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Book part
Publication date: 29 July 2009

Lynn Unruh, C. Allison Russo, H. Joanna Jiang and Carol Stocks

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion…

Abstract

Background – Reliable and valid hospital nurse staffing measures are a major requirement for health services research. As the use of these measures increases, discussion is growing as to whether current nurse staffing measures adequately meet the needs of health services researchers.

Objective – This study assesses whether the measures, sampling frameworks, and data sources meet the needs of health services research in areas such as staffing assessment; patient, nurse, and financial outcomes; and prediction of staffing.

Methods – We performed a systematic review of articles from 1990 through 2007, which use hospital nurse staffing measures in original research, or which address the validity, reliability, and availability of the measures. Taxonomies of measures, sampling frameworks, and sources were developed. Articles were analyzed to assess what measures, sampling strategies, and sources of data were used and to ascertain whether the measures, samples, and sources meet the needs of researchers.

Results – The review identified 107 articles that use hospital nurse staffing measures for original research. Multiple types of measures, some of which are used more often than others and some of which are more valid than others, exist in each of the following categories: staffing counts, staffing/patient load ratios, and skill mix. Sampling frameworks range from hospital units to all hospitals nationally, with all hospitals in a state being the most common. Data sources range from small-scale surveys to national databases. The American Hospital Association Annual Survey is the most frequently used data source, but there are limitations with its nurse staffing measures. Arguably, the multiplicity of measures and differences in sampling and data sources are due, in part, to data availability. The limitations noted by other researchers and by this review indicate that staffing measures need improvements in conceptualization, content, scope, and availability.

Discussion – Recommendations are made for improvements to research and administrative practice and to data.

Details

Biennial Review of Health Care Management: Meso Perspective
Type: Book
ISBN: 978-1-84855-673-7

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Article
Publication date: 18 February 2019

Zofia Bajorek and David Guest

The purpose of this paper is to address a gap in the recent literature on employment of temporary workers by exploring the impact of temporary workers on the perceptions…

Abstract

Purpose

The purpose of this paper is to address a gap in the recent literature on employment of temporary workers by exploring the impact of temporary workers on the perceptions, attitudes and behaviour of permanent staff with particular reference to their implications for patient safety and service quality in hospital accident and emergency departments. The analysis is set in the context of the job demands-resources theory.

Design/methodology/approach

The research was undertaken using a case study approach with semi-structured interviews in two London hospitals. Participants included staff from the HR director level, clinical managers and permanent staff who all had an influence in the hiring and management of temporary staff in some way. Transcripts were analysed thematically using an adopted framework approach.

Findings

The results indicate that the effect of temporary staff on permanent staff depended on the quality of the “resource”. There was a “hierarchy of preference” for temporary staff based on their familiarity with the context. Those unfamiliar with the department served as a distraction to permanent staff due to the need to “manage” them in various ways. While this was rarely perceived to affect patient safety, it could have an impact on service quality by causing delays and interruptions. In line with previous research, the use of temporary staff also affected perceptions of fairness and the commitment of some permanent staff.

Practical implications

A model developing an approach for improved practice when managing temporary staff was developed to minimise the risks to patient safety and service quality, and improve permanent staff morale.

Social implications

The review highlights the difficulties that a limited amount of temporary staff integration can have on permanent staff and patient care, indicating that consideration must be placed on how temporary staff are inducted and clarifying expectations of roles for both temporary and permanent staff.

Originality/value

This paper studies the under-researched impact of temporary staff, and, distinctively, staff employed on a single shift, on the behaviour and attitudes of permanent staff. It highlights the need to consider carefully the qualitative nature of “resources” in the job demands-resources theory.

