Distributed leadership patterns and service improvement: Evidence and argument from English healthcare

This article focuses on the pattern and impact of change leadership in complex, pluralistic, public sector settings, and specifically in English healthcare. The argument draws on evidence from ten comparative cases, exploring links between leadership patterns and organizational outcomes. Our analysis builds three themes. First, a pattern of widely distributed change leadership is linked to delivering improvements in service outcomes. Second, professional/managerial hybrids are shown to perform crucial lateral facilitation activities, adapting and extending their roles to suit their organizational context. Third, a foundation of good pre-existing relationships underpins the capacity of distributed leadership to implement service improvements. Conversely, poor relationships and conflicts erode the concerted capacity of distributed change leadership. The key contribution of this article thus concerns the establishment of links between situated patterns of distributed leadership, and service improvement outcomes, based on the cumulative effects of actors – managers and clinical hybrids – at different organizational levels.     

Statisticians Can Matter

Statisticians fall far short of their potential as guides to enlightened decision making in business. Two important explanations are: (1) Decision makers are often more easily convinced by concrete examples, however fragmentary and misleading, than by competent statistical analysis. (2) The effective use of statistics in the process of decision making requires hard thinking by decision makers, thinking that cannot be delegated entirely to the statistical specialist. Modern developments in interactive statistical computing may help to reduce the force of these limitations on exploitation of statistics; used properly, computing can encourage, almost force, the student or business user of statistics to think statistically.     

Validation of the 12 Item Short form Health Survey in a Sample from Region Central Jutland

In 2010 the Danish regions started a new program of public health surveillance in collaboration with the national and local health authorities using the short form health survey (SF-12) for measuring and reporting on health related quality of life among the Danish adult population. The instrument has not, however, been validated in a Danish setting. The aim of this study was to assess the reliability and validity of the physical component summary (PCS) and the mental component summary (MCS) score of the 12-item short form health survey (SF-12) in a sample from Central Denmark Region. A total of 26,397 persons above the age of 25 were included in the analyses. Reliability was assessed by Cronbach’s α. The validity was assessed using known-groups comparisons and convergent validity. The factor structure was investigated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s α showed high reliability with a score of 0.90 and 0.85 for PCS and MCS respectively. The SF-12 discriminated well with respect to gender, age, educational status and long term illness. Individual items correlated higher with own hypothesized scales than with other scales and summary measures corroborating the convergent validity. The EFA gave a two-factor structure. Irrespective of the chosen rotation method (varimax and oblimin) the items related to PCS loaded on one factor and the items related to MCS loaded on another factor. The factor structure was validated with acceptable model-fit values in CFA. The SF-12 instrument is a reliable and valid measure of health related quality of life among the population of Central Denmark Region.     

The demography of Tristan da Cunha

Abstract The eruption of the volcano on Tristan da Cunha in 1961 and the subsequent arrival of the island population in the United Kingdom provided a unique opportunity for studying the health of this formerly isolated community. During their stay, while the facilities and services of modern medicine were made available to them, investigations of many facets of their general biology were made under the auspices of the Medical Research Council, co-ordinated by Dr. H. E. Lewis. Analysis of their demographic history was essential to understand many features of their disease pattern, and the results of this analysis are presented here. They are of interest in that they not only show some consistent trends in the common variables of demography, but also demonstrate biological principles, some perhaps for the first time in man, which may be fundamental in the process of colonization as a biological phenomenon, e.g. the initial difficulty of establishment of a population in a new area, the curious demographic structure that may emerge in its earliest years, the bottleneck effect of population-size reduction, the founder principle.     

Patterns of Autonomic Arousal in Imaginal Situations of Winning and Losing in Problem Gambling

AIMS: To examine changes in skin conductance level (SCL), for problem gamblers in response to personally relevant imaginal tasks, representing winning or losing. SETTING, DESIGN, PARTICIPANTS AND MEASUREMENTS: SCL and subjective arousal were compared for problem poker machine gamblers (n = 13) and a control group (n = 20). Participants were asked to describe a situation in which they had (a) won and (b) lost during a period of gambling. Before and during the task, recordings of SCL were taken. FINDINGS: There were significant differences between responses of problem and social gamblers. A significant interaction indicated that social gamblers became more aroused in reaction to winning than losing, whereas problem gamblers became equally aroused in response to both tasks. CONCLUSIONS: The results suggest that it may be responses to losing, rather than winning that are paramount to the development and maintenance of problem gambling.     

TREATING CONDUCT-DISORDERED ADOLESCENTS AND YOUNG ADULTS BY WORKING WITH THE PARENTS

A method of therapy for families with an acting out adolescent or young adult is presented, as is a rationale for the method. The aim of the approach is to alter the underlying problem of immaturity that is hypothesized to exist in these families. Emphasis is placed on working with the parents in a systematic way over an extended period of time. As progress is made by the parents, an emotional crisis is created in the adolescent that can then be used by him as the basis for extensive change. The therapy of the parents proceeds in phases: 1) preparation for a long-term effort; 2) rethinking and objectively evaluating the nature of the relationship with the adolescent in specific areas; 3) translation of the newly gained perspective into action positions vis-à-vis the adolescent; and 4) non-child-focused therapy.     

Many a slip between cup and lip. Process evaluation of a program to promote and support evidence-based public health practice

The main aims of this study are to document whether an intervention for promoting evidence-based public health practice had been delivered as intended and to explore the reasons for its lack of impact. Process data from the implementation of the program and data from interviews with 40 public health physicians are analyzed. Although they expressed satisfaction with the service, the doctors experienced the program as rather irrelevant for their daily work. They did not perceive that they dealt with many issues relevant for the use of research information, and if they did, referring to research would not make any difference to the way others perceived their advice. There is a need to develop more overlying strategies for integrating evidence into decision making than addressing the individual level.     

Treatment of incarcerated, sexually-abused adolescent females: an outcome study

This study examined the psychosocial functioning of 100 adolescent females (ages 12-17) sentenced to secure care in a southeastern state and the impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of subjects who reported a history of sexual abuse. The Multidimensional Adolescent Assessment Scale (MAAS) was used to assess psychosocial functioning. Pre-test scores on the MAAS revealed significantly higher scores on 12 of 16 dimensions of psychosocial functioning and higher rates of serious criminal behavior for youth who subsequently disclosed sexual abuse histories as compared to those without such histories. At post-test, statistically significant improvements in psychosocial functioning were observed on 14 of 16 MAAS subscales for those who received the CBT intervention. Thus, incarcerated female adolescents who reported a history of sexual abuse demonstrated more impairment in their functioning as compared to those without a reported history of sexual abuse and responded positively to gender-specific, CBT-based intervention.     

Discovering classes in microarray data using island counts

We present a new biclustering algorithm to simultaneously discover tissue classes and identify a set of genes that well-characterize these classes from DNA microarray data sets. We employ a combinatorial optimization approach where the object is to simultaneously identify an interesting set of genes and a partition of the array samples that optimizes a certain score based on a novel color island statistic. While this optimization problem is NP-complete in general, we are effectively able to solve problems of interest to optimality using a branch-and-bound algorithm. We have tested the algorithm on a 30 sample Cutaneous T-cell Lymphoma data set; it was able to almost perfectly discriminate short-term survivors from long-term survivors and normal controls. Another useful feature of our method is that can easily handle missing expression data.