The Observer Effect and Its Impact on Staff Behavior in an Acquired Brain Injury Neurobehavioral Treatment Setting

Staff in three neurobehavioral residential settings (5 in each residence for a total of 15 staff) were trained on specific positive interaction behaviors in a multiple baseline design. Staff in each of the residences were provided with recommended behaviors for interacting with residents through an observational procedure where they observed and completed checklists on video models of the targeted staff interaction behavior. In addition to staff interaction behaviors, subsequent levels of adaptive resident behaviors were also examined, such as active engagement and indices of happiness. Targeted interactions increased from an average of 7.2% of intervals during baseline to 80% during the intervention. Productive involvement engaged in by residents increased from 17.9% in baseline to 73.9% during the intervention, and the happiness indices of residents increased from 6.1% in baseline to 67.5% during the intervention.     

The Effects of Verbal and Written Supervisory Feedback on Staff Compliance with Assigned Prompted Voiding in a Nursing Home

We examined the effects of staff performance feedback delivered by a supervisor verbally, and combined with written feedback on geriatric nursing assistants' (GNAs) completion of assigned prompted voiding. The goal of the staff management procedures was to increase the frequency of prompted voiding which would consequently maintain improvements in continence brought about on a specialized continence unit. The basic staff management system included GNA self-monitoring of their performance of prompted voiding, periodic supervisory monitoring, and verbal and graphic feedback provided to all GNAs on their performance. At a later time, the staff management program was modified to include letters of praise or disapproval sent bi-weekly to all GNAs based on their performance of the prompted voiding procedure. Also, a letter was sent to all GNAs every three months summarizing their performance during this period. These summary letters were placed in the GNAs' personnel file and used as part of their annual performance evaluation. Results suggest that, although individual verbal feedback alone resulted in acceptable maintenance of prompted voiding, the addition of written feedback produced significant improvements in the number of assigned prompted voiding completed. This study displays the utility and practicality of employing formalized staff management procedures in nursing homes.     

Effectiveness of Job Aids and Post Performance Review on Staff Implementation of Discrete Trial Instruction

Discrete-trial instruction (DTI) is a well-established instructional method for teaching children with autism. Accurate implementation of DTI procedures requires that staff be well trained. This study examined the effectiveness of job aids followed by post performance review of strengths, errors, and accuracy on discrete trial instructional accuracy in three participants who conducted DTI within their current job positions. Additionally, primary training procedures were embedded within a meta-shaping procedure, which involved the gradual and systematic introduction of three levels of behavioral components required for accurate implementation of the DTI sequence with mastery criteria set at 90% accuracy across all three levels. As demonstrated in a changing criterion within a multiple baseline design, staff demonstrated increases in DTI accuracy following the initiation of the job aid condition; however, some degree of performance-based feedback was required to establish high levels of procedural fidelity across the DTI sequence. Performance accuracy on maintenance probes remained at high levels. These findings provide support that job aids followed by performance-based feedback may be an effective and efficient method for shaping high levels of DTI procedural fidelity in staff. Additionally, gradual shaping of the DTI accuracy may scaffold performance, minimize errors, and increase social validity.     

Involving Families and Staff in Service Improvement

This study was designed to improve an important service for severely mentally retarded adolescents and adults. The overall objective was to investigate the effect on client and staff behavior of implementing procedures designed to achieve change in three priority service areas selected by the families and staff. The experimental design was a three phase time series design. In the final phase, three procedures designed to achieve change in the selected areas were introduced sequentially. The service areas selected were staff organization, staff-family communication and clients' recreational activities. The setting supervisors monitored staff use of the procedures by means of a structured checklist and gave staff direct feedback on their performance. Checklists used by the researchers revealed consistent use of the procedures by staff. Observational measures showed marked changes in the behavior of both staff and their clients. Comparisons of interviews with staff and families conducted prior to and following the interventions revealed general satisfaction with changes achieved and increased staff emphasis on client teaching. This study demonstrated the feasibility and desirability of involving staff and families in making plans for service improvement.     