Details

Journal of Organizational Effectiveness: People and Performance, vol. 6 no. 1
Type: Research Article
ISSN: 2051-6614

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Book part
Publication date: 12 June 2017

Jason Rodriquez

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit…

Abstract

This article examines how a profit-centered restructuring of labor relations in an academic medical center undermined team-based care practices in its intensive care unit. The Institute of Medicine has promoted team-based care to improve patient outcomes, and the staff in the intensive care unit researched for this paper had established a set of practices they defined as teamwork. After hospital executives rolled out a public relations campaign to promote its culture of teamwork, they restructured its workforce to enhance numerical and functional flexibility in three key ways: implementing a “service line” managerial structure; cutting a range of staff positions while combining others; and doubling the capacity of its profitable and highly regarded intensive care unit. Hospital executives said the restructuring was necessitated by changes to payment models brought forth by the Affordable Care Act. Based on 300 hours of participant-observation and 35 interviews with hospital staff, findings show that the restructuring lowered staff resources and intensified work, which limited their ability to practice care they defined as teamwork and undermined the unit’s collective identity as a team. Findings also show how staff members used teamwork as a sensitizing concept to make sense of what they did at work. The meanings attached to teamwork were anchored to positions in the hospitals’ organizational hierarchy. This paper advances our understanding of he flexible work arrangements in the health care industry and their effects on workers.

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Emerging Conceptions of Work, Management and the Labor Market
Type: Book
ISBN: 978-1-78714-459-0

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Article
Publication date: 13 February 2017

Dick E. Zoutman and B. Douglas Ford

The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care…

Abstract

Purpose

The purpose of this paper is to examine quality improvement (QI) initiatives in acute care hospitals, the factors associated with success, and the impacts on patient care and safety.

Design/methodology/approach

An extensive online survey was completed by senior managers responsible for QI. The survey assessed QI project types, QI methods, staff engagement, and barriers and factors in the success of QI initiatives.

Findings

The response rate was 37 percent, 46 surveys were completed from 125 acute care hospitals. QI initiatives had positive impacts on patient safety and care. Staff in all hospitals reported conducting past or present hand-hygiene QI projects and C. difficile and surgical site infection were the next most frequent foci. Hospital staff not having time and problems with staff prioritizing QI with other duties were identified as important QI barriers. All respondents reported hospital leadership support, data utilization and internal champions as important QI facilitators. Multiple regression models identified nurses’ active involvement and medical staff engagement in QI with improved patient care and physicians’ active involvement and medical staff engagement with greater patient safety.

Practical implications

There is the need to study how best to support and encourage physicians and nurses to become more engaged in QI.

Originality/value

QI initiatives were shown to have positive impacts on patient safety and patient care and barriers and facilitating factors were identified. The results indicated patient care and safety would benefit from increased physician and nurse engagement in QI initiatives.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 9 March 2021

Sandra G. Leggat, Cathy Balding and Melanie Bish

There is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the…

Abstract

Purpose

There is evidence that patient safety has not improved commensurate with the global attention and resources dedicated to achieving it. The authors explored the perspectives of hospital leaders on the challenges of leading safe care.

Design/methodology/approach

This paper reports the findings of a three-year longitudinal study of eight Australian hospitals. A representative sample of hospital leaders, comprising board members, senior and middle managers and clinical leaders, participated in focus groups twice a year from 2015 to 2017.

Findings

Although the participating hospitals had safety I systems, the leaders consistently reported that they relied predominantly on their competent well-meaning staff to ensure patient safety, more of a safety II perspective. This trust was based on perceptions of the patient safety actions of staff, rather than actual knowledge about staff abilities or behaviours. The findings of this study suggest this hegemonic relational trust was a defence mechanism for leaders in complex adaptive systems (CASs) unable to influence care delivery at the front line and explores potential contributing factors to these perceptions.

Practical implications

In CASs, leaders have limited control over the bedside care processes and so have little alternative but to trust in “good staff providing good care” as a strategy for safe care. However, trust, coupled with a predominantly safety 1 approach is not achieving harm reduction. The findings of the study suggest that the beliefs the leaders held about the role their staff play in assuring safe care contribute to the lack of progress in patient safety. The authors recommend three evidence-based leadership activities to transition to the proactive safety II approach to pursuing safe care.

Originality/value

This is the first longitudinal study to provide the perspectives of leaders on the provision of quality and safety in their hospitals. A large sample of board members, managers and clinical leaders provides extensive data on their perspectives on quality and safety.

