Role Conflict and Ambiguity

Abstract

This study explores the relationship between role conflict and role ambiguity, and burnout of mental health service providers. The study used a sample of 259 mental health service providers who completed a questionnaire that included several measures: role conflict and ambiguity scales, the Maslach Burnout Inventory, social support scales and an involvement scale. Results showed that role conflict and role ambiguity had statistically significant correlations with several of the burnout dimensions. The author discusses the potential implications for increasing workers' quality of work life.     

Understanding the factors that influence health promotion evaluation: The development and validation of the evaluation practice analysis survey

The demand for improved quality of health promotion evaluation and greater capacity to undertake evaluation is growing, yet evidence of the challenges and facilitators to evaluation practice within the health promotion field is lacking. A limited number of evaluation capacity measurement instruments have been validated in government or non-government organisations (NGO), however there is no instrument designed for health promotion organisations. This study aimed to develop and validate an Evaluation Practice Analysis Survey (EPAS) to examine evaluation practices in health promotion organisations. Qualitative interviews, existing frameworks and instruments informed the survey development. Health promotion practitioners from government agencies and NGOs completed the survey (n = 169). Principal components analysis was used to determine scale structure and Cronbach’s α used to estimate internal reliability. Logistic regression was conducted to assess predictive validity of selected EPAS scale. The final survey instrument included 25 scales (125 items). The EPAS demonstrated good internal reliability (α > 0.7) for 23 scales. Dedicated resources and time for evaluation, leadership, organisational culture and internal support for evaluation showed promising predictive validity. The EPAS can be used to describe elements of evaluation capacity at the individual, organisational and system levels and to guide initiatives to improve evaluation practice in health promotion organisations.     

The Coalition,austerity and mental health

In the United Kingdom, the Coalition government’s recent commitment to improving mental health provision masks the extent that their policies of austerity have already brought harm to those same services. Government-driven policies have led to significantly reduced funding within mental health, increasing pressure on a system that was already chronically under-resourced. Further, people who are experiencing mental distress, and mental health service users, have been especially vulnerable to the harms of the current austerity programme, including being at the sharp end of the assault on public services and welfare spending. This piece discusses the impact of austerity, exploring the effects of government policies and with a critical perspective of the dominant discourses around mental health. It argues that by exacerbating social inequality, government policies are also directly leading to worsening mental health in the United Kingdom.     

Staff & client perceptions of unit quality: a pilot study

This pilot study compared psychiatric health care team members' perceptions of unit quality with discharged clients' perceptions of quality of care received on the unit. The staff members were from four different service units in one acute care psychiatric facility. The study used the Perceptions of Unit Quality (PUQ) scale, a valid and reliable outcome measurement instrument, developed by Cronenwett. Most quality assurance instruments that exist have focused on individual caregivers' or service-specific views of quality, but the PUQ scale allows quality assurance data that represent team performance to be described through team perceptions of quality. Results of this pilot study suggest that use of the PUQ scale, in conjunction with clients' perceptions of unit quality, may be a legitimate approach in continuous quality improvement efforts in psychiatric-mental health care centers.     

Strengths, uses and problems of global scales as an evaluation instrument

A global scale can provided means for integrating a variety of client/patient assessment techniques to complement each other in a useful manner. Global scales have been applied to service planning and evaluation as well as being useful for the on-going communication of clients' clinical/functioning status. Global scales are attractive to many service programs because of their apparent ease of implementation and their apparent face validity. Furthermore, there is an extensive body of literature describing global scales as hightly reliable and valid when properly implemented and maintained. The literature also suggests that there are some serious pitfalls. While initial implementation of a global scale is easy, the maintenance of a reliable, valid and useful scale appears to require their active use in treatment planning, treatment review and clinical supervision processes. It also requires that more extensive multidimensional ratings be made at intake, review and termination. Furthermore, staff training and development sessions two or three times a year are needed to surface and deal with differences in clinician ratings. Given these sorts of supports, then, a global scale has been demonstrated as a useful tool in service program management as well as clinical process and outcome studies, including studies of cost effectiveness. Since the major use of a global scale is as an integrating construct, a quantitative model is offered to describe the relationship between global scale ratings and multidimensional facets influencing the global ratings.     

