Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

Pathways between education and health: a causal modelling approach

Summary.  The association of poor education and poor health has been consistently observed in many studies and in various countries. Thus far, studies examining the mechanisms underlying this association have looked at only a limited set of potential pathways. This study simultaneously examines six distinctive pathways, which have been hypothesized to link education and health and found support from previous studies. A causal analysis of education and health was performed using structural equation models. Data were used from six phases of the National Child Development Study, which is based on following up an initial sample of 17416 children who were born in 1958. The association between education and health appears to be explained by a combination of mechanisms: adolescent health and adult health behaviours for men and women, adult social class among men and parental social class among women. We conclude that improvements in population educational attainment may not automatically lead to improvements in population health, and that health policies for improving health and reducing health inequalities need to target specific causal pathways.     

Evaluation: Stakeholder-focused Criteria

Identifying and selecting suitable criteria is an important consideration in evaluating the performance of public sector organizations. Which criteria are chosen, and how they are weighted, will depend largely on the perspective being taken; different stakeholders (for example, clients, providers or commissioners) are likely to emphasize different criteria. In this paper a number of criteria are identified and an argument is developed to indicate which criteria are likely to be valued by various stakeholders. Furthermore, a number of approaches and mechanisms for evaluation are identified and the links between these, the criteria appropriate to them and the various stakeholders are made explicit. Finally, the issue of politics and the distribution of power between the stakeholders is addressed with a call for greater explicitness in using and balancing criteria (for example, as between professionals and the intended beneficiaries of services). In this way, while recognizing the inherent political nature of performance evaluation, the planning and implementation of services may be improved by a more mutually informed approach to evaluation.     

A review of research on the happiness measures: A sixty second index of happiness and mental health

Eighteen years of research using the Happiness Measures (HM) is reviewed in relation to the general progress of well-being measurement efforts. The accumulated findings on this remarkably quick instrument, show good reliability, exceptional stability, and a record of convergent, construct, and discriminative validity unparalleled in the field. Because of this, the HM is offered as a potential touchstone of measurement consistency in a field which generally lacks it.     

Secularization and the politics of traditionalism: The case of the right-to-life movement

Research on the traditionalist movement against abortion needs alignment with currents in historical sociology, the theory of social movements and the sociology of politics. The religious (specifically, Christian) basis of the right-to-life movement has attracted considerable attention in the literature. The movement is seen as a traditionalist bloc claiming to oppose secularization and return to customary restrictions. However the tradition in question appears to be a recent social construction. There is slim warrant in the actual traditions of Western religion for asserting a categorical right to life. As a result, the movement's ideology is best approached as the product of—rather than the antidote to—secularizing processes (including the demographic transition, discourse about rights, markets for symbolic entrepreneurs and the separation of church and state) and possibly as an unintended import from non-Western religion. Implications for traditionalism, the functions of religion, and the study of countermovements are explored. This case illustrates the value of attending to historical sequences and the external cultural environments of social movements.     

The encoding and decoding of liking from behavioral cues in both auditory and visual channels

Fifty high school students met in same-sex dyads for the first time over a cup of coffee in an experimental room designed as a comfortable living room. They then responded to a questionnaire designed to measure liking and perceived similarity. The interactions were video-taped. Two different panels of 6 judges later either viewed (video only) or heard (audio-only) the videotape and raed the subjects behavior on a number of scales. The judges also judged the degree of liking felt by the subjects by estimating subjects responses to the questionnaire. In addition gaze behaviour during the interaction was measured. Factor analysis demonstrated that 60% of the variance in The Liking Scale was attributed to 14 items relating to liking and perceived similarity. A separate factor to assess perceived similarity could not be found. Twenty-nine percent of the variance in the liking reported by subjects was predicted by an interrelated pattern of expressing behaviour including approproate looking, mutual gaze, self-disclosure, synchrony in movement and gesture, expressiveness of the face and liveliness of the voice. Video judges liking correlated 0.33 with subjects liking and 48% of the variance in their judgements was explained by the valid cues of looking and expressiveness of the face. Audio judges liking, although it correlated at 0.34 with video judges liking, did not correlate at all with subjects' liking because of an over-reliance on the important content cues. It is suggested that major problems leading to decoding inaccuracy may be over-reliance on content cues and over-confidence in the possibility of decoding accuracy. The evidence suggests that differences between subjects in encoding may be considerable.     

