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Book part
Publication date: 24 October 2019

Catherine C. Quatman-Yates, Mark V. Paterno, Mariann L. Strenk, Michelle A. Kiger, Tory H. Hogan, Brian Cunningham and Rebecca Reder

The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating…

Abstract

The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating a culture that supports continuous learning and quality improvement in health care settings is currently available.

The purpose of this report is to characterize the evolution of a large division of physical therapists and occupational therapists in a pediatric hospital setting from 2005 to 2018 to identify key facilitators and barriers for cultivating a culture empowered to engage in continuous learning and improvement.

An ethnographic methodology was used including participant observation, document review, and stakeholder interviews to acquire a deep understanding and develop a theoretical model to depict insights gained from the investigation.

A variety of individual, social, and structural enablers and motivators emerged as key influences toward a culture empowered to support continuous learning and improvement. Features of the system that helped create sustainable, positive momentum (e.g., systems thinking, leaders with grit, and mindful design) and factors that hindered momentum (e.g., system uncertainty, staff turnover, slow barrier resolution, and competing priorities) were also identified.

Individual-level, social-level, and structural-level elements all influenced the culture that emerged over a 12-year period. Several cultural catalysts and deterrents emerged as factors that supported and hindered progress and sustainability of the emergent culture.

Cultivating a culture of continuous learning and improvement is possible. Purposeful consideration of the proposed model and identified factors from this report may yield important insights to advance understanding of how to cultivate a culture that facilitates continuous learning and improvement within a health care setting.

Details

Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

Keywords

Book part
Publication date: 16 October 2014

Larry R. Hearld, Kristine R. Hearld and Tory H. Hogan

Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary…

Abstract

Purpose

Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community.

Design/methodology/approach

Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH.

Findings

Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH.

Implications

Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH’s ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities.

Originality/value

To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices’ PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.

Details

Population Health Management in Health Care Organizations
Type: Book
ISBN: 978-1-78441-197-8

Keywords

Content available
Book part
Publication date: 24 October 2019

Abstract

Details

Structural Approaches to Address Issues in Patient Safety
Type: Book
ISBN: 978-1-83867-085-6

Content available
Book part
Publication date: 16 October 2014

Abstract

Details

Population Health Management in Health Care Organizations
Type: Book
ISBN: 978-1-78441-197-8

Article
Publication date: 1 January 1987

J.R. Carby‐Hall

Civil wrongdoings with consequent financial and other loss or damage to employers, employees and third parties may result in the course of various trade union activities…

Abstract

Civil wrongdoings with consequent financial and other loss or damage to employers, employees and third parties may result in the course of various trade union activities. These day to day trade union activities take a variety of forms. The most common ones are inducement of breach of contract, conspiracy, trespass, nuisance, and intimidation. Each of these activities constitutes a tort which, unless the statutory immunities apply, would normally give rise at common law to an action for damages or, as is more frequent, enable the aggrieved party to obtain an injunction.

Details

Managerial Law, vol. 29 no. 1/2
Type: Research Article
ISSN: 0309-0558

Article
Publication date: 1 June 2002

Barrie O. Pettman and Richard Dobbins

This issue is a selected bibliography covering the subject of leadership.

22795

Abstract

This issue is a selected bibliography covering the subject of leadership.

Details

Equal Opportunities International, vol. 21 no. 4/5/6
Type: Research Article
ISSN: 0261-0159

Keywords

Article
Publication date: 1 April 1982

Stephen Smith

Developments in the technology of electronic transmission of information are rapidly transforming the tools available to the general public for gathering information about…

Abstract

Developments in the technology of electronic transmission of information are rapidly transforming the tools available to the general public for gathering information about current events. Direct access to news and retrieval of bibliographic information pertaining to traditional printed news sources are a daily reality for a growing number of individuals, on the job, at home, through personal computer terminals or at libraries. The purpose of this paper is to examine the characteristics of electronic databases providing access to news, as well as applications of these tools to various library settings.

Details

Reference Services Review, vol. 10 no. 4
Type: Research Article
ISSN: 0090-7324

Article
Publication date: 1 September 1907

In a recent issue of the Municipal Journal there appeared a short but apparently inspired article on the subject of London Government, in which is foreshadowed another…

Abstract

In a recent issue of the Municipal Journal there appeared a short but apparently inspired article on the subject of London Government, in which is foreshadowed another drastic and apparently imminent alteration of the system of local administration at present in operation in the Metropolis.

Details

British Food Journal, vol. 9 no. 9
Type: Research Article
ISSN: 0007-070X

Article
Publication date: 1 June 2004

Jessie L. Tucker and Patricia E. Kennedy‐Tucker

Agency theory, stewardship theory, the legalistic perspective and the substitution hypothesis have served as central themes of corporate governance research. Using this…

1063

Abstract

Agency theory, stewardship theory, the legalistic perspective and the substitution hypothesis have served as central themes of corporate governance research. Using this theoretical foundation, this study investigates the relationship between the equity ownership structure and performance of managed care firms. Results suggest that CEO stock options as a percentage of outstanding shares is negatively associated with some aspects of firm performance but that blockholder equity ownership appears to have an insignificant impact on firm performance.

