Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies

Proper identification of all stakeholders and the comprehensive assessment of their evolving and often conflicting Needs, Wants, and Desires (NWDs) is a fundamental principle of human factors science and human-centered systems engineering; it is not yet a consistent element in development and deployment of new health information technologies (HIT). As the single largest group of healthcare professionals, nurses are critical stakeholders for these new technologies. Careful analysis can reveal nurse stakeholder dissonance (NSD) when integrating new technologies into the healthcare environment. Stakeholder dissonance is a term that describes the conflict between the NWDs of different stakeholders which, if left unresolved, can result in dissatisfaction, workarounds, errors, and threats to patient safety. Three case studies drawn from the authors' experience in a variety of acute-care settings where new HITs have been recently deployed are examined to illustrate the concept of NSD. Conflicting NWDs, other stakeholders, and possible root causes of the NSD are analyzed and mapped to threats to patient safety. Lessons learned, practical guidance for anticipating, identifying, and mitigating NSD, future research and implications for HFE and nursing practice are discussed.     

Understanding Nurse Perceptions of a Newly Implemented Electronic Medical Record System

Nurses are the frontline of healthcare; however, there has been little theoretically-driven research on their acceptance of information technology use in care delivery. This research utilized the unified theory of acceptance and use of technology (UTAUT) model to understand how hospital nurses perceived the implementation of a new electronic medical record (EMR) system. This study used mix methods. The survey responses indicated that social influence and performance expectancy were significant factors in system adoption. Effort expectancy did not have a significant influence on the intention to use the EMR. The interviews were utilized to better understand these results. The UTAUT model highlighted factors that are important to nurses during an EMR deployment and can help in future implementations of technology in healthcare.     

Multi‐stakeholder Groups for Better Sector Performance: A Key to Fighting Corruption in Natural‐Resource Governance?

Multi‐stakeholder groups – involving representatives from civil society, government and the private sector — are increasingly seen as a means of promoting improved service delivery and operational performance in natural‐resource sectors. Although the intention is to promote dialogue, learning and collaboration towards agreed goals and the implementation of standards for better sector governance and performance, the impact of these initiatives will be shaped by members' incentives and external constraints. This article describes how incentive incompatibilities will prevent the group from effectively addressing fundamental problems in the sectors, such as corruption. Multi‐stakeholder groups can be a viable forum for debate, but should not be expected to perform a role in fighting corruption in natural‐resource management.     

Knowledge Management in Social Work–Towards a Conceptual Framework

SUMMARY

Knowledge management (KM) is receiving increasing attention in the human services such as social work. Social service organizations have started to use information and communication technology for knowledge management purposes with the aim of improving service efficiency and effectiveness. Existing KM studies, particularly in the commercial or industrial sectors, mainly focus on the reductionistic “knowledge-as-object” view, while other perspectives such as “knowledge-as-process” are less discussed. This paper argues that these mainstream conceptions of knowledge in KM do not fully fit with that of social work knowledge, and that a spectrum view may be more useful for future practice and inquiry in the area.     

Relationship marketing and service quality.

The delivery of services in college health centers is improved through the use of relationship marketing and service quality advancement. Relationship marketing works to attract, maintain, and enhance customer or client relationships with the healthcare provider. The facets of relationship marketing are explored, with the greatest emphasis placed on internal marketing. Higher quality health services come from continuous improvement, a focus on process, and intensive staff development and participation, which build a service culture.     

Relationship Marketing and Service Quality

Abstract

The delivery of services in college health centers is improved through the use of relationship marketing and service quality advancement. Relationship marketing works to attract, maintain, and enhance customer or client relationships with the healthcare provider. The facets of relationship marketing are explored, with the greatest emphasis placed on internal marketing. Higher quality health services come from continuous improvement, a focus on process, and intensive staff development and participation, which build a service culture.     

POST-PANOPTIC SURVEILLANCE THROUGH HEALTHCARE RATING SITES

This article examines websites where patients rate and evaluate healthcare services as mechanisms for transforming citizens into surveillers of public services in order to generate knowledge about the everyday performance of professionals and institutions. Using post-panoptic theories about the use of information and communication technologies in daily life, it questions how such sites, and the knowledge they generate, relate to existing surveillance structures. It begins with a review of current surveillance literature before turning to the empirical case of the Dutch website Zoekdokter. It situates the site in its specific national health and policy context, which enables not only an analysis of the site, but also the existing rules, norms and structures for monitoring performance and the dynamic between multiple types of surveillance that occur simultaneously in practice. Zoekdokter.nl is one of six cases in this research project and is the only case where patients are encouraged to evaluate individual professionals identified by name and location. I analyze website texts and 15 stakeholder interviews using the post-panoptic concepts of sousveillance, coveillance and infoveillance. In the discussion, I use the case to reflect on several assumptions made in current post-panoptic theory and, more specifically, on the transferability of these ideas to specific sectors, such as healthcare.     

