Addressing Psychosocial Barriers to Hospital Discharge: A Social Work Led Model of Care

Australian hospitals regularly care for patients who cannot be discharged routinely due to complex psychosocial needs that manifest as barriers to discharge. These long-stay or “stranded” patients are at risk of detrimental health outcomes resulting from their extended stay while also potentially delaying admission for those who need acute care. This article discusses a new social work led model of care developed at an Australian metropolitan hospital that targets long-stay patients with psychosocial barriers to discharge. The model of care, overseen by a specialist social worker and assistant, demonstrates how the social work profession can take leadership within the psychosocial realm to improve both organisational and patient outcomes.     

Building cultural intelligence through supervisor support: Social exchange and subjective career success as mediators and organisational support as a moderator

This study offers a new perspective on how organisational factors influence migrant workers' cultural intelligence (CQ) by examining a moderated mediation model of the mechanism underlying the relationship between perceived supervisor support and CQ. We tested our model using a survey on a sample of 462 migrants. We found that employees' social exchange and subjective career success mediated the relationship between their perceptions of supervisor support and CQ. Furthermore, perceived organisational support moderated the social exchange–CQ relationship, and this relationship was stronger among workers with perceived high organisational support than for those with perceptions of low support. We also found that the indirect effect of employees' perceived supervisor support on CQ via social exchange was stronger for those with perceived high organisational support than for those with perceptions of low support. This study contributes to a better understanding of factors that foster migrant workers' abilities to navigate diverse workplaces.     

Learning manual handling without direct supervision or support: a case study of home care workers

How home care workers (HCWs) adapt their classroom training to their workplaces is central to their own safety and that of their care recipients. A case study approach was adopted for this inquiry into HCW training in Australia, where new workers were directly observed and interviewed in their workplaces following classroom training. Findings from the study advance four contributions: (a) learning is person-dependent, (b) artefacts in the form of written materials afford a valuable form of learning support; (c) opportunities for these workers to meet, share and refresh their knowledge are important for further development of occupational capacities; and (d) more organisational support for such socially isolated workers’ learning is needed.     

Applying the congruence model of organisational change in explaining the change in the Indian economic policies

Abstract

Faced with a dynamic and globalised external economic environment and a deteriorating internal economic environment, the Indian government decided to reform its economic policies. The changes meant overhauling India's economic system by making it more market oriented. This article applies NadlerTushman's Congruence Model of organisational change to the changes in the Indian economic system and attempts to examine the model's validity in large-scale organisational settings. The findings show that although the change process is consistent with the model's features, the model does not recommend any action strategies to handle resistances. Resistances being a significant part of any change process, inclusion of strategies to manage resistances would enhance the applicability of the congruence model.     

Responding to ambiguity, responding to change the value of a responsive approach to evaluation

Loosely organised teams and flexible arranged programs offer a new answer to improve the practice of palliative health care. Given the ambiguity of this care concept and the innovative organisational arrangement it is possible for confusion to emerge over the goals, core activities and target groups. In such a context it is not sufficient to determine the degree to which goals have been attained because the search for goals is part of the developmental process. An evaluation of a palliative team in a Dutch health region shows that it is more appropriate to acknowledge ambiguity and to go on to facilitate the handling of ambiguity as a vital element in dynamic learning processes. The utility of a responsive approach to evaluation, methodological considerations and learning experiences are described. The article is educational for workers in the field of health care but also to scholars and practitioners in an evaluation community.     

CONSCIOUSLY WORKING AT THE UNCONSCIOUS LEVEL: PSYCHODYNAMIC THEORY IN ACTION IN A TRAINING ENVIRONMENT

The author explores methods of working with residential child care foster care agencies in developing a psychotherapeutic culture. He suggests that such a culture can only be built on the firm foundations of clear organisational boundaries and task, but that such clarity is not sufficient. In addition, senior managers must have an understanding of unconscious processes and how they affect relationships between adults and children and between colleagues within the organisational hierarchy. The process requires a range of possible interventions including organisational consultancy, practice consultancy and staff support, specialist training and explorations of team processes.     

Barriers preventing high-quality nursing care of people with disabilities within acute care settings: a thematic literature review

This literature review was conducted to identify obstacles in the provision of quality nursing care to people with disabilities within acute care settings. Research in 2006 by the Disability Rights Commission found that people with disabilities have healthcare needs that are not being adequately met with the quality of care expected or anticipated. Obstacles to the provision of high-quality nursing care are a matter of concern to nursing clinicians, educators and researchers involved with establishing and maintaining professional standards of care for nursing practice. Therefore, this review has identified three major themes illustrating barriers to provision of high-quality nursing care in the acute care setting to people with disabilities. Themes identified were: professional competence, professional attitudes and organisational management. Nurses have an obligation to take into account the concerns and needs of individual clients with a disability.     

