Innovation, cultural values, and the management of change in British hospitals

This paper describes the results of a study of innovation in the management teams of 27 UK hospitals. It is argued that the content of innovations provides an accurate representation of the underlying cultural values of the management teams, and the cultural values which they seek to purvey within the wider organizational settings. The authors propose that values in action (as opposed to espoused values) are manifest in the range of innovations introduced by top management within organizations. Using a typology of organizational culture, they categorize the innovations introduced by the management teams, in order to map their underlying cultural values. The results indicate predominant orientations of hospital management teams towards rational goal and hierarchical values in the current context of health care in Britain. Internal climate and service innovations were relatively infrequent, suggesting that the hospitals were dominated by management concern for control rather than flexibility. The costs of such cultural strategies in health service settings are discussed.     

The role of support person for Ngaanyatjarra women during pregnancy and birth

BackgroundThis study took place in a remote community on the Ngaanyatjarra Lands, Western Australia. Ngaanyatjarra women's cultural practices have been subject to erosion during the past 70 years. Women are now expected to birth hundreds of kilometres from home and, due to financial barriers, without family support. Older women lament their lack of input into, and control of, contemporary birthing services.Research questionIn order to provide culturally appropriate maternity services we asked: What issues would the Ngaanyatjarra women of the community like to see resolved in the area of antenatal and birthing services?Participants and methodsEligible participants were any Ngaanyatjarra women of the study community who had birthed at least once. We utilised a participatory research methodology. 36 women were interviewed.FindingsThis paper discusses one finding related to support for child-bearing women. The role is important in many ways. Ngaanyatjarra women did not traditionally have their support persons with them during labour and birth, nor do they necessarily expect them to be present in current times. Most women do, however, wish to have a support person with them during antenatal checkups and when they travel to town to await birth.ConclusionAboriginal women from remote communities should be able to have a support person with them when they access regional birthing services, but the nature of this role must not be assumed. A culturally appropriate service has input from the community, provides options and respects choices.     

Chemical Health Effects Assessment Methodology for Airborne Contaminants

Chemical Health Effects Assessment Methodology (CHEM) is a new procedure for assessing hazardous properties of airborne toxic contaminants. CHEM evaluates substances for four major health effect categories: carcinogenicity, mutagenicity, reproductive/developmental toxicity, and toxic effects other than the first three. Three elements are considered in the assessment: weight of evidence, potency, and severity of effect. This approach produces a profile of toxic properties of chemicals which preserves their unique multidimensional character and highlights data gaps.     

Philosophical speculations on systems design

Belief in the value of the scientific method as a means of implementing improvement in social systems (here called “systems design”—SD) raises important philosophical questions concerning, inter alia, the meaning of “scientific method”, of “improvement”, and of social reality. One underlying problem is that of the “self reflecting paradox”; e.g. the content and validity of the scientific method can only be discovered by the application of the scientific method. Similarly, SD has its own “social reality” through which it perceives that of its client. “Improvement” is bound up with ethics but ethics does not admit the limitation of obligation to one sub-system, therefore improvement requires the recognition of sub-system linkages. Paradoxically, again, the “improver” is himself part of the total system and bears its impress. Implementation (of improvement) meets the paradox that SD on SD is needed to judge the worth of the SD proposal. The pragmatic escape from the paradox identifies SD with a heuristic role in social progress but presupposes the possibility of progress. “Implementation” secures the possibility of such progress. The second major problem is that SD requires a social reality in which individuals have visible goals; but the “inner world” of individual goals is unknown and cannot be tracked from observable responses. In any case, Kant's moral precept requires that individuals be valued as ends rather than means. Much of SD uses them as means. Though SD is and must be practised, such philosophical speculation raises SD's self knowledge and points the neat paradox of its technical precision won at the price of its fundamental woolliness.     

Workplace discrimination and cancer

Data from the Equal Employment Opportunity Commission (EEOC) Integrated Mission System database were analyzed with specific reference to allegations of workplace discrimination filed by individuals with cancer under ADA Title One. These 6,832 allegations, filed between July 27, 1992 and September 30, 2003, were compared to 167,798 allegations from a general disability population on the following dimensions: type of workplace discrimination; demographic characteristics of the charging parties (CPs); the industry designation, location, and size of employers; and the outcome or resolution of EEOC investigations. Results showed allegations derived from CPs with cancer were more likely than those in the general disability population to include issues involving discharge, terms and conditions of employment, lay-off, wages, and demotion. Compared to the general disability group, CPs with cancer were more likely to be female, older, and White. Allegations derived from CPs with cancer were also more likely to be filed against smaller employers (15-100 workers) or those in service industries. Finally, the resolution of allegations by CPs with cancer were more likely to be meritorious than those filed from the general disability population; that is, actual discrimination is more likely to have occurred.