after the voluntary flu vaccination in a university hospital in Barcelona. Observational study. We used the HCW immunization record to calculate the vaccination coverage. We collected AEs using a voluntary, anonymous, self-administered survey during the 2011-2012 flu vaccination campaign. We performed a logistic regression model to determine the associated factors to declare AEs. The influenza vaccination coverage in HCW was 30.5% (n=1,507/4,944). We received completed surveys from 358 vaccinated HCW (23.8% of all vaccinated). We registered AEs in 186 respondents to the survey (52.0% of all respondents). Of these, 75.3% (n=140) reported local symptoms after the flu vaccination, 9.7% (n=18) reported systemic symptoms and 15.1% (n=28) both local and systemic symptoms. No serious AEs were self-reported. Female sex and aged under 35 were both factors associated with declaring AEs. Our self-reporting system did not register serious AEs in HCW, resulting in an opportunity to improve HCW trust in flu vaccination. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

EFFECTS OF MEDICAL DISPUTES ON INTERNET COMMUNICATIONS OF NEGATIVE EMOTIONS AND NEGATIVE ONLINE WORD-OF-MOUTH.

PubMed

Lee, Yi-Chih; Wu, Wei-Li

2015-08-01

Emotions play an important role in human behavior. Negative emotions resulting from medical disputes are problems for medical personnel to solve but also have a significant impact on a hospital's reputation and people's trust in the hospital. One medical dispute case was chosen from an Internet news source to assess the correlation between people's negative emotions and negative online word-of-mouth. Convenience sampling was used in school faculties and university students who had shared their medical treatment experiences online were the research participants. A total of 221 Taiwanese participants volunteered (158 women, 63 men; ages: 26.7% under 19, 22.6% 20-29, 30.8% 30-39,19.9% over 40). Four negative emotions were measured using rating scales: uncertainty, anger, disappointment, and sadness. Four negative online word-of-mouth measures were: venting, advice search, helping receiver, and revenge. A modeled relationship was assessed by partial least square method (PLS). Then, people's positive emotions were further analyzed to assess changes after spreading negative word-of-mouth. The results showed that uncertainty had a positive effect on venting and advice search. People who felt anger or regret spread word-of-mouth in order to help the receiver. Disappointment may trigger the revenge behavior of negative word-of-mouth. Negative emotions could be relieved after engaging in the behavior of helping the receiver.

Rural hospital ownership: medical service provision, market mix, and spillover effects.

PubMed

Horwitz, Jill R; Nichols, Austin

2011-10-01

To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

Surrogate Motherhood: A Trust-Based Approach.

PubMed

Beier, Katharina

2015-12-01

Because it is often argued that surrogacy should not be treated as contractual, the question arises in which terms this practice might then be couched. In this article, I argue that a phenomenology of surrogacy centering on the notion of trust provides a description that is illuminating from the moral point of view. My thesis is that surrogacy establishes a complex and extended reproductive unit--the "surrogacy triad" consisting of the surrogate mother, the child, and the intending parents--whose constituents are bound together by mutual trustful commitments. Even though a trust-based approach does not provide an ultimate answer to whether surrogacy should be sanctioned or prohibited, it allows for at least some practical suggestions. In particular, I will argue that, under certain conditions, surrogacy is tenable within familial or other significant relationships, and I will stress the necessity of acknowledging the new relationships and moral commitments that result from this practice. © The Author 2015. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Medical bribery and the ethics of trust: the Romanian case.

PubMed

Manea, Teodora

2015-02-01

Medical bribery seems to be a global problem from Eastern Europe and the Balkans to China, a diffuse phenomenon, starting with morally acceptable gratitude and ending with institutional bribery. I focus my attention on Romania and analyze similar cases in Eastern European and postcommunist countries. Medical bribery can be regarded as a particular form of human transaction, a kind of primitive contract that occurs when people do not trust institutions or other forms of social contract that are meant to guarantee their rights and protect their interests. Concluding with strategies to fight medical bribery, I will underline better public policies for financing health and social care, and an ethic of trust that may help to restore trustworthiness of institutions and to rebuild interpersonal trust. This should be complemented by an educational program dedicated to understanding the negative consequences and mechanisms of corruption and the importance of ethical behavior. © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessing Community Quality of Health Care.