Increasing Physical Therapy Equipment Preparation Using Task Clarification,Feedback and Environmental Manipulations

The purpose of this study was to increase completion of tasks related to morning preparation procedures among 2 full-time and 4 part-time employees at a physical therapy clinic. A functional assessment was conducted to aid in the development of the treatment package consisting of graphic feedback, task clarification, and equipment manipulations. Later, graphic feedback was replaced with verbal feedback from the manager to facilitate maintenance of the intervention by the manager. During baseline, the mean checklist completion percentage was 18.4% and 56.5% for the therapy area and the hygienic activity area, respectively. This improved to 82.1% and 90.3% during the first intervention phase and remained above baseline levels at 75.6% and 100% during the second intervention phase. The results of this study suggest that the package intervention derived from the assessment was effective at increasing preparation task completion. Performance maintained above baseline levels at a three-month follow-up observation for the therapy area (50%) and the hygienic activity area (83.3%). According to the treatment acceptability assessment, graphic and verbal feedback were viewed as favorable by employees.     

Engagement of Patients and Staff on a Psychiatric Hospital Ward

Patient and staff behavior on a psychiatric hospital ward were assessed through behavioral observation. Twenty-four codes for patient behavior, 18 codes for ward locations, and two codes for staff behavior were used to analyze the activity of 30 dually- diagnosed (mentally retarded and mentally ill) patients. The results showed that patients spend much of their waking time unengaged in day rooms and halls. Staff spend the majority of their time in indirect care activities in a nursing station.     

A Comparison of Pyramidal Staff Training and Direct Staff Training in Community-Based Day Programs

This study evaluated two methods of training staff who were working with individuals with developmental disabilities: pyramidal training and consultant-led training. In the pyramidal training, supervisors were trained in the principles of applied behavior analysis (ABA) and in delivering feedback. The supervisors then trained their direct-care staff and, subsequently, provided ongoing performance feedback. In the consultant-led training, the direct-care staff was trained in the principles of ABA. Both groups learned similar amounts of knowledge of ABA principles, but pyramidal training was more effective in teaching staff to use correct teaching procedures with consumers. In addition, the pyramidal training group maintained the improvement in their teaching procedures at a 3-month follow up, while the consultant-led training group's performance declined.     

A Case Study in the Programming and Maintenance of Institutional Change

While behavior change projects and component analyses have been critical to the development of behavioral technology, behaviorists working in human service institutions have not focused enough attention on the "packaging" and systematic application of a technology for institutional change. In the present study, a package of organizational behavior management procedures was systematically introduced in a human service setting. The goal of intervention was to promote and maintain institutional change sufficient to support the wide scale implementation and maintenance of state-of-the-art behavioral procedures for program management and service delivery. The specific procedures utilized in the study included the following: (1) planning; (2) establishing functional organizational structure; (3) recruiting, orienting, and training management and direct service personnel; (4) contracting for staff performance; (5) scheduling, supervising, and evaluating personnel; (6) obtaining and managing financial resources; (7) evaluating program operation; (8) ensuring legal safety; and (9) disseminating results. Sixteen dependent variables, chosen to illustrate the quantity and quality of institutional change, were measured for the three years prior to, and five years following, intervention. Data from these measures indicated that intervention resulted in a positive change in virtually every aspect of program operation and that change resulting from the study was durable over time. Within the limitations imposed by case study design, these results were interpreted to suggest that institutional change is possible and that the technology required to effect such change is currently available.     

Implementing Computerization in Hospitals:

This study examines the impacts of a medical information system (MIS) upon select work related attitudes and reported work role behavior of a randomly selected group of hospital employees. Measures of attitude toward the MIS, job satisfaction, role tensions, and reports of work activities were administered at three points before and after the implementation of the system. Results of analyses of the trends that were observed suggest that over time employee attitudes toward the system became less favorable, levels of job satisfaction increased, and that the system's introduction affected several categories of reported work activity.     

Implementing a quality assessment program

It is difficult to imagine a more stressed organization than today's hospital. If the scope of change is not a sufficient challenge, the rate of the change is staggering, especially in quality assessment. Now we are poised for continuous quality improvement, whereby outcomes identified by quality assessment become the focus for system and process review and modification. It is imperative that a good quality assessment program be in place before implementing and integrating a continuous quality improvement process. The purpose of this article is to show how a quality assessment system can be implemented in a community hospital, regardless of size or scope of services. Key to the process is making all staff members part of the system's development and operation.     