Details

Journal of Health Organization and Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 15 February 2021

Chiara Pomare, Kate Churruca, Janet C. Long, Louise A. Ellis and Jeffrey Braithwaite

Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different…

Abstract

Purpose

Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different stakeholders have the opportunity to contribute to the design and planning of hospital redevelopment projects. The purpose of this study is to examine the potential for misalignment between policy (“work as imagined”) and staff experiences of a hospital redevelopment (“work as done”).

Design/methodology/approach

A case study of a large Australian hospital in a capital city undergoing redevelopment. Forty-six semi-structured interviews were conducted with hospital staff. Staff experiences were identified in corroboration with additional data: key-informant discussions with members of the hospital executive; document analysis (e.g. hospital and government documents) and survey responses about experiences of the hospital redevelopment.

Findings

A disjuncture was identified between policy and the experiences of hospital staff. Over one in every three (36.0%) staff felt uninformed about the redevelopment and 79.4% were not involved in decisions throughout the process of design and redevelopment, which contradicted the procedure laid out in policy for hospital development.

Originality/value

Despite the seemingly “good news story” of allocating billions of dollars to redeveloping and modernising health services in Australia, the experiences of staff on the front lines suggest a lack of consultation. Rectifying these concerns may be integral to avoid fragmentation during the challenging circumstances of hospital redevelopment.

Details

Journal of Health Organization and Management, vol. 35 no. 4
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 18 December 2020

Stephanie Petty, Amanda Griffiths, Donna Maria Coleston and Tom Dening

Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred…

Abstract

Purpose

Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting.

Design/methodology/approach

A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis.

Findings

Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes.

Research limitations/implications

The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research.

Originality/value

In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.

Details

Quality in Ageing and Older Adults, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1471-7794

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Article
Publication date: 7 August 2017

Mojtaba Rafiei

The purpose of this paper is to study the effect of emotional quotient (EQ) on the organizational citizenship behavior (OCB) of some Iranian hospital staff in 2015. For…

Abstract

Purpose

The purpose of this paper is to study the effect of emotional quotient (EQ) on the organizational citizenship behavior (OCB) of some Iranian hospital staff in 2015. For this purpose, all hospital staff in Zahedan city were studied as the statistical population.

Design/methodology/approach

A randomized sampling method was used, and according to the Morgan Table, the statistical population was calculated as 346. This was a descriptive survey with a correlational and causative nature. Two questionnaires, namely, Bradbury and Graves’ Emotional Quotient and Podsakoff’s Organizational Citizenship Behavior, were used to collect the required information; they were distributed among the respondents after testing their validity and reliability. The people in the studied population were classified into classes that were homogeneous in terms of their properties.

Findings

The results of testing the hypotheses indicate that all the dimensions of EQ have a direct and significant effect on the emergence of OCB among the hospital staff in Zahedan. Finally, the results indicate the effect of EQ on OCB of the hospital staff.

Practical implications

Hospitals should consider emotional capabilities of the staff at the beginning of the employment period, and increase their sociability by inducting an atmosphere of organizational culture based on cooperation and empathy. It is suggested that a guideline of emotional eligibility and OCB be codified, which can influence job promotion and the promotion system. On specific occasions, hospital managers can honor the staff who have made positive and effective relationships in their career, and have achieved the satisfaction of their patients and colleagues by demonstrating extra-role behaviors. Thus, employees will be encouraged to continue this behavior and also provide a model to the staff. Through pre-service or in-service training classes and job seminars on the control of negative emotions and stresses while acquiring the skills of EQ, hospitals and other organizations can create OCB in the staff. As a result, visitor satisfaction would be gained, leading to better performance of hospitals.

Originality/value

It is suggested that a guideline of emotional eligibility and organizational citizenship behavior has to be codified which can affect the job promotion and promotion system. In specific occasions, the hospital managers can honor and pay tribute to the people who have made positive and effective relationships in their career, and have achieved the satisfaction of their patients and colleagues by showing extra-role behaviors.