Inclusive Governance Practices in Nonprofit Organizations and Implications for Practice

An inclusive board seeks information from multiple sources, demonstrates an awareness of the community and constituents that benefit from and contribute to the organization's services, and establishes policies and structures to foster stakeholder contributions. This research investigated the prevalence of inclusive governance practices and its relationship to board composition, diversity attitudes, and recruitment practices. Fifty‐six executive directors and forty‐three board members representing sixty‐two nonprofit organizations returned a mailed survey (29 percent response rate). The study profiled two organizations that represented different styles of inclusive governance. The survey, part of a larger study, contained questions about inclusive practices, board composition, attitudes toward diversity, and recruitment practices. Most organizations indicated that they operate with inclusive governance practices. The organizational profiles provide a picture of boards that used different strategies to accomplish the goal of inclusivity. Boards that use more inclusive practices were not necessarily heterogeneous in board member composition. Inclusive boards were more inclined to be sensitive to diversity issues and used recommended board recruitment practices. The existence of a task force or committee on diversity was also significantly associated with a more inclusive board. Nonprofit organizations must consider their philosophy on stakeholder involvement, recognizing that different strategies lead to different levels of stakeholder involvement.     

Collaborating for consensus: Considerations for convening Coalition stakeholders to promote a gender-based approach to addressing the health needs of sex workers

Women involved in sex work experience myriad challenges, such as poverty, illiteracy, low social status and gender inequity, as they struggle to access healthcare. These challenges place them at high risk for poor health outcomes. The purpose of this article is to describe the formation of a strong cross-system Coalition representing both the criminal justice and healthcare systems to address the health needs of sex workers in Delaware. The Delaware Coalition for Health and Justice implemented a Coalition-building strategy to design interventions and streamline systems to promote health and reduce criminal justice contact for sex workers. The sequential intercept model was utilized to organize Coalition membership and build consensus among varied stakeholders. The model assisted the Coalition in understanding differing primary objectives for key system programs, recognizing the limitations and barriers of each stakeholder group, sharing findings and discovering opportunities for partnership, and engaging stakeholders in designing and providing a comprehensive “systems” approach. This work suggests that aligning the criminal justice, healthcare, and community social services in a systemic process to build consensus can result in the implementation of effective systems change initiatives that address gender disparities and promote the health of justice-involved women.     

Factors affecting stakeholder’s levels of satisfaction with community partnership association in Rayong Province,Thailand

ABSTRACT

Corporate social responsibility (CSR) studies have investigated the differences among five parameters: gender, age, education, income, and occupation; however, the findings are generally dissimilar. For instance, no comprehensive concordance has been reached on the performance and importance of the differences among those five parameters regarding stakeholder expectations and perceptions of CSR activities. Some voluminous investigations have revealed that the literature does not discuss the essential importance of the differences among the five parameters, and as a consequence, the magnitude of such differences is unexplained. This research analyses the quantitative and qualitative significances of the differences among the five parameters in stakeholder satisfaction level and perceptions of CSR activities conducted by the Community Partnership Association in Rayong Province, Thailand. Overall satisfaction levels positively correlated with education and age, indicating that intellectual background and personal experiences considerably influence the perceptions of CSR activities. This study assists policymakers and industrial sectors to launch the most practical strategies for plotting, scheming, implementing, and evaluating sustainability initiatives.     

Spiritual development in adolescence: toward enriching theories, research, and professional practice

The author notes that she finds the case for making spiritual development a priority surprisingly compelling-"surprisingly" because although she is an expert on adolescent development, she has not done research or previously written about spiritual development. She suggests that a systems analysis occur first, before engaging frontline youth workers in this realm, to identify the interests of key stakeholder groups and ways to unleash creativity and engagement in each of them. The key will be framing engagement of spiritual development in ways that include rather than divide sectors and groups.     

