Engaging Professionals in Sustainable Workplace Innovation: Medical Doctors and Institutional Work

This paper investigates the role of medical professionals in the success and longevity of the implementation of workplace innovation and organizational change in the Accident and Emergency (A&E) Departments of two large public hospitals, in Australia and Canada, during the introduction of process improvement using Lean Management (LM) methodologies. We ask why and how doctors resist, influence or enable LM initiatives in healthcare. Using a qualitative methodology, we contribute to institutional work theory by unpacking the complex forms of boundary and practice work undertaken by key actors who effectively use their professional status and power to enable practice changes to be embedded. Our findings lend support to the importance of the involvement and ownership of senior doctors in the design, introduction and implementation of successful workplace innovation and organizational change. Senior doctors use their professional expertise, positional and political power at the industry, organization and workplace levels to influence strategically the use of resources designated for workplace innovation to improve efficiencies, quality of patient care and maintain their dominance. The significant organizational change achieved reflected the ownership and leadership of the workplace innovation by senior doctors in ‘hybrid roles’ who captured the rhetoric and minimized adversarialism among key stakeholders.     

Targeting lean process improvement projects for maximum financial impact

This empirical paper details a 12-month applied research project at a UK low-volume manufacturer of large vehicles. The industry problem from which this study originates was a concern over the subjective nature with which the firm’s existing lean intervention projects were being targeted (prioritised and selected). A structured literature review on this topic was unable to identify any objective decision support mechanism for doing so; one that encompassed financial as well as operational criteria. The resultant study was organised around an established seven-step action research framework. The main body of evidence was derived from extensive analysis of financial and operational data extracted from the firm’s enterprise resource planning system, along with two structured workshops that each involved multiple informants drawn from the firm’s production centres and its accountancy department. Supplementary primary research was provided in the guise of numerous unstructured interviews to validate data and from observation of shop floor practices. The main contribution of this article is identifying and addressing the gap highlighted above, by developing and testing a financially driven method for objectively targeting process improvement interventions within this large and geographically dispersed operation. This innovative method includes five new constituent techniques.     

Using an Objective Structured Clinical Examination for Bachelor of Midwifery students’ preparation for practice

BackgroundContemporary midwifery practice needs a rigorous and standardised assessment of practical skills, and knowledge to ensure that safety is maintained for both women and neonates before, during and after childbirth.AimTo evaluate the use of Best Practice Guidelines (BPG) for Objective Structured Clinical Examinations (OSCE) as a standardised tool to develop clinical competence of Bachelor of Midwifery students.MethodA pragmatic mixed method approach with surveys, focus groups and interviews was used to evaluate the OSCEs for first year students. Quantitative and qualitative data were combined to understand student and academic perceptions of students’ confidence for clinical practice following the OSCE.FindingsThirty-four students responded to surveys (response rate 94%); and 13 participated in focus groups. Two academic lecturers participated in an interview (100%). Two main themes emerged (1) the OSCEs improved student confidence (2) the OSCEs were relevant and prepared students for practice. Most students indicated that they practised for the OSCE using an integrated approach (70%), and that this assisted them in their approach to the assessment of the neonate or post-partum mother.ConclusionThe use of BPGs to ensure that OSCEs focus on important aspects of knowledge and practice helped students to learn and to perform well. Students’ confidence in their ability for the imminent professional experience placement was high. OSCEs designed with the BPGs should be implemented broadly across midwifery education to enhance students’ competence and provide rigorous meaningful assessment.     

Two Decades of Research Comparing For‐Profit and Nonprofit Health Provider Performance in the United States*

Objective. This article reports on a systematic review of data‐based, peer‐reviewed scientific assessments of performance differences between private for‐profit and private nonprofit U.S. health care providers published since 1980. Methods. Computerized bibliographic searches of all relevant databases yielded 149 studies (179 assessments) that compared the performance of for‐profit and nonprofit health care providers on four performance criteria (access, quality, cost/efficiency, and/or amount of charity care). Reported findings on performance were coded in one of three ways: for‐profit superiority, nonprofit superiority, or no difference/mixed results. Results. Overall, the nonprofits were judged superior 59 percent of the time, the for‐profits superior only 12 percent of the time, and for the rest (29 percent), no difference was found or results were mixed. Conclusions. Caution is warranted on policies that encourage private for‐profit entities to replace private nonprofit providers of health care services in the United States.     

How much do OECD countries spend on social protection and how redistributive are their tax/benefit systems?