PubMed

Herrin, Jeph; Kenward, Kevin; Joshi, Maulik S; Audet, Anne-Marie J; Hines, Stephen J

2016-02-01

To determine the agreement of measures of care in different settings-hospitals, nursing homes (NHs), and home health agencies (HHAs)-and identify communities with high-quality care in all settings. Publicly available quality measures for hospitals, NHs, and HHAs, linked to hospital service areas (HSAs). We constructed composite quality measures for hospitals, HHAs, and nursing homes. We used these measures to identify HSAs with exceptionally high- or low-quality of care across all settings, or only high hospital quality, and compared these with respect to sociodemographic and health system factors. We identified three dimensions of hospital quality, four HHA dimensions, and two NH dimensions; these were poorly correlated across the three care settings. HSAs that ranked high on all dimensions had more general practitioners per capita, and fewer specialists per capita, than HSAs that ranked highly on only the hospital measures. Higher quality hospital, HHA, and NH care are not correlated at the regional level; regions where all dimensions of care are high differ systematically from regions which score well on only hospital measures and from those which score well on none. © Health Research and Educational Trust.

Howard University Hospital finds partner in helping children succeed.

PubMed

Botvin, Judith D

2005-01-01

Howard University Hospital, Washington, D.C., becomes the site for the launch of a national ad campaign by the nonprofit youth education organization, Communities in Schools. The hospital and university share the organization's mission of supporting young people in the community.

The relationship between organizational culture and performance in acute hospitals.

PubMed

Jacobs, Rowena; Mannion, Russell; Davies, Huw T O; Harrison, Stephen; Konteh, Fred; Walshe, Kieran

2013-01-01

This paper examines the relationship between senior management team culture and organizational performance in English acute hospitals (NHS Trusts) over three time periods between 2001/2002 and 2007/2008. We use a validated culture rating instrument, the Competing Values Framework, to measure senior management team culture. Organizational performance is assessed using a wide range of routinely collected indicators. We examine the associations between organizational culture and performance using ordered probit and multinomial logit models. We find that organizational culture varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance. Moreover, hospitals are moving towards more competitive culture archetypes which mirror the current policy context, though with a stronger blend of cultures. The study provides evidence for a relationship between culture and performance in hospital settings. Copyright © 2012 Elsevier Ltd. All rights reserved.

Junior doctor dementia champions in a district general hospital (innovative practice).

PubMed

Wilkinson, Iain; Coates, Anna; Merrick, Sophie; Lee, Chooi

2016-03-01

Dementia is a common condition in the UK with around 25% of patients in acute hospitals having dementia. In the UK, there is national guidance on the assessment of cognitive impairment in acute hospitals. This article is a qualitative study of junior doctors' experiences as part of a dementia and delirium team involved in changing the care of patients with dementia in a hospital in the UK. It draws on data from a focus group and follow-up questionnaire in two hospital trusts. We examine what drives doctors to become involved in such projects and the effects of this experience upon them. We suggest a typology for getting junior doctors involved in projects generating change when working with patients with dementia. Being more actively involved in caring for and developing services for patients with dementia may represent the crossing of an educational threshold for these junior doctors. © The Author(s) 2016.

An action research approach for developing research and innovation in nursing and midwifery practice: building research capacity in one NHS foundation trust.

PubMed

Moore, Jenny; Crozier, Kenda; Kite, Katharine

2012-01-01

The National Health Service in the United Kingdom is committed to a process of reform centred on quality care and innovative practice. Central to this process is the need for research capacity building within the workforce. The aim of this study was to develop an infrastructure for research capacity building within one National Health Service Foundation Trust. Using an Action Research methodology, sixteen individuals were purposefully selected from a population of nurses and midwives to participate in the study. This nonprobability sampling method enabled the researchers to select participants on the basis of who would be most informative about existing research capacity building structures and processes within the Trust. Data were collected in the form of semi-structured individual interviews with each participant. The main findings were that research activity was not embedded in the culture of the organisation, and initiating and undertaking change was a complex process. As a result, a range of structures and processes which were considered necessary to enable the Trust move forward in developing capacity and capability for research were developed and implemented. This paper reports the first two stages of this process, namely: the findings from the pre-step and an outline of how these findings were used to create an infrastructure to support research capacity building within one NHS Foundation Trust Hospital in the United Kingdom. Copyright © 2011 Elsevier Ltd. All rights reserved.