Primary healthcare planning,bottleneck analysis and performance improvement: An evaluation of processes and outcomes in a Nigerian context

Operational planning of interventions defines roadmaps, timelines and resources necessary for translating policies into expected health outcomes along the evidence-policy-implementation continuum. However, bottlenecks often hinder the attainment of objectives and the timely delivery of intervention packages leading to sub-optimal performance of health systems. Bottleneck identification, analysis and removal approaches to planning, which requires key stakeholders’ participation, have been recommended to improve health system outcomes in LMICs. This study demonstrates how integration of participatory action research (PAR) within a quality improvement model can help navigate the complexities of health system bottleneck analyses, planning and performance improvement in a Nigerian sub-national context.The study is based on data collected between June 2016 and June 2017, from Chikun LGA in Kaduna State Nigeria. PAR was integrated into a quality improvement model called DIVA (Diagnose-Intervene-Verify-Adjust) applied across selected interventions (eMTCT, Antenatal care, skilled birth attendance, immunization and Integrated Management of Childhood Illnesses). PAR was used to identify and analyse health system bottlenecks, as well as develop, monitor implementation and follow-up on action plans to address them. Evaluations were conducted involving 2 cycles of DIVA. The outputs (bottleneck analysis charts, driver diagrams, operational plans, M/E reports, etc.) from each cycle of the DIVA process were collated and analysed. Bottlenecks identified include availability of human resources for health, availability of health commodities as well as geographical accessibility. These had implications on acceptability and quality of services. Mean Improvements recorded were 20.4%, 14.0% and 10.8% and 11.2%, 7.5%; 5.5% (across eMTCT, maternal health and child health interventions) in the 1 st and 2nd DIVA cycles respectively. This study highlights processes and outcomes of integrating PAR in quality improvement design and operations in health intervention programmes with a focus on health systems strengthening in a Nigerian context. Implementing the DIVA model using a PAR approach may be considered an effective strategy for planning and implementing health interventions in comparable settings.     

Can we make health IT safe enough for patients?

Health information technology (HIT) is widely believed to be an essential modality for improving the efficiency, effectiveness, and safety of healthcare, and has its adoption has been vigorously promoted. However, the safety of commercially available HIT systems has never been independently and rigorously assessed. This paper discusses critical issues to be considered in the development of safe and reliable HIT, and identifies a group of structural impediments that may slow or prevent the arrival of HIT that is actually safe enough for routine clinical use. It argues that this situation is analogous to NASA's promotion of the space shuttle not as an experimental, risky technology, but rather as a routine, ready-for-ordinary-use resource.     

Stakeholders’ partnership approach to infrastructure provision and management in developing world cities: lessons from the Sustainable Ibadan project

In recent decades unprecedented urbanization has constituted a huge challenge to urban infrastructure development and management in most developing countries. Meanwhile, the appropriateness of conventional urban planning approaches to the improvement of urban environmental conditions in the face of deteriorating urban environment have often been questioned. It became inevitable to search for new approaches particularly in the context of low-income urban communities. International organizations such as the United Nations Development Programme (UNDP) and the United Nations Centre for Human Settlements (UNCHS) have subsequently initiated strategies to evolve a participatory approach to the development and management of the urban environment. One of such strategies is the Sustainable City Programme (SCP) which aims to provide municipal authorities and city stakeholders in the public, private and community sectors with an enhanced capacity for environmental planning and management. The programme is being implemented in several cities in parts of the developing world, including Ibadan – the Sustainable Ibadan Project (SIP) – in Nigeria. This paper examines the partnership approach to urban environmental infrastructure improvement, development and management as represented by the SIP. The relevance of the participatory partnership approach of the SIP for cities in parts of developing regions is examined. The paper implicitly stresses that bottom-up participatory stakeholder partnership is a strategy capable of enlisting the financial, material resources and expertise of various sectors of the urban community towards the improvement of urban environmental infrastructure. The paper presents preliminary findings of a study. Although traditional appraisal techniques were not employed, nonetheless, the paper presents a discussion of the processes and dynamics of the SIP on the basis of which some useful lessons may be drawn.     

A Comparative Analysis of VHA,Non-VHA,and Overall Outpatient Treatment Use Intensity Among Older U.S. Veterans Denied or Awarded VA Service-Connected Disability Compensation

Poorer health is often associated with greater healthcare use among the general population. In contrast, while many veterans denied VA disability compensation ("denied applicants") are as impaired as those awarded VA disability compensation ("awarded applicants"), studies suggest that these veterans may nevertheless utilize less VHA healthcare. Whether they concurrently utilize less non-VHA, and overall healthcare, however, remains a critical, unresolved issue. The 2001 National Survey of Veterans was used to examine VHA, non-VHA, and overall outpatient healthcare treatment use intensity during the previous 12 months among veterans denied or awarded VA disability compensation. Results: Denied applicants were significantly more likely than those awarded to have not used any VHA outpatient healthcare during the previous 12 months (OR=2.45, 95% CI: 1.24, 4.81). Moreover, while not statistically significant, point estimates consistently suggested that denied may have concurrently used more non-VHA, and overall outpatient healthcare than awarded. It appears veterans denied VA disability compensation are forgoing VHA outpatient healthcare services, perhaps in favor of non-VHA outpatient healthcare services. While this result may be consistent with the intent of VA service-connected disability policy, further analysis is necessary to confirm adequate access to healthcare for denied veterans.     