Details

Kybernetes, vol. 46 no. 7
Type: Research Article
ISSN: 0368-492X

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Article
Publication date: 7 November 2016

Nawaf Alharbe and Anthony S. Atkins

Expert knowledge is an important organisational resource, and organisations need to retain the knowledge learned by experience, which can be shared as part of…

Abstract

Purpose

Expert knowledge is an important organisational resource, and organisations need to retain the knowledge learned by experience, which can be shared as part of inter-professional learning. In a healthcare context, radio-frequency identification (RFID) and ZigBee technologies can be used together, to provide real-time information for decision support and to create a secure and reliable smart hospital management information system (SHMIS) that allows the dynamic control of objects and transforms operational processes, while minimising any potential risks to patients and staff. Currently, the RFID technology in Saudi Arabia is being solely used for the monitoring of newborn infants, and some difficulties have been encountered during the different stages of tagging and monitoring. The current system in Medina Maternity and Children’s Hospital (MMCH) uses battery-powered active RFID tags, which are expensive and require routine maintenance. This study aims to discuss the way in which the MMCH in Medina, Saudi Arabia, could be transformed into an SHMIS.

Design/methodology/approach

The extraordinary growth of RFID and ZigBee technologies has made it possible to identify, locate and track objects in various environments in real time. The RFID technology is a non-contact identification technology that is cheap and reliable but has limited range in the case of passive tags. ZigBee has greater range and lower power consumption, giving more precise location of the object’s movements (0.6 m). Passive RFID when combined with ZigBee technology can be used to improve services provided by healthcare organisations through continuous data collection and supporting real-time decision-making, by applying expert knowledge of domain experts to data produced by communication from electronic and sensor technologies.

Findings

A prototype object-tracking system using RFID and ZigBee was developed to support the knowledge transformation for knowledge reasoning for decision support (KRDS), and the outcome of this research was validated with domain experts in hospitals in Saudi Arabia. Two feasibility case studies were conducted at MMCH in Saudi Arabia, to evaluate the proposed system. A survey was also conducted to address the requirements at MMCH, and the researcher adopted a range of strategy techniques, including interviews and meetings with staff, and the setting up of communities of practise (CoPs) at the target hospital.

Research limitations/implications

This paper has investigated the transformation process of an automatic healthcare tracking and monitoring systems for the purpose of developing a smart system in Saudi hospitals. For the scope of the project, the prototype implementation was restricted to a laboratory environment, to demonstrate the proposed proof of concept. The next phase will include conducting a scale up of the system, with implementation and testing done in a real hospital environment.

Originality/value

This paper proposes a prototype application of an (SHMIS that allows the dynamic control of objects and transforms operational processes, while minimising any potential risks to patients and staff.

Details

International Journal of Pervasive Computing and Communications, vol. 12 no. 4
Type: Research Article
ISSN: 1742-7371

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Article
Publication date: 11 April 2018

Bettina Ravnborg Thude, Egon Stenager, Christian von Plessen and Erik Hollnagel

The purpose of the study is to determine whether one leader set-up is better than the others according to interdisciplinary cooperation and leader legitimacy.

Abstract

Purpose

The purpose of the study is to determine whether one leader set-up is better than the others according to interdisciplinary cooperation and leader legitimacy.

Design/methodology/approach

The study is a qualitative study based on semi-structured interviews at three Danish hospitals.

Findings

The study found that the leadership set-up did not have any clear influence on interdisciplinary cooperation, as all wards had a high degree of interdisciplinary cooperation independent of which leadership set-up they had. Instead, the authors found a relation between leadership set-up and leader legitimacy. In cases where staff only referred to a leader from their own profession, that leader had legitimacy within the staff group. When there were two leaders from different professions, they only had legitimacy within the staff group from their own profession. Furthermore, clinical specialty also could influence legitimacy.

Originality/value

The study shows that leadership set-up is not the predominant factor that creates interdisciplinary cooperation; but rather, leader legitimacy also should be considered. Additionally, the study shows that leader legitimacy can be difficult to establish and that it cannot be taken for granted. This is something chief executive officers should bear in mind when they plan and implement new leadership structures. Therefore, it would also be useful to look more closely at how to achieve legitimacy in cases where the leader is from a different profession to the staff.

Details

Leadership in Health Services, vol. 32 no. 1
Type: Research Article
ISSN: 1751-1879

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