Trust in Physicians, Continuity and Coordination of Care, and Quality of Death in Patients with Advanced Cancer.

PubMed

Hamano, Jun; Morita, Tatsuya; Fukui, Sakiko; Kizawa, Yoshiyuki; Tunetou, Satoru; Shima, Yasuo; Kobayakawa, Makoto; Aoyama, Maho; Miyashita, Mitsunori

2017-11-01

Provider-centered factors contribute to unexplained variation in the quality of death (QOD). The relationship between healthcare providers (HCPs) and patients, bidirectional communication, and consistency of longitudinal care planning are important provider-centered factors. To explore whether the level of trust in HCPs, the quality of continuity of care, and the level of coordination of care among home HCPs are associated with the QOD for cancer patients dying at home. This study was a part of a nationwide multicenter questionnaire survey of bereaved family members of cancer patients evaluating the quality of end-of-life care in Japan. We investigated 702 family members of cancer patients who died at home. The QOD was evaluated from nine core domains of the short version of the Good Death Inventory (GDI). We measured five factors on a Likert scale, including patient and family trust in HCPs, continuity of care by home hospice and hospital physicians, and coordination of care among home hospice staff. A total of 538 responses (77%) were obtained and 486 responses were analyzed. Trust in HCPs was correlated with the GDI score (r = 0.300-0.387, p < 0.001). The quality of care coordination was associated with the GDI score (r = 0.242, p < 0.001). Trust of the patient and family in home hospice staff, as well as coordination of care among hospice staff, are associated with the QOD for cancer patients dying at home.

Reflections of a Vaccinologist: Lessons Learned About What We Can Do to Improve Trust in Vaccines and Vaccine Programsa.

PubMed

Halsey, Neal A

2017-03-01

Public trust can be improved by learning from past mistakes, by establishing a standing forum for review of new concerns as they arise, and by maintaining a robust vaccine safety system. Developing standard guidelines for reporting causality assessment in case reports would help educate physicians and prevent future unnecessary concerns based on false assumptions of causal relationships. © The Author 2015. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Expertise on Call.

ERIC Educational Resources Information Center

Jordan, Ronald R.

1996-01-01

College and university planned giving program administrators are advised to establish an advisory committee of financial professionals (attorneys, certified public accountants, brokers, investment advisors, financial planners, trust officers, insurance professionals) to act as a source of referrals, advice, and program support. Member selection,…

Minimum nurse staffing legislation and the financial performance of California hospitals.

PubMed

Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A

2012-06-01

To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

PubMed

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews

PubMed Central

Sheldon, Trevor A; Cullum, Nicky; Dawson, Diane; Lankshear, Annette; Lowson, Karin; Watt, Ian; West, Peter; Wright, Dianne; Wright, John

2004-01-01

Objectives To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence (NICE). Design Interrupted time series analysis, review of case notes, survey, and interviews. Setting Acute and primary care trusts in England and Wales. Participants All primary care prescribing, hospital pharmacies; a random sample of 20 acute trusts, 17 mental health trusts, and 21 primary care trusts; and senior clinicians and managers from five acute trusts. Main outcome measures Rates of prescribing and use of procedures and medical devices relative to evidence based guidance. Results 6308 usable patient audit forms were returned. Implementation of NICE guidance varied by trust and by topic. Prescribing of some taxanes for cancer (P < 0.002) and orlistat for obesity (P < 0.001) significantly increased in line with guidance. Prescribing of drugs for Alzheimer's disease and prophylactic extraction of wisdom teeth showed trends consistent with, but not obviously a consequence of, the guidance. Prescribing practice often did not accord with the details of the guidance. No change was apparent in the use of hearing aids, hip prostheses, implantable cardioverter defibrillators, laparoscopic hernia repair, and laparoscopic colorectal cancer surgery after NICE guidance had been issued. Conclusions Implementation of NICE guidance has been variable. Guidance seems more likely to be adopted when there is strong professional support, a stable and convincing evidence base, and no increased or unfunded costs, in organisations that have established good systems for tracking guidance implementation and where the professionals involved are not isolated. Guidance needs to be clear and reflect the clinical context. PMID:15514342

Much ado about flu: A mixed methods study of parental perceptions, trust and information seeking in a pandemic.