Ergonomic risk assessment of nasogastric tube placement and implications for design and training

The placement of nasogastric (NG) tubes is known to be prone to error and may lead to serious issues for patient safety and wellbeing. In some instances these have been catastrophic and resulted in the death of the patient. This study sought to explore the potential risks associated with this procedure through the use of systematic prospective risk assessment. The research team used the Prospective Hazard Analysis (PHA) toolkit developed by Ward et al (2010) . The study has shown a wide number of risks that cover equipment design, work organisation, and training issues. The link between equipment design and training provides an important example of the need for a systematic approach to reducing errors and improving resilience in this aspect of healthcare.     

Stakeholder influence,government power,and new opportunities for Chinese Internet companies: A multilevel network analysis of cross-sector networks

In recent decades, Chinese Internet companies have experienced exponential growth. As the Internet industry increasingly commends tremendous financial resources, they also face growing stakeholder expectations for corporate social responsibility (CSR) actions. One way through which Chinese Internet companies conduct CSR is by building cross-sectoral collaborations with nonprofit and nongovernmental organizations (NGOs) and governmental agencies. Aiming to understand Internet companies’ strategic relationship building on CSR issues, the researchers drew from stakeholder influence theory and research on a network approach to stakeholder influence, and applied multilevel network analysis to model three networks related to Chinese Internet companies’ CSR collaborations. Specifically, we found that power and urgency are significant predictors of the structure of Internet companies’ cross-sector CSR alliance network. Organizations affiliated or endorsed by the central Chinese government are the most desirable CSR stakeholders. Additionally, the study also revealed that for Internet companies, devoting their attention to Internet-related social issues could increase their desirability as strategic stakeholders from other sectors and among Internet companies.     

The Political Economy of Employee Ownership in the United States: From Economic Democracy to Industrial Democracy?

This study examines the development of economic democracy in the United States since the 1700s with particular emphasis on the last 30 years. The particular focus is on employee ownership, although the phenomenon of profit sharing receives some attention. The nature of research and documentation on the subject is reviewed. The study concludes that research in the area has emphasized narrative studies of particular companies and sectors until the 1980s. At that time the support for the concept by the US Federal Government created reporting requirements for companies to the US Department of Labor and the US Internal Revenue Service (the taxation authority) and the US Securities and Exchange Commission. These data-sets have made systematic research on the phenomenon possible. Results of the first national random sample of employed individuals and work sites on the incidence of employee ownership and profit sharing are presented. Finally, we conduct a political economic analysis of the phenomenon. We demonstrate that, despite the growth of employee ownership in particular, a form of employee ownership has developed which encourages workers to use their savings to buy stock in their companies. This form dominates employee ownership in terms of the number of workers, firms, and dollar assets involved. Nevertheless, there is significant employee ownership in a group of closely held firms that use traditional ESOPs (Employee Stock Ownership Plans) and in a group of publicly traded high technology companies that use broad-based stock options. These two sectors offer fertile territory for the development of both economic democracy and nascent forms of industrial democracy.     

Short Term Gain, Long Term Pain

This paper examines the role of informal job search methods on the labour market outcomes of displaced workers. Informal job search methods could alleviate short-term labour market difficulties of displaced workers by providing information on job opportunities, allowing them to signal their productivity and may mitigate wage losses through better post-displacement job matching. However if displacement results from reductions in demand for specific sectors/skills, the use of informal job search methods may increase the risk of job instability. While informal job search methods are associated with lower wage losses, they lead to increased job instability and increased risk of subsequent job displacement.     

On the Integration of Science and Practice in College Health

Abstract

College health professionals want to assure the unique healthcare and health education needs of college students will continue to be met under national and state healthcare reform. This may be an “all or nothing” proposition. Either colleges and universities will have exclusive control of healthcare delivery for the college student population or else college health will not be a major force in healthcare reform. If college health is to play a meaningful role in future government-controlled health insurance programs, it must first demonstrate that current health services and insurance financing programs meet minimum quality standards. This proposal calls for expanding existing federal laws to create qualified student health plans and integrating the college health model into a reform package based on employer-sponsored health insurance. The concept of qualified student health plans allows for a high degree of flexibility that can be integrated into the majority of state and federal healthcare reform proposals, including the plan proposed by President Clinton, that are not based on a single-payer system. Ultimately, the authors suggest, their proposed plan would eliminate the current situation, in which large numbers of college students are uninsured or underinsured.