Coping with change in the NHS: a frontline district's response to AIDS

The core of this paper is a case study of how a District Health Authority (Paddington and North Kensington, now Parkside DHA following a recent merger with Brent DHA) in Inner London responded to a major new health care issue of the 1980s--Aids, but the paper also seeks to locate this case study material within wider debates. What theories are there of organisational change which could be used to illuminate policy and service change in the health care sector? How, indeed, do we best study change in health care organisations? The paper is thus in three parts. In the first section we identify some streams of literature which act as a frame of reference defining our initial research question and discuss implications for methodology. The second section presents the case itself, while the last section discusses some emerging findings.     

Children and Society Policy Review: Health Policy Affecting Children and Young People

The Health and Social Care Act comes into force in April 2013. It changes the organisation of the health service and accelerates the integration of health and social care. New relationships between primary and secondary healthcare will develop and the culture of clinical and cost effectiveness will expand into social care; work on children in public care is in the vanguard of this change. However, this is not an organisational change designed for children and there are considerable anxieties about how it will impact on the delivery of health care. The issues for children in public care need to stay high on the national agenda and in local fora.     

Modelling Chinese manufacturers' technology adoption behaviour

Abstract

This paper uses firm-level survey data from Hong Kong to identify determinants of technology adoption. The data analysis was guided by proposing a new model that was built upon the Theory of Planned Behaviour and Technology Acceptance Model. Three types of determinants are considered. They are determinants controllable by the technology suppliers and technology buyers, respectively; an external determinant that is not controllable by both the technology suppliers and buyers. This paper reviews research in related areas and the proposed model suggests ways in which behavioural, environmental and organisational issues may be important to technology adoption. The result reveals that behavioural and organisational issues are relevant to technology adoption decision, whereas the relevance of environmental issues is questionable.     

Citizen participation in neighborhood health centers for the poor: the politics of reform organizational change, 1965-77

Through a longitudinal study of neighborhood health centers for the poor in the United States, this paper presents an analysis of the political economy of change within reform organizations. In the final accounting, we seek to explain the shift in the role of poor people participating in health care decision making from that of program developer and change agent to the role of program restrictor. We conceptualize the neighborhood health center (NHC) as a reform organization whose initial objective was to use health care as a tool for achieving political and economic development within low-income rural and urban communities. The analysis, based on a prospective study of NHCs between 1965 and 1977, using interviews with citizen board members, NHC project administrators, NHC physicians, HEW decision elites, and oral history interviews with former Office of Economic Opportunity (OEO) administrators and directors, exemplifies the generic social organizational problem of how social, political, economic, and ideological forces shape the emergence and performance of a new reform organization.     

Community Aged Care Case Managers Transitioning to Consumer Directed Care: More Than Procedural Change Required

Abstract

Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. A key finding is that changes in values, attitudes, and organisational culture are needed before staff can fully implement CDC principles of service user self-determination, empowerment, and choice. Process changes needed to assist staff transition to CDC are: using a change management strategy that maximises certainty; monitoring and responding to feelings of anxiety through ongoing consultations; and providing ongoing education and support in group sessions.     

An evaluation u-turn: From narrow organisational objectives to broad accountability

The development of evaluation scholarship progresses, but the slow and incremental steps taken are largely refinements on a direction of thinking that has become established and virtually taken for granted. Most frameworks and models which have gained recognition in the academy and practice follow programme logic methodology. They also point to the achievement of organisational objectives as being the principal, but not always sole, purpose of public relations programmes. The achievement of organisational objectives has therefore been the focus of evaluation.Parallel, to this, a second strand of thinking in the scholarship and practice has questioned the assumption that the meeting of organisational objectives is paramount and whether organisations alone should determine the measures of success. Other perspectives such as stakeholder judgements of success and the obligation of organisations to meet societal expectations have been discussed as legitimate ways in which to evaluate programmes and activities.This paper takes forward this second strand by proposing that the evaluation debate should be ‘flipped’. Instead of organisational objectives being a primary denominator for evaluation, the paper proposes that whether organisations discharge their accountabilities to stakeholders and society is of equal, if not more weight. An organisation will succeed only if it sustains its licence to operate. To achieve that it has to meet the reasonable expectations that licence-givers have and to obtain their active consent to support its actions. The key questions for public relations are therefore: who/what holds us to account? What are their expectations? How are their expectations fulfilled? Drawing on the management and public relations literature to answer these questions, the paper calls for a radical ‘turn’ from the prevailing thinking, which the authors suggest is more about public relations explaining and justifying itself, towards a model that aligns with contemporary management thinking and practice.The paper proposes a model and process that provides a way forwards based not only on organisational aspirations, but on a hierarchy of obligations: to society, stakeholders, the organisation, and to the professional function which runs campaigns. It offers a principles based evaluation approach. In doing so, it takes the evaluation debate in a new direction and thereby adds to theory-building. It also offers a new way forwards for the practice which has become increasingly mired in developing more comprehensive lists of indicators and metrics and expanding taxonomies of evaluation terms.     