PubMed

King, Catherine L; Chow, Maria Y K; Wiley, Kerrie E; Leask, Julie

2018-07-01

Effective public health messaging is essential in both the planning phase and duration of a pandemic. This study aimed to gain an understanding of parental information seeking, trusted sources and needs in relation to pandemic influenza A 2009 (pH1N1) to inform future policy planning and resource development. We conducted a mixed methods study; parents from 16 childcare centres in Sydney, Australia, were surveyed between 16 November and 9 December 2009, and interviews were conducted with participants from six childcare centres between June 2009 and May 2011. From 972 surveys distributed, 431 were completed; a response rate of 44%. Most parents (90%) reported that doctors were "trusted a lot" as a source of influenza information, followed by nurses (59%), government (56%) and childcare centres (52%). Less trusted sources included media (7% selected "trusted a lot"), antivaccination groups (6%) and celebrities (1%). Parents identified a range of key search terms for influenza infection and vaccine. From 42 in-depth interviews, key themes were as follows: "Action trigger," "In an emergency, think Emergency," "Fright to hype" and "Dr Google and beyond." Parents relied heavily on media messages, but cynicism emerged when the pandemic was milder than expected. Parents viewed a range of information sources as trustworthy, including doctors, authoritative hospital or government websites, and childcare centres and schools. A user-centred orientation is vital for pandemic communications including tailored information provision, via trusted sources based on what parents want to know and how they can find it. © 2018 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.

PubMed

Perkins, Gavin D; Davies, Robin P; Quinton, Sarah; Woolley, Sarah; Gao, Fang; Abella, Ben; Stallard, Nigel; Cooke, Matthew W

2011-10-18

Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. ISRCTN56583860.

Accuracy and Coverage of Diagnosis and Procedural Coding of Severely Injured Patients in the Finnish Hospital Discharge Register: Comparison to Patient Files and the Helsinki Trauma Registry.

PubMed

Heinänen, M; Brinck, T; Handolin, L; Mattila, V M; Söderlund, T

2017-09-01

The Finnish Hospital Discharge Register data are frequently used for research purposes. The Finnish Hospital Discharge Register has shown excellent validity in single injuries or disease groups, but no studies have assessed patients with multiple trauma diagnoses. We aimed to evaluate the accuracy and coverage of the Finnish Hospital Discharge Register but at the same time validate the data of the trauma registry of the Helsinki University Hospital's Trauma Unit. We assessed the accuracy and coverage of the Finnish Hospital Discharge Register data by comparing them to the original patient files and trauma registry files from the trauma registry of the Helsinki University Hospital's Trauma Unit. We identified a baseline cohort of patients with severe thorax injury from the trauma registry of the Helsinki University Hospital's Trauma Unit of 2013 (sample of 107 patients). We hypothesized that the Finnish Hospital Discharge Register would lack valuable information about these patients. Using patient files, we identified 965 trauma diagnoses in these 107 patients. From the Finnish Hospital Discharge Register, we identified 632 (65.5%) diagnoses and from the trauma registry of the Helsinki University Hospital's Trauma Unit, 924 (95.8%) diagnoses. A total of 170 (17.6%) trauma diagnoses were missing from the Finnish Hospital Discharge Register data and 41 (4.2%) from the trauma registry of the Helsinki University Hospital's Trauma Unit data. The coverage and accuracy of diagnoses in the Finnish Hospital Discharge Register were 65.5% (95% confidence interval: 62.5%-68.5%) and 73.8% (95% confidence interval: 70.4%-77.2%), respectively, and for the trauma registry of the Helsinki University Hospital's Trauma Unit, 95.8% (95% confidence interval: 94.5%-97.0%) and 97.6% (95% confidence interval: 96.7%-98.6%), respectively. According to patient records, these patients were subjects in 249 operations. We identified 40 (16.1%) missing operation codes from the Finnish Hospital Discharge Register and 19 (7.6%) from the trauma registry of the Helsinki University Hospital's Trauma Unit. The validity of the Finnish Hospital Discharge Register data is unsatisfactory in terms of the accuracy and coverage of diagnoses in patients with multiple trauma diagnoses. Procedural codes provide greater accuracy. We found the coverage and accuracy of the trauma registry of the Helsinki University Hospital's Trauma Unit to be excellent. Therefore, a special trauma registry, such as the trauma registry of the Helsinki University Hospital's Trauma Unit, provides much more accurate data and should be the preferred registry when extracting data for research or for administrative use, such as resource prioritizing.