Global scales : Strengths, uses and problems of global scales as an evaluation instrument

A global scale can provided means for integrating a variety of client/patient assessment techniques to complement each other in a useful manner. Global scales have been applied to service planning and evaluation as well as being useful for the on-going communication of clients' clinical/functioning status. Global scales are attractive to many service programs because of their apparent ease of implementation and their apparent face validity. Furthermore, there is an extensive body of literature describing global scales as hightly reliable and valid when properly implemented and maintained. The literature also suggests that there are some serious pitfalls. While initial implementation of a global scale is easy, the maintenance of a reliable, valid and useful scale appears to require their active use in treatment planning, treatment review and clinical supervision processes. It also requires that more extensive multidimensional ratings be made at intake, review and termination. Furthermore, staff training and development sessions two or three times a year are needed to surface and deal with differences in clinician ratings. Given these sorts of supports, then, a global scale has been demonstrated as a useful tool in service program management as well as clinical process and outcome studies, including studies of cost effectiveness. Since the major use of a global scale is as an integrating construct, a quantitative model is offered to describe the relationship between global scale ratings and multidimensional facets influencing the global ratings.     

PRODUCTION COSTS, TRANSACTION COSTS, AND LOCAL GOVERNMENT CONTRACTOR CHOICE

Local governments that choose to externally produce a service can contract with other governments, for-profit firms, or nonprofit organizations. This contractor choice is modeled as one in which the local government decision maker minimizes service delivery costs, both production and transaction costs, subject to political and fiscal constraints. The model is estimated using data on three frequently contracted health services obtained from a national survey of local government service delivery arrangements. The empirical analysis reveals the importance of both production and transaction costs, as well as the choice set of available suppliers, to contractor choice.     

Outcomes in the sociology of mental health and illness: where have we been and where are we going?

Sociologists of mental health and illness have traditionally used outcome measures that they have obtained from other disciplines, especially psychiatry and psychology. These include official statistics, symptom scales, and diagnostic measures. Answers to the central sociological question of how social arrangements affect mental health might require the development of explicitly sociological outcome measures. This introduction provides an overview of several issues that arise in grappling with this question. These include whether symptom scales or diagnoses best capture the mental health consequences of social arrangements; when single or multiple outcomes are necessary to compare the consequences of social arrangements across different groups; if sociologists should explore the positive as well as the negative consequences of social forces; and when sociological attention should be directed toward social-level as well as individual-level outcomes. The papers in this symposium that follow provide more detailed analyses of each of these issues.     

Coordinating health, extended care, and community support services: reforming aged care in Australia

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Ethnicity and Health Service Use in a Women's Prison

ABSTRACT

This paper highlights the findings in relation to health need, ethnicity, and health service use among a sample of women in prison. Medical records review for 129 women and interviews with 15 women were conducted to determine factors associated with differential service use. Statistical analyses reveal that ethnicity and an interaction between ethnicity and whether one is on medication at prison admission (a health need variable) significantly predict extent of service use. Women of color use fewer services overall, with the exception of those on medication. Qualitative analyses reveal that women of color view the quality of medical care and the ways they are treated less positively than White women. Implications for equitable service provision are explored.     

A comprehensive health service evaluation and monitoring framework

ObjectiveTo develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services.MethodA targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders.ResultsThe framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable.ConclusionData collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.     

加强服务型社会组织建设研究

近年来,我国服务型社会组织得到较快发展,但其大多数仍缺乏现代社会组织所必备的专业性、创新性和服务性,缺乏承接政府职能、提供公共服务的足够能力。对此,政府应坚持"政社分开、权责明确、依法自治"的原则,推动各级政府部门向社会组织转移职能和购买公共服务,构建服务型社会组织的培育扶持政策体系,健全服务型社会组织的监督管理机制,不断提升服务型社会组织发展质量和参与社会服务管理的能力和水平。     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Face to face with the 'sovereign consumer': service quality and the changing role of professional academic librarians

This article considers the impact of service quality initiatives on the role of professional academic librarians.¹ It is argued that these initiatives—by asserting the dominant role of ‘sovereign’ consumers—offer a powerful legitimating device which is currently being used to support radical changes in professional work. One possible outcome of this is a weakening of professional autonomy and power to unilaterally determine levels and standards of service. The case of academic librarians is adopted to illustrate these points. Firstly, two ideal types of library and professional organisation, developed from a review of the librarian literature, are compared. These are the ‘traditional’ and the ‘service quality-led’ models. Following this, a case study of an academic library which has recently adopted various quality improvement strategies is discussed. The results of this investigation suggest that not only have service quality initiatives provided a legitimation for radical change, but they have also generated a number of unintended consequences and hidden costs for the users of library services. Finally, some of the wider problems associated with service quality initiatives in the public sector are discussed.     