Le modèle de « l'État-stratège » : genèse d'une forme organisationnelle dans l'administration française

Since the 1990s, a new organisational form of the administrative system in France has been steadily redefining relations between central administrations and local state units. Labelled “the steering state” or the “managerial state”, this new paradigm hinges on separating the strategic functions of steering and controlling the state from the operational functions of execution and policy implementation. The making of this new form of state organization involves two parallel processes: political and cognitive. For one thing, the adoption of concrete measures for “government at distance” results from power struggles between three major ministries (Home Office, Budget and Civil Service). For another, a new legitimate “categorization of the state” is being formed in the major committees involved in the reform process of the 1990s; it is borne by top civil servants and inspired by the ideas of New Public Management. — Special issue: New patterns of institutions.     

Exploring Digital Culture in Virtual Teams: Implications for Leading and Developing Distributed Organisations

Understanding human communication in the technological age is becoming more complex as advances in technology and its use in human exchange are being magnified. New studies show that technology is no longer just a device for human connections; it is an integrated artefact in the human exchange and communication process. As a result, we are witnessing and experiencing new norms and patterns of behaviour, values in human connections, expectations of one another, language, and other symbol systems: a digital culture. This article explores further development of the digital culture model in relation to organisational work culture. Specifically, the dimensions related to digital communication and online group dynamics are further articulated from a literature review. The findings are also presented from a study of e-process teams in a distributed organisation based on data from a digital culture inventory, focus group observations, and participant reflections, which illustrate changes in behaviour, language, group dynamics, and communication exchange between team members working in a distributed organisation. The article aims to contribute new insights which could inform approaches to organisational development that view organisational culture as central to the process.     

Enhancing Critical Reflection amongst Social Work Students: The Contribution of an Experiential Learning Group in Care Homes for Older People

As part of a Practice Learning Centre, representing a partnership between an English University social work department and a non-governmental organisation, 12 students were placed in care homes for older people for their first period of assessed practice. The aims of this initiative were to facilitate: development of critical reflection; deployment of social work skills in a care home setting; and opportunities for social work students to work with care home residents. The learning was captured via four Experiential Groups facilitated by the Practice Educator with responsibility for assessing the students' practice. On-site supervisors also participated. Key learning included understanding of: the importance of critical reflection as a key social work skill; the influence of organisational norms and care home culture on the quality of care practice; the complexity and emotion-rich nature of person-centred care; and the pivotal role of relationships in work with people with dementia. Links made in the Groups—between the experiential and theoretical, the emotional and cognitive, and the structural and personal—demonstrate their value as learning platforms. Placements in care homes have considerable potential to enrich practice education; this is especially important in the context of an ageing population.     

Pschiatric nurses in the age of health care reform

With the March 2010 passage of the health care reform law, the Patient Protection and Affordable Care Act, the U.S Congress completely transformed the health care industry and fundamentally altered how hospitals will deliver and receive payment for care. The purpose of this article is to examine the provisions of the Affordable Care Act and its significance for behavioral healthcare. Key components of health care reform ( i.e., measuring and benchmarking quality patient care outcomes; payment reform; and the reorganization of the health care delivery system to ensure accountable, accessible, patient-centred, coordinated care) are reviewed with regard to their impact on behavioral health. The challenges, opportunities, and implications of health care reform are examined for the nursing field in general and psychiatric nursing practice specifically.     

Death and the Penguin: modularity,alienation and organising

ABSTRACT

The originality of this paper lies in the ways in which it explores how the depiction of organised crime within Andrey Kurkov’s novel Death and the Penguin can inform our understanding of organisational modularity. This non-orthodox approach might open up new avenues of thought in the study of organisational modularity while further illustrating how novelistic worlds can inform accounts of organisational realities. Two main research questions underlie the paper. How can Andrey Kurkov’s novel further our understanding of the complexity of organisational worlds and realities by focusing our attention on different landscapes of organising? How does Kurkov’s novel help us grasp the concept of modularity by drawing attention to new forms of modular organisation? Drawing from our reading of Kurkov’s novel, we primarily explore organisational modularity through Kurkov’s depiction of organised crime and consider the themes of alienation and isolation in the context of modular organising.     

Inequitable Access to Health Services for Older Adults with Diabetes: Potential Solutions on a State Level

Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.     

Tax incentives and family labor supply in Austria

The family policy reform 2009 introduced tax deductibles for children and child care expenditures in Austria. In this paper we evaluate this reform based on a structural labor supply model with unitary households which has been estimated on the European Statistics on Income and Living Conditions cross-sections 2004–2008. We find that the reform had only small employment effects, most of them being generated through the introduction of a child care deductible. However, to illustrate the employment potential of a shift from universal child transfers to tax deductibles we propose additional simulations showing that such a policy shift would yield an increase in full time equivalents of approximately .70 % of overall employment, with married females increasing their labor supply by up to 1.5 %. While the proposed policy shifts have regressive effects in terms of their distributional impact, we show that phasing-out the tax deductible at higher income allows for the compensation of lower-income households without jeopardizing positive employment effects.