Modeling cascading failures with the crisis of trust in social networks

NASA Astrophysics Data System (ADS)

Yi, Chengqi; Bao, Yuanyuan; Jiang, Jingchi; Xue, Yibo

2015-10-01

In social networks, some friends often post or disseminate malicious information, such as advertising messages, informal overseas purchasing messages, illegal messages, or rumors. Too much malicious information may cause a feeling of intense annoyance. When the feeling exceeds a certain threshold, it will lead social network users to distrust these friends, which we call the crisis of trust. The crisis of trust in social networks has already become a universal concern and an urgent unsolved problem. As a result of the crisis of trust, users will cut off their relationships with some of their untrustworthy friends. Once a few of these relationships are made unavailable, it is likely that other friends will decline trust, and a large portion of the social network will be influenced. The phenomenon in which the unavailability of a few relationships will trigger the failure of successive relationships is known as cascading failure dynamics. To our best knowledge, no one has formally proposed cascading failures dynamics with the crisis of trust in social networks. In this paper, we address this potential issue, quantify the trust between two users based on user similarity, and model the minimum tolerance with a nonlinear equation. Furthermore, we construct the processes of cascading failures dynamics by considering the unique features of social networks. Based on real social network datasets (Sina Weibo, Facebook and Twitter), we adopt two attack strategies (the highest trust attack (HT) and the lowest trust attack (LT)) to evaluate the proposed dynamics and to further analyze the changes of the topology, connectivity, cascading time and cascade effect under the above attacks. We numerically find that the sparse and inhomogeneous network structure in our cascading model can better improve the robustness of social networks than the dense and homogeneous structure. However, the network structure that seems like ripples is more vulnerable than the other two network structures. Our findings will be useful in further guiding the construction of social networks to effectively avoid the cascading propagation with the crisis of trust. Some research results can help social network service providers to avoid severe cascading failures.

Staff perceptions of quality of care: an observational study of the NHS Staff Survey in hospitals in England.

PubMed

Pinder, Richard J; Greaves, Felix E; Aylin, Paul P; Jarman, Brian; Bottle, Alex

2013-07-01

There is some evidence to suggest that higher job satisfaction among healthcare staff in specific settings may be linked to improved patient outcomes. This study aimed to assess the potential of staff satisfaction to be used as an indicator of institutional performance across all acute National Health Service (NHS) hospitals in England. Using staff responses from the NHS Staff Survey 2009, and correlating these with hospital standardised mortality ratios (HSMR), correlation analyses were conducted at institutional level with further analyses of staff subgroups. Over 60 000 respondents from 147 NHS trusts were included in the analysis. There was a weak negative correlation with HSMR where staff agreed that patient care was their trust's top priority (Kendall τ = -0.22, p<0.001), and where they would be happy with the care for a friend or relative (Kendall τ = -0.30, p<0.001). These correlations were identified across clinical and non-clinical groups, with nursing staff demonstrating the most robust correlation. There was no correlation between satisfaction with the quality of care delivered by oneself and institutional HSMR. In the context of the continued debate about the relationship of HSMR to hospital performance, these findings of a weak correlation between staff satisfaction and HSMR are intriguing and warrant further investigation. Such measures in the future have the advantage of being intuitive for lay and specialist audiences alike, and may be useful in facilitating patient choice. Whether higher staff satisfaction drives quality or merely reflects it remains unclear.