Measuring the quality of health care

This Issue Brief examines some of the issues involved in defining and measuring the quality of health care and in implementing quality measures. It discusses the importance of measures of health care quality in the evolving health care delivery system, examines some of the conceptual issues involved in defining quality of care, and discusses some of the measures of health care quality and how these measures have been implemented in the health care delivery system. The major impetus for quality assurance programs is cost management: it is an attempt to allocate scarce health care resources efficiently. This requires making choices among alternatives, which may mean that maximizing quality of care for whole populations may not maximize the quality of care for individuals. Quality, in terms of any single good or service, has a number of dimensions. Health care is a complex bundle of services, and each component service within an episode of care affects the other components and the patients differently. Moreover, patients differ in numerous ways, which means that similar symptoms may require different services if care is to be effective. Measuring quality of health care services requires accounting for all of these factors. In attempting to manage health care costs, employers and other private health plans have begun to employ process measures of quality, i.e., evaluating caregivers' activities, the decisions made at each step in an episode of illness, and the appropriateness of the care provided. Process is an important component of quality measures because it focuses directly on the uncertainty in the efficacy of treatment. Given this uncertainty, the logic of medical decision making is an important determinant of quality and cost effectiveness. Examining the process of care involves assembling a panel of physicians who review medical records to determine the appropriateness of the care received. Providers have increasingly found that their medical decision making and practice styles are being monitored by purchasers as new health care delivery systems are being formed. The American Medical Association found that 39 percent of surveyed physicians were subject to clinical profiling.     

Managed care and the rationalization of mental health services

Managed care represents a response to the wider institutional demand for technical rationality and efficiency, and it may be in conflict with professionally generated logics of mental health care which emphasize the delivery of quality care, as well as providing services to all who need care. The organizational and policy conundrum is to balance conflicting institutional demands for efficiency (cost savings) and effectiveness (access and quality). This paper examines managed care in one public sector mental health care system that has attempted to incorporate the principles of managed care into a community based system of care and to overcome the potential contradictions between demands for efficiency and professional logics of care. Both qualitative and quantitative data are used to examine changes in organizational structure and service offerings; providers' experience of managed care, and the effect of managed care on working conditions and work experiences, and changes in the goals of the organization as measured by the specification of client outcomes. I find that, while increased performance accountability and outcome assessment (in keeping with demands for efficiency) have the potential to improve mental health care services, in fact, providers report that the primary effect of managed care has been an emphasis on cost containment, and there has been a corresponding de-emphasis on the provision of community based services for clients with long term care needs. However, there is potential for professional logics to be maintained by larger institutional forces demanding quality care.     

Constructing quantitative implementation scales from categorical services data. Examples from a multisite evaluation

Like measures of outcome, measures of implementation are most useful and analytically powerful when measured at client-level and are quantitative. However, high-quality, individual-level, quantitative service utilization data can be expensive, intrusive, or otherwise impractical to obtain. Cruder data--for example, presence versus absence of a given service--are often more feasible to collect, as well as more likely to be available. Consequently, evaluators can benefit by finding ways to better exploit such data at the analysis phase to compensate for shortcomings at the collection phase. This article documents one such instance in which this was done. Specifically, it describes how quantitative, client-level implementation scales were derived from qualitative (categorical) data and used to support a cross-site synthesis of implementation and outcome analyses in a multisite evaluation. It also suggests additional scenarios in which quantitative implementation scales might be derived form qualitative services data.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Racism and Xenophobia

Racism is perhaps the most serious basic problem affecting the welfare of people referred to as migrants or black people in Europe today. Racism is not just about personal racial prejudice but also about institutional processes, ways of thinking and ways of doing things that are deeply ingrained in European culture, including health care—especially mental health care. The prevention of racism in a health service requires a clear statement of intent in a race equality policy that generates monitoring systems, action plans and forward planning. Combating racism must go hand‐in‐hand with the promotion of cultural sensitivity in health care; equal opportunities in access to a service must be balanced by strict control of institutional racism in the quality of the service and employment practices.     

上海教育国际化的配套政策及服务体系研究

上海教育国际化的核心内涵是通过教育活动国际化、教育者与受教育者的国际化、教学机构国际化以及国际维度与观念融入过程的国际化等途径，推动上海整体教育水平的提高，吸引和培养高素质的国际型人才，服务于上海经济社会可持续发展的大局。上海教育国际化的配套政策要围绕优质教育资源的引入和输出展开：制定“引智”政策，以吸引优秀海外专家、学者，扩大开放现行科研体系，引入教育国际化高端资源；制定教学计划与课程国际化建设、“留学上海”系列服务、优质教育资源引进、“国际化品牌项目”支持、全社会共同参与、服务体系信息化等政策。建立以政府各相关部门为主体的管理体系、以高校及其他办学机构为主体的教学体系及以企业、各类社会组织及市民为主体的社会服务体系。