Details

Management Research News, vol. 27 no. 6
Type: Research Article
ISSN: 0140-9174

Keywords

Article
Publication date: 1 October 1941

Generally speaking a “new” loaf is demanded and the baker who cannot deliver “new” loaves loses trade. But what is a “new” loaf? From the point of view of the chemist this…

Abstract

Generally speaking a “new” loaf is demanded and the baker who cannot deliver “new” loaves loses trade. But what is a “new” loaf? From the point of view of the chemist this question has formed the subject of innumerable investigations. A definition of a “new” loaf demands an understanding of “staleness” and the staling of bakery products is a subject of great complexity. The old idea was that it was entirely a question of the “drying out” of the bread, but cereal chemistry has proved that such a solution, namely the prevention of “drying out,” is only of partial efficacy; in fact “staleness” is caused by a change in the starch of the flour which is inherent in it and cannot be prevented by precautions which maintain the moisture content at a certain figure. The investigation of this type of staling has occupied the attention of many famous chemists, but the full explanation has not yet been obtained. Mass production has demanded many studies in that aspect of science known as “physical chemistry.” An example can be found in the preparation of certain sauces. Those of you who have made mayonnaise sauce know that to beat the olive oil into the mixture is fraught with difficulties. By means of the fork, used as a beater, the oil is distributed in very small particles through the mass of liquid, so that every globule of oil is separated from every other one. If the action docs not proceed properly the system breaks down and the mayonnaise “turns” and is spoiled. The manufacturer has to prevent this “turning,” not in a few pints but in hundreds of gallons. It is the chemist who has enabled him to do this and to manufacture with success those scores of salad‐dressings which are so delectable and the purchase of which relieves the housewife of so many hours of work and so much arm‐ache. An example of some interest is concerned with smoked salmon, which normally is a very variable product, whether it be the highly salted variety of the northern climes or the much less salted kind which has found favour in this country. The production of a lightly salted product is far more difficult than the more salted variety because much smaller changes in salt content become more noticeable. These small differences are so obvious to the confirmed smoked salmon eater that he detects not only the differences between one grade and another, but also the differences of salt content that occur in different parts of the same side of fish. It has fallen to the chemist so to change the methods of production of the lightly flavoured variety that the distribution of salt through the fish is even and the flavour therefore constant. This study of smoked salmon is only an example of the very big problem of standardisation, standardisation demanded by the consumer—and it follows that the big manufacturer must produce goods of standard flavour and appearance. Science steps in and gives the manufacturer those controls which enable him to produce, day in and day out, that standard range of article, whether it be ice‐cream or toad‐in‐the‐hole, Worcester sauce or cheese cakes, roast beef or jelly crystals. Modern science has introduced a new factor into our conception of what food should be. In the past it was only necessary to ensure that food should be “pure and wholesome,” by which was meant—in general terms—digestible and without any harmful constituents, be they natural or adventitious, bacterial or otherwise. So long as food complied with this broad definition everyone was satisfied. But biochemists and physiologists have demonstrated the importance of other factors, salts and vitamins, and it is necessary to consider the new situation thus created because it may be that the treatment of food to retain those substances may make it necessary to change preconceived notions. It may be that “palatability” may be affected, palatability which includes taste and appearance and odour. The whole subject is so complicated and, notwithstanding the enormous amount of work carried out, so little understood that no one as yet can be dogmatic, no one can state what are the optimum amounts of vitamins required by ordinary persons to keep them in good health. Having, however, decided the amount required, are we to try to preserve such quantities as occur naturally, or are we to fortify the food which we cat by added synthetic or even by purified natural vitamins? A further important consideration is whether the degree of maturity of, say, fruit in relation to maximum vitamin content coincides with optimum palatabilty. Certain it is that information gradually being accumulated on the importance—in many cases vital importance—of the minor constituents of foodstuffs leads to the conclusion that, to ensure the presence of all valuable minor constituents—be they known or unknown—the foodstuffs must, as articles of diet, be ingested almost in their entirety. This is probably an extreme view, for, in many cases, the result would be a product of reduced palatability or appearance, or, what is probably more important, “different,” and people do not like their food to be abnormal, i.e., to differ from their preconceived notion of what it should be. Nevertheless an “improvement” in the method of production, put into practice by the food manufacturer with the best intentions, may possibly result in a lowering of the dietetic value of the food, as, for example, by mechanical removal of an important part (the classical example being polished rice), by heat treatment, by oxidation or by materials added during cooking. The minor metallic constituents of food are gradually being revealed in their true importance. Copper, zinc, and iron are now known to be of importance. It is probable that every baby is born poor in calcium but rich in iron; milk, the natural food of the infant, is rich in calcium. It is only in the last few years that it has been shown that green vegetables as usually cooked are of very little real value. Cooking green vegetables in water containing sodium carbonate results in the almost complete destruction of the Vitamin C, and the discarding of the water removes the extracted salts. A green product certainly results but of greatly reduced nutritional value. On the other hand, it would appear that little destruction of vitamin activity takes place when the canning of vegetables or fruits is properly controlled. Sherman has said that attention to mineral salts and vitamins will lead to “buoyant” as distinguished from merely “passable” health. It is obvious that education of the public is essential if an intelligent use is to be made of the knowledge being gained by chemists and allied scientists. It is a most important fact that methods are being developed to assay foods for vitamins by chemical means. Biological feeding tests are obviously unsuitable for control purposes but, as the chemical identity of the vitamins becomes more clarified, chemical tests will become available for their determination. It is obviously the duty of the medical services of the country to guide the public as far as is possible on questions of nutrition. When such guidance becomes effective, the food producer will not be slow to see that his goods are up to the standard necessary, adding one more burden to the already loaded back of the chemist concerned with food production.

Details

British Food Journal, vol. 43 no. 10
Type: Research Article
ISSN: 0007-070X

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