Building Public Governing Board Capacity through State-Level Education Programs for College and University Board Members. State Policy Brief

ERIC Educational Resources Information Center

Association of Governing Boards of Universities and Colleges, 2013

2013-01-01

State policymakers and the public at large have a vested interest in the successful governance of their higher education system. The citizens who are appointed or elected to serve as trustees and regents of the state's colleges and universities oversee valuable public assets that they hold in trust for the state and current and future…

Using Covert Means to Establish Cybercraft Command and Control

DTIC Science & Technology

2009-03-01

unknown entity. This mimics human trust patterns in many ways [15]. Take for example a human trying to find 10 a new auto mechanic or a new babysitter ...AIR UNIVERSITY AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. The views...Department of Electrical and Computer Engineering Graduate School of Engineering and Management Air Force Institute of Technology Air University Air

Why and When do Patients Use e-Consultation Services? The Trust and Resource Supplementary Perspectives.

PubMed

Li, Jia; Liu, Minghui; Liu, Xuan; Ma, Ling

2018-01-01

e-Consultation provides a new way to deliver healthcare services online. With the help of e-Consultation services, patients can gain access to nationwide medical expertise that otherwise would not be available to them. As an online delivery approach, e-Consultation also provides a choice for patients to receive medical advice from online doctors immediately, no matter how far away from the hospital they may be or how late in the day it is. However, the adoption and usage of e-Consultation is still far from satisfactory. Therefore, understanding why and when patients use e-Consultation services are important research questions. Considering that the choice of a healthcare provider is a serious decision, this research uses the trust perspective to explain the e-Consultation service adoption phenomenon. Specifically, trust is conceptualized as a second-order construct consisting of two dimensions: competence and integrity. In addition, e-Consultation is viewed as a supplementary resource to traditional off-line consultation services, and disease type as a contextual factor is hypothesized to focus the context where e-Consultation services are more suitable. A scenario-based survey was conducted to test the proposed research model. We obtained a total of 190 valid questionnaires. Our results indicated that trust (p < 0.01) had a positive effect on the intention to use an e-Consultation service. Meanwhile, our results also indicated that the higher the disease is in rarity (p < 0.05), severity (p < 0.01), or urgency (p < 0.05), the lesser the positive effect of trust is on the intention to use an e-Consultation service. Trust is the major driving force of an e-Consultation service adoption. When the disease is high in rarity, severity, or urgency, an off-line healthcare provider is less capable of providing meaningful, qualified, and immediate service. Therefore, there is a decreased positive effect of trust on the intention to use an e-Consultation service for those diseases.

The use of mobile technology in health libraries: a summary of a UK-based survey.

PubMed

Chamberlain, David; Elcock, Martin; Puligari, Preeti

2015-12-01

Health libraries have changed over the past fifteen years in the format of the information they provide. This is driven by developments in technology. To conduct a survey of NHS health libraries in the United Kingdom in order to summarise how mobile technologies are being used, how they are promoted and how they are delivered, highlighting good practice and solutions to issues. An online survey was carried out in 2013 and sent to academic and NHS web-based discussion lists. There were 199 responses. Main replies were from large Acute Hospital Trusts. Only 18% of respondents had conducted research into use of mobile technology (MT) within their Trust. Forty per cent of Trusts offered clinical point of care tools, 29% mobile catalogues, and 30% had mobile enabled web sites. Libraries utilised third-party partnerships rather than develop their own applications or tools. Seventy per cent of Trusts promoted new MT services via e-mail. Network restrictions were the main barrier to development as well as finance and expertise. Uptake and development of MT is sporadic and driven by individuals. There is an opportunity for collaboration and sharing resources and expertise. There are benefits to adopting user-friendly resources. © 2015 Health Libraries Group.

[Gerontopsychosomatic consultation/liaison service in inpatient acute geriatrics : Effects of trust and support on patient-nurse interaction].

