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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.

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.

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.

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.

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.

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.

The authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.

The authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.

The authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.

Hospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.

This study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.

This research aims to explore the fine-grained relationships between nurse staffing and hospital operational performance with respect to care quality and operating costs. The authors also investigate the moderation effect of competition in local hospital markets on these relationships.

A six-year panel data is assembled from five separate sources to obtain information of 2,524 USA hospitals. Fixed-effect (FE) models are used to test the proposed hypotheses.

First, nurse staffing is initially associated with improved care quality until nurse staffing reaches a turning point, beyond which nurse staffing is associated with worse care quality. Second, a similar pattern applies to the relationship between nurse staffing and operating costs, although the turning point is at a much lower nurse staffing level. Third, market competition moderates the relationship between nurse staffing and care quality so that the turning point of nurse staffing will be higher when the degree of competition is higher. This shift of turning point is also observed in the relationship between nurse staffing and operating costs.

The study identifies three ranges of nurse staffing in which hospitals will likely experience simultaneous improvements, a tradeoff or simultaneous decline of care quality and operating costs when investing in more nursing capacity. Hospitals should adjust nurse staffing levels to the right directions to achieve better care or reduce operating costs.

Nurses constitute the largest provider group in hospitals and profoundly impact care quality and operating costs among all health care professionals. Optimizing the level of nurse staffing, therefore, can significantly impact the care quality and operating costs of hospitals.

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.

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.

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.

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

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.

In this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.

A comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.

Management in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.

Finding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

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.

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.

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.

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.

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.

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”).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.