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The purpose of this paper is to examine whether the experience, impact and likelihood of an acute business interruption, along with the perceived ability to intervene, influences the “threat orientation” of owner-managers in small- and medium-sized enterprises (SMEs) in the UK. The concept of “threat orientation” is introduced in this study as a way to eschew the binary view of whether an organisation does or does not have processes and capabilities to respond to acute interruptions.

“Threat orientation” is operationalised and survey data are collected from 215 SMEs in the UK. Data from owner-managers are analysed using multiple regression techniques.

The results of this study provide empirical evidence to highlight the importance of firm age rather than size as a determinant of the propensity to formalise activities to deal with acute interruptions. Recent experience and the ability to intervene were statistically significant predictors of threat orientation but the likelihood and concern about specific types of threat was not found to positively influence threat orientation.

Although the data are self-report in nature, the respondents in the study are the chief decision and policy makers in their organisations and thus it is essential to understand the influences on their threat orientation. Results are generalisable only to UK SMEs.

The findings of the paper contribute to a nascent understanding of planning for acute interruptions in SMEs and (despite the cross-sectional nature of the study), the findings clearly reinforce the need for continuing longitudinal research into how resilience develops in smaller organisations.

Risk management is an essential cornerstone of any effective unit. The maternity dashboard has been found to be an efficient governance tool, but there is no such scorecard in gynaecology. The paper aims to conceptualise and implement an acute gynaecology dashboard in a teaching hospital over a period of two years and review the changes brought in practice as a result of the dashboard.

This acute gynaecology dashboard was designed in line with the existing maternity dashboard. Goals and benchmarks were determined on the basis of available national guidelines, expert opinions and local policies. The dashboard was prospectively implemented, updated monthly and presented in the relevant forums. A retrospective overview of the changes brought in the practice is presented in this paper.

Through the use of the dashboard significant problems related to workforce, training and clinical activity were identified. A number of changes were subsequently executed to improve patient management, service provision and training. This paper provides empirical insights about how positive changes in clinical practice could be brought in by the implementation of the acute gynaecology dashboard. The acute gynaecology dashboard was found to be a valuable governance tool to monitor performance and improve training and patient care.

The acute gynaecology dashboard can be used as an effective clinical governance tool to monitor performance and leads to improvement in clinical practice in other acute gynaecology units.

Though the maternity dashboard is widely in use, there has been no previous description of an acute gynaecology dashboard and this is the first paper in this area. With the increasing demand of acute gynaecology services, the dashboard becomes an essential tool for clinical governance.

Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of “street-level bureaucracy” has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice.

This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics.

Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing “assimilist” from “externalist” positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients’ personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work.

A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled care from illness or injury to outcomes such as recovery, death and chronic illness.

After generating a literature review drafting an initial conceptual model, GCM software (CS Global MAX^TM) is used to organize and identify strengths and directionality between concepts generated through feedback about the model from several stakeholder groups: acute care and non-acute care providers, patients, payers and policymakers. Through online and in-person population-specific focus groups, the GCM approach seeks feedback, assigned relationships and articulated priorities from participants to produce an output map that described overarching concepts and relationships within and across subsamples.

A clustered concept map made up of relational data points that produced a taxonomy of feedback was used to update the model for use in soliciting additional feedback from two technical expert panels (TEPs), and finally, a public comment exercise was performed. The results were a stakeholder-informed improved model for an acute care episode, identified factors that influence process and outcomes, and policy recommendations, which were delivered to the Department of Health and Human Services’s (DHHS) Assistant Secretary for Preparedness and Response.

This study provides an example of the value of cross-population multi-stakeholder input to increase voice in shared problem health stakeholder groups.

This paper provides GCM results and a visual analysis of the relational characteristics both within and across sub-populations involved in the study. It also provides an assessment of observational key factors supporting how different stakeholder voices can be integrated to inform model development and policy recommendations.

Clinical audit may undergo organisational change as the new primary care trusts assume responsibility for community health services. Very little has been published, however, about community‐based audit. A survey of audit activities involving clinical audit staff was carried out in seven acute hospital trusts and seven community trusts in south east England in 1997. Audit staff completed survey forms for 65 acute projects and 75 community projects on defined topics. Managers in community trusts were much more likely to initiate audit projects or act as lead investigators than managers in the acute trusts, and they more frequently received copies of project reports. Clinical audit staff in community trusts participated more fully in the various phases of the audit process than staff in the acute trusts. If the best of the conventions for community audit practice are transferred to primary care trusts, the foundations of their clinical governance programmes should be strengthened.

The purpose of this study is to examine the acute toxicity and antidiabetic activity of Asystacia gangetica leaf ethanol extract.

The study was designed as completely randomized in vivo experimental model. Where acute toxicity study was carried out using 30 albino mice, randomly assigned into six groups of five mice each. Toxicity signs and mortality were observed in the rats within a period of 24 h. The acute and sub-acute antidiabetic study was carried out using 50 rats, randomly assigned into five groups of 10 rats each. The rats’ blood glucose levels were determined and used to assess the acute and sub-acute antidiabetic activity of the extract.