PubMed

Lindner, Reinhard

2018-06-01

Geriatric and psychosomatic medicine follow a biopsychosocial paradigm. Despite this similar "Menschenbild" in general, collaboration between geriatrics and psychosomatics is still rare. This comparative interventional study aims to find possible effects of psychosomatic work in geriatrics on the interaction between patients and nursing staff and contentment of patients with treatment in general. In the period of one year 238 geriatric patients (return rate 22.2%) of the intervention ward (psychosomatic consultation-/liaison service) and the control ward (TAU) were investigated with an anonymized questionnaire. Two questions were evaluated, concerning the patients trust in the nurses and their experience of being able to speak with them about their anxieties and concerns. This is interpreted as an indicator for the advancement of patients' contentment with treatment. In comparison with the control ward during the intervention the answers to both questions showed an increasing trust in the nurses and an increasing experience of speaking about anxieties and concerns with the nurses. This is evaluated as some evidence for the promotion of the patients' contentment with the treatment CONCLUSION: A psychosomatic consultation-/liaison service in geriatric medicine generates a positive effect on the relationship between patients and nursing staff, especially concerning trust and acceptance in existential situations of illness and limitation in hospital.

A substantial number of scientific publications originate from non-university hospitals.

PubMed

Fedder, Jens; Nielsen, Gunnar Lauge; Petersen, Lars J; Rasmussen, Claus; Lauszus, Finn F; Frost, Lars; Hornung, Nete; Lederballe, Ole; Andersen, Jens Peter

2011-11-01

As we found no recent published reports on the amount and kind of research published from Danish hospitals without university affiliation, we have found it relevant to conduct a bibliometric survey disclosing these research activities. We retrieved all scientific papers published in the period 2000-2009 emanating from all seven Danish non-university hospitals in two regions, comprising 1.8 million inhabitants, and which were registered in a minimum of one of the three databases: PubMed MEDLINE, Thomson Reuters Web of Science and Elsevier's Scopus. In 878 of 1,252 papers, the first and/or last author was affiliated to a non-university hospital. Original papers made up 69% of these publications versus 86% of publications with university affiliation on first or last place. Case reports and reviews most frequently had authors from regional hospitals as first and/or last authors. The total number of publications from regional hospitals increased by 48% over the 10-year period. Publications were cited more often if the first or last author was from a university hospital and even more so if they were affiliated to foreign institutions. Cardiology, gynaecology and obstetrics, and environmental medicine were the three specialities with the largest number of regional hospital publications. A substantial number of scientific publications originate from non-university hospitals. Almost two thirds of the publications were original research published in international journals. Variations between specialities may reflect local conditions. not relevant. not relevant.

A hospital-specific template for benchmarking its cost and quality.

PubMed

Silber, Jeffrey H; Rosenbaum, Paul R; Ross, Richard N; Ludwig, Justin M; Wang, Wei; Niknam, Bijan A; Saynisch, Philip A; Even-Shoshan, Orit; Kelz, Rachel R; Fleisher, Lee A

2014-10-01

Develop an improved method for auditing hospital cost and quality tailored to a specific hospital's patient population. Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, New York, and Texas between 2004 and 2006. A template of 300 representative patients from a single index hospital was constructed and used to match 300 patients at 43 hospitals that had a minimum of 500 patients over a 3-year study period. From each of 43 hospitals we chose 300 patients most resembling the template using multivariate matching. We found close matches on procedures and patient characteristics, far more balanced than would be expected in a randomized trial. There were little to no differences between the index hospital's template and the 43 hospitals on most patient characteristics yet large and significant differences in mortality, failure-to-rescue, and cost. Matching can produce fair, directly standardized audits. From the perspective of the index hospital, "hospital-specific" template matching provides the fairness of direct standardization with the specific institutional relevance of indirect standardization. Using this approach, hospitals will be better able to examine their performance, and better determine why they are achieving the results they observe. © Health Research and Educational Trust.

Blinkered assumptions imply that i do not belong in nursing.

PubMed

Scott, David

2012-07-04

Starjeena D'Costa writes that barring nurses employed on NHS contracts from agency work is anti-competitive and potentially in breach of sex discrimination legislation (June 27). She writes: 'Would hospital trusts want to prevent tradesmen from doing paid work at the weekends or doctors working for an agency?' As a male third-year nursing.

Colleges and Employees Explore Ways to Provide for Healthy Retirements

ERIC Educational Resources Information Center

Dotinga, Randy

2008-01-01

Faculty members and administrators should not assume that their colleges will pick up their medical bills during their retirement. Medicare benefits are not guaranteed that they will remain the same. Experts believe that the Medicare trust fund that pays for retiree hospital care will go bankrupt by 2019. As such, insurance experts are now urging…

Millions in cash in your hospital halls. Calculating the cash value of employee engagement, Part II.