The global economic crisis has reignited interest in social policy and public spending on different types of social benefits. Public social spending‐to‐GDP ratios are often used to consider the magnitude of welfare systems in international perspective, but such comparisons alone give an incomplete picture of social effort across countries. This article looks at these different factors, before briefly considering the redistributive nature of tax/benefit systems in different member countries of the Organisation for Economic Co‐operation and Development (OECD). The article also considers trends in social spending and compares spending in the late 2000s with the early 1990s when the previous economic crisis played out. The article ends by illustrating the profound effect the recent global economic crisis had on social spending trends across OECD countries.     

How to support families of children with disabilities? An exploratory study of social support services

Support services to families of children with disabilities have previously been documented. While the effectiveness and consequences of some support strategies have been defined, their comparison remains problematic primarily because of the diversified existing definitions. The present study aimed to elaborate and validate a typology to describe different types of support that can be offered to families of children with disabilities. A review of literature highlighted a variety of support services and allowed a categorical grouping. Content analysis ensured that each category was defined distinctively. Afterwards, a panel of experts and representatives of organizations from seven developed countries (Australia, Belgium, Canada, Denmark, France, Sweden and Switzerland) validated the typology. A database of services offered in these countries was created. The resulting typology was divided into four categories related to the family needs: support, respite, child minding and emergency support. Each type of support can be illustrated within organizations in the database. As such, social workers can use the defined typology to identify the needs of families of children with disabilities and suggest alternatives when services are not available. Overall, the described typology should facilitate discussion between stakeholders and families by providing a common communication system.     

Nonparametric predictive comparison of lifetime data under progressive censoring

In reliability and lifetime testing, comparison of two groups of data is a common problem. It is often attractive, or even necessary, to make a quick and efficient decision in order to save time and costs. This paper presents a nonparametric predictive inference (NPI) approach to compare two groups, say X and Y, when one (or both) is (are) progressively censored. NPI can easily be applied to different types of progressive censoring schemes. NPI is a statistical approach based on few assumptions, with inferences strongly based on data and with uncertainty quantified via lower and upper probabilities. These inferences consider the event that the lifetime of a future unit from Y is greater than the lifetime of a future unit from X.     

Healing loss, ambiguity, and trauma: a community-based intervention with families of union workers missing after the 9/11 attack in New York City

A team of therapists from Minnesota and New York worked with labor union families of workers gone missing on September 11, 2001, after the attack on the World Trade Center, where they were employed. The clinical team shares what they did, what was learned, the questions raised, and preliminary evaluations about the multiple family meetings that were the major intervention. Because of the vast diversity, training of therapists and interventions for families aimed for cultural competence. The community-based approach, preferred by union families, plus family therapy using the lens of ambiguous loss are proposed as necessary additions to disaster work.     

Spouse-aided Therapy and Psychiatric Nursing: A Preliminary Report

The training of psychiatric nurses as behavioural nurse therapists has been successfully established in the U.K. by Marks et al. However, their approach has a number of theoretical and practical limitations, such as a rigid adherence to an illness model of psychiatric disorder. This paper describes and evaluates an approach to the training of psychiatric nurses based on systems theory. Four nurses were trained in the use of Spouse-aided Therapy, a time-limited, goal-orientated outpatient approach to the treatment of married psychiatric patients with persisting psychological disorders. Patients' spouses are involved throughout therapy, with the aim of making full use of resources within marriage which may facilitate patients' recovery. Questionnaire and anecdotal data from 12 patients showed a mean fall of 30% in patients' symptoms and a mean fall of 20% in marital dissatisfaction after therapy. The pattern of results supported a systems theory interpretation of outcome.     

Ramadan Fasting and Diabetes Management among Muslims in the United States: An Exploratory Study

There is a lack of knowledge and awareness among health care providers (HCPs) about how a member of the Islamic faith manages diabetes while fasting during Ramadan, which often leads to inadequate health advice and guidance, especially in Muslim-minority countries. The purpose of this study was to explore diabetes management practices among Muslims who chose to fast during Ramadan in the United States. Data were collected from 47 participants using a self-administered questionnaire that included measures on participants’ characteristics and diabetes management practices. The majority of the participants were males (61%), had type 2 diabetes (90%), and reported they fast during Ramadan (76%). Approximately, 26% of fasting participants reported they decreased the number of finger-stick glucose monitoring performed. Compared to non-fasting participants, fasting participants were more likely to change the dose and/or timing of their medications, but also more likely to include their HCPs in their health decisions. Almost 90% of fasting participants reported no increase in the amount of food consumed and no change in the consumption of concentrated sweets, greasy foods, and sugary drinks. This study supports the need to develop educational programs that involve religious leaders as well as HCPs to ensure patients receive health advice combining religious and medical directives.