Changing Patterns of Residential Care

The use of soft-tie restraint, a common means of controlling the assaultive behavior of mentally retarded residents in institutions, was examined with a retrospective design. Naturally occurring changes over a 39-month period were divided into (a) changes in management personnel that were associated with changes in management support of behavioral programming, (b) changes in staff training and feedback, and (c) a change in the physical location of the Program. Use of restraint decreased when the use of behavioral programming was supported by management and increased when it was not. When a four-person Training Team provided staff with training and formal and informal fecdback, restraint was used less than it was when the Training Team was outside the Program and training and feedback were not provided. Changing the physical location of the Program had little effect on the use of restraint. Relative to baseline, use of restraint decreased by 80% when management supported the use of behavioral programming and the Training Team was in the Program providing training and feedback. Reductions in the use of restraint were correlated with a corresponding reduction in Special Incident Reports which were filed when an event such as injury to a resident or staff member occurred.     

Hospital and medical staff strategic planning: developing an integrated approach

The physician as the principal customer of the hospital is a relatively new concept, indicative of the shift to a more complete market orientation in strategic planning. Although medical staff and medical community dynamics receive increasing attention in strategic planning, much more sophistication is now needed to involve physicians constructively in strategic planning for the hospital and medical staff. While full consonance of physician and hospital plans may be achievable only in a completely integrated delivery system, there is considerable room for improvement in current organizational models.     

Anxiety, burnout and coping styles in general hospital staff exposed to workplace aggression: a cyclical model of burnout and vulnerability to aggression

Although an increasing problem, the aggression ( physical assault, threatening behaviour and verbal aggression) directed toward general hospital staff rather than staff in psychiatric institutions has not been widely investigated. The present study first compared anxiety, coping styles and burnout according to the frequency of aggressive experiences. Second, a sub-sample was examined to determine any immediate after-effects from aggressive encounters. Healthcare staff ( n = 375) across professions completed the State-Trait Anxiety Inventory, the Maslach Burnout Inventory and the Coping Responses Inventory, which were analysed according to the type and frequency of aggression experienced within the preceding year. There were no significant differences in levels of anxiety or in coping styles. However, significant differences were determined in levels of burnout. Emotional exhaustion and depersonalization were significantly higher in those staff more frequently victimized suggesting that aggressive encounters might lead to an increase in burnout. Equally, the converse might be true. Therefore, a cyclical model is put forward in which we propose that elevated levels of burnout from all sources might increase vulnerability to victimization. Increases in emotional exhaustion lead directly to an increase in depersonalization as a coping mechanism, which subsequently manifests as a negative behavioural change toward patients, thus rendering staff more vulnerable to further aggression.     

A Comparison of Lecture Versus Role-Playing in the Training of the Use of Positive Reinforcement

Managers of organizations, often in coordination with personnel departments, create training programs for their staff. The emphasis in human service organizations is to train staff to use behavior modification techniques, especially to reinforce appropriate client behavior. Unfortunately, published research evaluating the quality of this training has been almost nonexistent (Kazdin & Moyer, 1976). Two different instructional formats of training were compared in this study: two groups received a lecture on reinforcing appropriate behavior and two groups role-played the act of reinforcing appropriate behavior. Follow-up observations of the staff showed that the performance of the lecture-trained staff was stable or declined after an initial improvement. The performance of staff who role-played, however, continued to improve. Feedback and physical action may be the reasons for the superiority of role-playing over a lecture format.     

The shadow dance of political climate: Engagement in political behavior in local government authorities

In describing the processes of organizations as political acts, we are not making a moral judgment; we simply are making an observation about a process. Bacharach and Lawler, 1980, p. 2.This study focuses on the ways a perceived political climate influences engagement in political behavior during a national election period. By using social cognitive theory as a way to predict behavior in organizations, we study how managers' engagement in political behavior is shaped. A qualitative research methodology was used. Sixteen interviews with managers were conducted in various local authorities during the 2015 election campaign for Israel's parliament. Participants perceived an intensification of political climate during the pre-election period, which they attributed to a significant connection between electoral and intraorganizational politics. Additionally, a perceived organizational political climate intensifies engagement in a range of political behaviors throughout an organization and is connected with an administrative role. The findings suggest that managers use “political capital” that the election period provides to influence and manipulate their organization's future and their own.     