PubMed

Simon, Matthew

2003-01-01

Quality of care and the bottom line are often seen as trade-offs. But this can be a false dichotomy. As we shall see, many of the factors impacted by employee engagement--a term that encompasses trust, loyalty, motivation and cooperative spirit--contribute to both quality of care and financial performance.

An Overview of a UK Paediatric Visual Impaired Population and Low Vision Aid Provision

ERIC Educational Resources Information Center

Theodorou, Nana; Shipman, Tracey

2013-01-01

A retrospective study was carried out to evaluate the paediatric visual impaired population attending the Low Vision Clinic at Sheffield Teaching Hospitals NHS Foundation Trust, over a period of 14 years. Data were collected and analysed for children less than 17 years for prevalence, demographics, registration status, aetiologies, and types of…

Relationship between trusting behaviors and psychometrics associated with social network and depression among young generation: a pilot study.

PubMed

Watabe, Motoki; Kato, Takahiro A; Teo, Alan R; Horikawa, Hideki; Tateno, Masaru; Hayakawa, Kohei; Shimokawa, Norihiro; Kanba, Shigenobu

2015-01-01

Maladaptive social interaction and its related psychopathology have been highlighted in psychiatry especially among younger generations. In Japan, novel expressive forms of psychiatric phenomena such as "modern-type depression" and "hikikomori" (a syndrome of severe social withdrawal lasting for at least six months) have been reported especially among young people. Economic games such as the trust game have been utilized to evaluate real-world interpersonal relationships as a novel candidate for psychiatric evaluations. To investigate the relationship between trusting behaviors and various psychometric scales, we conducted a trust game experiment with eighty-one Japanese university students as a pilot study. Participants made a risky financial decision about whether to trust each of 40 photographed partners. Participants then answered a set of questionnaires with seven scales including the Lubben Social Network Scale (LSNS)-6 and the Patient Health Questionnaire (PHQ)-9. Consistent with previous research, male participants trusted partners more than female participants. Regression analysis revealed that LSNS-family (perceived support from family) for male participants, and item 8 of PHQ-9 (subjective agitation and/or retardation) for female participants were associated with participants' trusting behaviors. Consistent with claims by social scientists, our data suggest that, for males, support from family was negatively associated with cooperative behavior toward non-family members. Females with higher subjective agitation (and/or retardation) gave less money toward males and high attractive females, but not toward low attractive females in interpersonal relationships. We believe that our data indicate the possible impact of economic games in psychiatric research and clinical practice, and validation in clinical samples including modern-type depression and hikikomori should be investigated.

Hospital Advertising, Competition, and HCAHPS: Does It Pay to Advertise?

PubMed

Huppertz, John W; Bowman, R Alan; Bizer, George Y; Sidhu, Mandeep S; McVeigh, Colleen

2017-08-01

To test whether hospital advertising expenditures predict HCAHPS global ratings. We examined media advertising expenditures by 2,142 acute care hospitals in 209 markets in the United States. Data on hospital characteristics, location, and revenue came from CMS reports; system ownership was obtained from the American Hospital Association. Advertising data came from Kantar Media. HCAHPS data were obtained from HospitalCompare. Regression models examined whether hospitals' advertising spending predicts HCAHPS global measures and whether market concentration moderated this association. Hospital advertising spending was calculated by adding each individual hospital's expenditures to the amount spent by its parent health system, proportionally allocated by hospital revenue. Health system market share was used to estimate market concentration. These data were compared to hospitals' HCAHPS measures. In competitive markets (HHI below 1,000), hospital advertising predicted HCAHPS global measures. A 1-percent increase in advertising was associated with a 1.173-percent increase in patients rating the hospital a "9" or "10" on the HCAHPS survey and a 1.540-percent increase in patients who "definitely" would recommend the hospital. In concentrated markets, this association was not significant. In competitive markets, hospitals that spend more on advertising earn higher HCAHPS ratings on global measures. © Health Research and Educational Trust.