Business restructuring,management control,and corporate organization

Conclusions After half a century of growing dominance of the large corporation by non-owning managers, the 1980s were marked by a slowing or even reversing of their quiet revolution. Professional managers had come to control the corporation on the premise that they could more efficiently produce shareholder value than the original founder-owners. They turned shareholding into a passive investment on the same premise. As companies faced increasingly competitive pressures during the 1980s, however, the legitimacy of the rule of incumbent management came under challenge. No longer could government interference be blamed for many of the problems facing business; fingers pointed at management itself. As the criticism of corporate leadership gathered momentum, a leading diagnosis focused on one of managerial capitalism's crowning achievements: the autonomous power of professional management.The critique viewed the managerial autonomy as excessively permissive, the agency system as no longer effective. Professional managers had come to show too much concern for the social welfare of various stakeholder groups, including themselves, and too little concern for the financial welfare of the only stakeholder group that should really count — the shareholders. Many of the restructuring efforts were thus undertaken in the name of returning companies to the single-minded pursuit of ownership interests. What had stood in the way of such a pursuit was less a matter of government constraint and more a matter of inadequate stockholder vigilance by their appointed agents.Mindful of the critique, incumbent managements moved during the mid- to late-1980s to improve stockholder returns by paring the workforce and cutting other costs. Corporate acquisitions and leveraged buyouts brought new management teams to the fore where others had seemingly fallen short. The resulting restructuring reached a large proportion of the nation's major companies. Half or more of the largest companies had undergone a significant reduction in their workforce. And the dollar value of company resources changing ownership hands expanded considerably. The aggregate purchase price of mergers and acquisitions of publicly-traded firms in 1988 was nearly three times greater than in 1981. Even more striking was the sharp increase in the number of publicly-traded companies and divisions that were taken private. The aggregate dollar value of such buyouts in 1988 had increased almost 25 times over that in 1981. This opening of the market for corporate control among major U.S. firms brought a significant fraction of the nation's large corporations more directly under the immediate oversight of ownership interests.The reassertion of ownership control over large corporations was usually taken in the name of improving corporate earnings. Would be takeover groups generally promised more internal discipline and stronger financial performance. Whatever the actual financial impact of the intensification of ownership interests, available research suggests that it has had organizational impact. General company strategies may come to be more centrally guided while specific operating actions are devolved further down the organization.Ownership change and other restructuring steps have also ramified into corporate social and political action. That outreach is likely to be less vigorous and more divided. It is also being redirected. During the 1970s and early 1980s, corporate energies focused on reducing government regulation and improving community opinion. Those energies are now increasingly focused on facilitating or resisting restructuring. Companies have fought legislation that would limit the process of plant closings, but they have also sought legislation to protect themselves against hostile takeovers.The evidence also suggests that considerable managerial discretion remains in shaping company response to the restructuring pressures. Although market and organizational factors are sure to act as constraints, top management, whether a relatively autonomous non-owning management group or an owner-dominated management, retains an important independent capacity to exercise strategic choice. That choice is likely to receive special shaping by the long-term ascendance of financial managers and the decline of manufacturing personnel at the executive level.Yet corporate change must not be viewed as isolated managerial responses to changing market conditions. Companies and managements frequently look to one another for guidance in coping with ambiguous circumstances. DiMaggio and Powell's analysis of organizational isomorphism, for example, suggests that firms frequently adopt organizational practices not because they are dictated by the firm's market strategies, but rather because they are already used by other companies. Similarly, Granovetter's analysis of the social embeddedness of economic action indicates that company decisions are partially shaped by top management's contacts with their counterparts in other firms. Understanding company responses to restructuring pressures therefore requires a focus on inter-company flows of ideas and doctrines as well as purely internally generated responses specific to the company. Reactions to the restructuring pressures that are collectively developed and defined in the broader business community may prove to be as critical as individually fashioned solutions in guiding management approaches to restructuring during the years to come.

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Zeroing in on leadership effectiveness: The methodological challenges of benchmarking leadership practices

Business success in the 21st century will be based on the widespread mastery of leadership roles, rather than on the directives of a professional or leadership elite. The first step for systematically enacting a leadership development agenda for our nation is to identify the factors, values or qualities most important to leadership effectiveness. Next, we must improve our understanding of how these guiding ideas and insights translate into what successful leaders do. As we perfect this understanding, we will need to operationally define the best practices of successful leaders. These best practices must then become benchmarks for intensive leadership development efforts.This article considers nine methodological challenges of the first agenda item-identification of the factors, values or qualities most important to leadership effectiveness. To illustrate these challenges, the authors use their own business leadership research as a case study. This research surveys 127 chairmen, chief executive officers, and presidents-a cross section of successful U.S.A. business leaders, including men and women from all parts of the nation who have diverse industry, racial, ethnic and religious backgrounds. The authors identify where methodological improvements are needed to cope with the challenges of leadership research. They suggest important directions for methodological development and propose three minimum standards for future leadership research.     

A rational approach to career change

Recently, the number of physicians who have been interested in alternative careers has vastly increased. Many physicians express dissatisfaction with clinical practice, but they are uncertain about which nonclinical options are appropriate for them. Pursuing a different career after many years of studying and practicing medicine can seem like an overwhelming task. In this article, the author briefly outlines a decision-making process that can be used in analyzing career options and suggests some careers that have provided challenging opportunities for physicians.