Trust‐Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem‐focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution‐focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational‐level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.     

Learning by wrong-doing: aspiration and transgression among German pupils after the Thirty Years' War

Early modern schools have long been known to have been unruly places. Yet historians have struggled to contextualize violence and other forms of transgressive behaviour committed by pupils, either interpreting such behaviour as part of a virtually timeless culture of children and youth or as a reflection of a decline in morals due to macro-historical events. This article adopts the sociological concept of aspirational reference groups to analyse pupils' transgressive behaviour such as drinking, brawling and carrying rapiers in the context of the violence frequently committed by early modern adults. It does so on the basis of disciplinary cases which have survived as part of the exceptionally well-preserved papers of a teacher-scholar at a Lutheran Latin (grammar) school in Saxony. Pupils' transgression reflected their humanist training and foreshadowed the culture of students. Transgressive behaviour at schools prepared pupils for the similarly violent and hierarchical culture of early modern universities. Though subject to disciplinary measures on the part of urban authorities, pupils' transgression was in fact essential in perpetuating a common code of behaviour for men of learning in the decentralized Holy Roman Empire and therefore served to stabilize rather than destabilize existing hierarchies in early modern society.     

Eliciting and Combining Decision Criteria Using a Limited Palette of Utility Functions and Uncertainty Distributions: Illustrated by Application to Pest Risk Analysis

Utility functions in the form of tables or matrices have often been used to combine discretely rated decision‐making criteria. Matrix elements are usually specified individually, so no one rule or principle can be easily stated for the utility function as a whole. A series of five matrices are presented that aggregate criteria two at a time using simple rules that express a varying degree of constraint of the lower rating over the higher. A further nine possible matrices were obtained by using a different rule either side of the main axis of the matrix to describe situations where the criteria have a differential influence on the outcome. Uncertainties in the criteria are represented by three alternative frequency distributions from which the assessors select the most appropriate. The output of the utility function is a distribution of rating frequencies that is dependent on the distributions of the input criteria. In pest risk analysis (PRA), seven of these utility functions were required to mimic the logic by which assessors for the European and Mediterranean Plant Protection Organization arrive at an overall rating of pest risk. The framework enables the development of PRAs that are consistent and easy to understand, criticize, compare, and change. When tested in workshops, PRA practitioners thought that the approach accorded with both the logic and the level of resolution that they used in the risk assessments.     

Innovative activity in small businesses: Competitive context and organization level

The effect of market type and product technology on innovation was studied using data from 3800 employees in 88 small businesses. Results demonstrate that: (1) organizational context effects on innovative activity are significant at administrative and strategic levels, (2) organizational members in consumer markets initiate more innovations but implement fewer than organizational members in industrial markets, (3) members of service-providing organizations report less innovative activity than those in goods-producing organizations, and (4) operative level employees appear to play a small role in the innovation process.     

Managing learning and developing management

Dr Alan Mumford is best known in the UK for his pioneering work on managerial learning and board-level development in the corporate sector. After his early career in the construction industry, he worked as an internal management development adviser to a number of UK companies before leaving fifteen years ago to join International Management Centres Europe as a professor. Alan continues to advise as an independent consultant and to devote time to writing. A prolific author, his classic text Management Development: Strategies for Action recently appeared in its fourth edition published by the Institute of Personnel and Development, and his reflections on board-level and senior executive development in Learning at the Top (McGraw-Hill, 1995). Of greatest renown is his collaboration with Dr Peter Honey on developing the Learning Styles Questionnaire and the Manual of Learning Styles (Honey, 3rd edn, 1992) which have become the most frequently used diagnostic and development tools on UK corporate management development programnles. Jean Woodall interviewed Alan at his home in London.

Jean Woodall is Professor of Human Resource Development at Kingston University.