Beyond the Skinner Box: The Design and Management of Organization-Wide Performance Systems

A discussion of the need for organizational behavior management practitioners to shift their application paradigm from a dyadic perspective to a systems perspective is presented. Such a shift would improve the identification of performance improvement opportunities, reduce the effects of unintended contingency interactions, and help ensure sustainable improvement efforts. Nine performance system tools are described that assist the analyst in the design of a performance system and its long-term management and maintenance. A manufacturing case study describing the application of these tools is provided.     

A Model for Planning Resource Requirements in Health Care Organizations

In this paper we present a general model and solution methodology for planning resource requirements (i.e., capacity) in health care organizations. To illustrate the general model, we consider two specific applications: a blood bank and a health maintenance organization (HMO). The blood bank capacity planning problem involves determining the number of donor beds required and determining the size of the nursing and support staff necessary. Capacity must be sufficient to handle the expected number of blood donors without causing excessive donor waiting times. Similar staff, equipment, and service level decisions arise in the HMO capacity planning problem. To determine resource requirements, we develop an optimization/queueing network model that minimizes capacity costs while controlling customer service by enforcing a set of performance constraints, such as setting an upper limit on the expected time a patient spends in the system. The queueing network model allows us to capture the stochastic behavior of health care systems and to measure customer service levels within the optimization framework.     

Using a Consultant Workshop Model to Improve Performance Management in Chinese Autism Agencies: A Preliminary Study

ABSTRACT

This study investigated the outcomes of using a consultant workshop model to help implement performance management (PM) methods in selected Chinese autism agencies. A need for improvement of educational services in Chinese autism agencies was identified. However, the theory and methods of organizational behavior management (OBM) in general and PM in particular are still foreign in the Chinese autism community. The primary research question of the current study was whether first-line teacher performance in Chinese autism agencies could be improved by the use of a consultant workshop model to train management staff to implement a PM system. Four autism agencies in different Chinese provinces participated in this study. Results demonstrated that after the implementation of the PM system through a consultant workshop model in the participating agencies, the performance of first-line teachers in these agencies improved in several important areas. The intervention appeared modestly effective. Implications of the outcome data and future directions for practitioners and researchers are discussed.     

Functional Assessment and Intervention for Organizational Behavior Change: Improving the Timeliness of Staff Meetings at a Human Services Organization

We implemented functional behavioral assessment (FBA) at a human services organization to reduce the tardiness of scheduled staff meetings. Following baseline, FBA focused on antecedent and consequence conditions that affected staff arriving on time to scheduled meetings. These data were subsequently presented at a staff meeting in which staff planned an intervention to improve the timeliness of meetings. The intervention, composed of premeeting reminders, positive reinforcement for arriving on time, and meeting termination criteria (to facilitate meeting-to-meeting transitions), was implemented in a multiple baseline design across 3 types of meetings. As a result of the intervention, the number of minutes late that meetings started decreased. We discuss FBA within organizational behavior management that targets performance improvement objectives.     

Anxiety,burnout and coping styles in general hospital staff exposed to workplace aggression: A cyclical model of burnout and vulnerability to aggression

Although an increasing problem, the aggression ( physical assault, threatening behaviour and verbal aggression) directed toward general hospital staff rather than staff in psychiatric institutions has not been widely investigated. The present study first compared anxiety, coping styles and burnout according to the frequency of aggressive experiences. Second, a sub-sample was examined to determine any immediate after-effects from aggressive encounters. Healthcare staff ( n = 375) across professions completed the State-Trait Anxiety Inventory, the Maslach Burnout Inventory and the Coping Responses Inventory, which were analysed according to the type and frequency of aggression experienced within the preceding year. There were no significant differences in levels of anxiety or in coping styles. However, significant differences were determined in levels of burnout. Emotional exhaustion and depersonalization were significantly higher in those staff more frequently victimized suggesting that aggressive encounters might lead to an increase in burnout. Equally, the converse might be true. Therefore, a cyclical model is put forward in which we propose that elevated levels of burnout from all sources might increase vulnerability to victimization. Increases in emotional exhaustion lead directly to an increase in depersonalization as a coping mechanism, which subsequently manifests as a negative behavioural change toward patients, thus rendering staff more vulnerable to further aggression.