Results obtained from the acute toxicity study indicated no death in any of the study groups, even at 5,000 mg/kg body weight and showed no signs of toxicity. The acute antidiabetic study showed that treatment with 400 mg/kg of the extract significantly (p = 0.01) lowered glucose level in the diabetic rats from 430.6 to 177.4 mg/dl while 800 mg/kg brought down glucose level from 370 to 144.2 mg/dl by the end of 6 h following administration when compared with the diabetic control group. It was observed that the effect of the extract mostly at 800 mg/kg also compared favorably with that of the standard drug (glibenclamide), which lowered glucose level in diabetic rats from 374.2 to 176.4 mg/dl. Furthermore, the significant reduction was evident from 4, 2 and 2 h for 400 mg/kg extract, 800 mg/kg extract and 5 mg/kg glibenclamide, respectively. At sub-acute level the blood glucose was lowered from 155.6 to 127.2 mg/dl, 137 to 124.4 mg/dl and 151.8 to 121.8 mg/dl for diabetic rats treated with 400 mg/kg, 800 mg/kg and 5 mg/kg glibenclamide, respectively, when compared to the diabetic untreated rats, which ranged from 417.6 to 358.6 mg/dl. The biochemical profile, lipid profile and hematological examination were all positively restored near to normal with the herbal treatment at the different doses. At histopathology level, the liver of the rats treated with 400 mg/kg had moderate portal inflammation without interface or lobular hepatitis while that of 800 mg/kg showed severe portal inflammation with the interface and lobular hepatitis with extensive confluents necrosis. The pancreatic cells of the treated rat showed no significant difference in the β-cells of the islets of Langerhans with hyperplasia of the acinar cell when compared to the diabetic untreated.

The record of no death and signs of toxicity implies that the extract is safe for consumption even at a high dosage of 5,000 mg/kg body weight. The significant (p = 0.01) reduction in the plasma glucose level of the treated rats as compared to the control is an indication of blood glucose-lowering potential of the extract at two different doses. The significant reduction evident of the extract at different hours and days for the two doses implies that the extract rate of lowering potentials is dose-dependent. The evidence of moderate-severe portal inflammation with the interface and lobular hepatitis at 800 mg/kg treatment is an indication that the intake of this herb at high dosage for long period is not safe for the liver tissue.

The outcome of this study suggested that the Asystacia gangetica should also be used as a vegetable in-home food preparation and food processing to use its antidiabetic effect. The herbal extract could also be incorporated into a food product and processed into herbal tea bag for convenient. The subjection of this herbal plant to heat treatment during processing could be a possible avenue to make it safe.

The economic burden and complications of diabetes mellitus management will be reduced if the practical implication of this research finding is implemented in foods as vegetable and in functional food production.

This study revealed that Asystacia gangetica leaf extract may be safe and effective for use at a low dose for acute management of diabetes mellitus. This research may be of value to those living with diabetes mellitus.

This study aims to explore the involvement of middle management in forming strategies to manage variable acute patient flows at a hospital.

Empirical evidence from a university hospital was gathered via interviews, internal documents, observation and participation in meetings. The role of middle management in the development of strategies was analyzed using literature on middle management involvement.

In managing variable acute patient flows, middle management adopts a number of roles and behavioral characteristics that have been previously described in research. The role of facilitator is the most prominent, with middle managers prioritizing individual goals and strategies for the clinical departments that they manage before their collective responsibility for hospital performance. Unclear responsibilities and mandates within the organization, together with a lack of hospital-wide strategies concerning how the acute patient flow should be managed, are contributing factors to this behavior.

The research is based on an explorative, single case study methodology. Future research assessing the extent of different middle management roles in health care, in which more empirical data and quantitative analysis is conducted, is encouraged.

There is a need for top management to establish long-term goals to enhance middle management roles when developing strategies for managing variable patient flows.

Middle management involvement in developing strategies for managing variable patient flows is a novel topic for research. The interface and division of tasks between top and middle management is crucial for successful strategies in managing variable patient flows.

This paper aims to explore if actions used at a hospital to manage a variable acute patient flow can be categorised using the concepts of lean, agile and leagile.

Empirical evidence from a university hospital was gathered by interviews, internal documents, shadowing and participation in meetings. Identified actions used at both hospital level and departmental level are categorised as lean or agile, while combinations of actions are compared with different leagile approaches.

Actions from every lean and agile category derived from literature are used at the hospital, however in varying extent. Many agile actions are reactive, indicating a lack of proactive measures. Actions that directly manage external variation are also few in numbers. Leagile approaches of all three combinations derived from literature are also used at the hospital.

As a single-case study is used, empirical generalisation to other hospitals cannot be deduced. Future research assessing the appropriateness of different actions for managing a variable acute patient flow is encouraged.

The use of actions within both lean and agile categories indicate the possibility of combining these process strategies in hospitals, and not only focusing on implementing lean. By cleverly combining lean and agile actions, leagile approaches can be formed.

The use of lean in health care has been a topic of research, while the use of agile has been sparsely researched, as well as the combination of the two.

The costs associated with staffing acute mental health wards is the largest expenditure in the inpatient budget. Exploring skill mix and its impact on outcomes, particularly service user outcomes should be of interest to all stakeholders involved in the commissioning, delivery and receipt of acute mental health care. This paper describes the findings of a literature and practice review of initiatives undertaken to improve staffing and skill mix, and their impact on service user outcomes. The practice review was necessary due to the paucity of published research in this area. Both research and practice initiatives do not appear to be driven by service user need. This results in a restricted and service driven range of outcome measures being used. The paper concludes by proposing recommendations for future workforce development in acute mental health settings.

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process.

The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice.

The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.

The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings.

The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required.

This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.