Organizational Form as a Mechanism to Involve Staff,Public and Users in Public Services: A Study of the Governance of NHS Foundation Trusts

In addition to introducing markets and market‐like structures into public services, New Labour wished to promote the involvement of users and the public in decision‐making in other ways than as individual consumers. One way was to involve the public in the governance of organizations. This could be done by removing public services from state control, and transferring them to mutual ownership; or by increasing public involvement in the governance of public bodies. NHS foundation trusts (FTs) were presented as mutuals. Our study shows FTs are not mutuals, as they continue to be owned by the state. Moreover, staff of FTs were generally not engaging with the new governance structures. In general, there was mixed experience of the new structures enabling governors to increase accountability of the hospitals to the public. On the other hand, having a membership did enhance the legitimacy of FTs, as opposed to other NHS organizations. The findings of the study are of current interest as the coalition government is continuing with the policy of FTs, and also encouraging mutuals and other forms of public involvement.     

Reexamining the Nurse Scheduling Problem: Staffing Ratios and Nursing Shortages*

Legislators at the state and national levels are addressing renewed concerns over the adequacy of hospital nurse staffing to provide quality care and ensure patient safety. At the same time, the well‐known nursing shortage remains an ongoing problem. To address these issues, we reexamine the nurse scheduling problem and consider how recent health care legislation impacts nursing workforce management decisions. Specifically, we develop a scheduling model and perform computational experiments to evaluate how mandatory nurse‐to‐patient ratios and other policies impact schedule cost and schedule desirability (from the nurses' perspective). Our primary findings include the following: (i) nurse wage costs can be highly nonlinear with respect to changes in mandatory nurse‐to‐patient ratios of the type being considered by legislators; (ii) the number of undesirable shifts can be substantially reduced without incurring additional wage cost; (iii) more desirable scheduling policies, such as assigning fewer weekends to each nurse, have only a small impact on wage cost; and (iv) complex policy statements involving both single‐period and multiperiod service levels can sometimes be relaxed while still obtaining good schedules that satisfy the nurse‐to‐patient ratio requirements. The findings in this article suggest that new directions for future nurse scheduling models, as it is likely that nurse‐to‐patient ratios and nursing shortages will remain a challenge for health care organizations for some time.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al., 1994) and the Indiana Mental Health Services and HIV Risk Study (Wright, 2003). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HIV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.     

Connecting the Dots in Public Management: Political Environment, Organizational Goal Ambiguity, and the Public Manager's Role Ambiguity

This article is a systematic effort to study a key theoreticalquestion from the vantage point of public sector organizationalbehavior. Most political science models, with a primary interestin democratic control of bureaucracy, study the political influenceon the bureaucracy from an agency theory perspective. Organizationbehavior literature, on the other hand, is focused largely onthe study of individual-level phenomena in private organizationsand does not incorporate political context as part of explanatorymodels. This article proposes a middle-range theory to "connectthe dots," beginning with disparate sources in the polity influencingorganizational goal ambiguity, which in turn is expected toincrease managerial role ambiguity. An empirical test, usingdata collected from a national survey of managers working instate human service agencies, supports this theoretical model.We find that certain types of political influence have an impacton organizational goal ambiguity, which in turn has a directeffect in increasing role ambiguity and also an indirect effectin increasing role ambiguity through organizational structure.     

Identity Transformation and Family Caregiving: Narratives of African American Teen Mothers

This article explores connections between informal caregiving and identity transformation as experienced by pregnant teens. Based on in‐depth interviews with 51 African American teen mothers, the article examines teens’ pregnancy narratives as an example of narrative repair, illuminating how attending to processes that connect one’s identity to the care of others can work to empower individuals to resist threats to a positive sense of self or a damaged identity. The authors suggest that family caregiving can provide an important context that supports identity transformation not only among pregnant teens as they strive to become good mothers but among those experiencing other types of disruptions to their lives.     

Football hooligans: theory and evidence

This paper describes empirical research amongst hooligans. Such research has not always been valued. The significant factor in hooligan behaviour may be asserted to be the generation of violence in the lower working class and its dissemination amongst football fans. It is commonly asserted that hooligans operate in well-organized groups. It is argued here that such assertions need to be based on better evidence. A detailed account is given of the behaviour of a notorious group of fans and its key individuals. This shows that the ‘hard core’ fans were distinguished from others only by greater dedication to football and their club; they had a potentiality for violence but only of the low level kind that many others shared; they were more often involved simply because they went to more matches; they lacked organization. Nevertheless outsiders were, not unreasonably, sure they were a violent, organized group. This casts doubt on similar beliefs held about other groups unless beliefs are well substantiated. Detailed ethnography is valuable because it helps to sort out the nature of the ‘hooligan’ problem that requires to be theorized.