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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.

This chapter discusses the implementation and current use of an inquiry-based approach to teaching and learning at Whitireia Community Polytechnic (Whitireia), a tertiary education institution, known for its high student success rate and culturally diverse student body. The Faculty of Health at Whitireia have developed the use of a context-based learning (CBL) approach across a range of courses in several health disciplines; these include nursing (undergraduate and postgraduate), paramedic, and foundational support work courses.

This chapter uses the structural and relational dimension of social capital theory (SCT) as a lens for examining the impact of the supervisor–subordinate relationship on nurses' perceptions of the usefulness of their workplace networks, sociability, and affective commitment. A survey was used to collect data from 1,064 Australian nurses.

The findings suggest that nurses rely on very small workplace networks (typically only one other person) with which they have strong ties. Further, in over half of the cases, the supervisor (the Nurse Unit Manager (NUM)) holds the centric position. Moreover, for those nurses who did not include the NUM in their workplace network, their position appears even worse. For example, the usual reason given by nurses for not including the NUM was that the NUM was unavailable. This is a concern for health care management because the past two decades have delivered many changes to the nursing profession, including a reduction in the number of nursing positions and subsequent higher workloads. The consequences suggest that without effective workplace networks, nurses are working under conditions where solving problems is more difficult.

Medicaid home and community-based services (HCBS) support community living for three million disabled people in the United States. As a state-federal partnership, these programs are highly variable across states. Because eligibility determination and services differ from state to state, this Medicaid structure becomes a barrier for those HCBS users whose desired futures include cross-state moves.

I examine narratives of citizenship and personhood for Medicaid HCBS users circulating within policy arenas and explore tensions between these and the stories Medicaid HCBS users tell of their own lives. Specifically, I explore the degree to which narratives about Medicaid HCBS users include an affirmation of the right to cross-state movement. My analysis includes data from public statements from policy makers, legislative texts, organizational framings of Medicaid policy, and 18 semi-structured interviews with Medicaid PCA users who desired or pursued cross-state moves.

I conclude that institutional narratives of Medicaid HCBS users are an inadequate representation of the stories told by those who rely on this program and, in consequence, programs stemming from policy fail to offer services that would allow service recipients to pursue their objectives.

Medicaid HCBS policy is part of a broader story of disability rights progress over the last four decades, making its role as an obstacle to cross-state movement a bit of a paradox. This paradox points to the value of narrative analysis in calling attention to invisible contradictions and the need for institutional and organizational change.

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

Purpose – This chapter aims to present an overview of what constitutes child murder, including definitions, history, prevalence, risk factors, offender motivations, and theoretical understanding.

Design/methodology/approach – The author uses secondary data from the National Incident-Based Reporting System, Uniformed Crime Reports, and Vital Statistics to show comparisons with previously conducted research. This allows for an overview of child murder.

Findings – There are numerous inconsistencies due to methodological issues. It is hard to find studies where a large sample was used. Definitions of child vary between studies, as does the age categories used. In addition, child homicide is predicted to be grossly underrepresented due to lack of communication between agencies, lack of formalized training, lack of a formalized classification system, and lack of reporting.

Originality/value – Research on child homicide can be instrumental in many areas including policy creation, implementation, and evaluation. It can serve as a benefit for those attempting to provide preventative measures. It may also help law enforcement with investigation. It is only through continued analysis of these types of cases and vigilant research, policy, and practice that society can more effectively protect young children from exposure to potentially murderous outcomes.