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PubMed1996

Aspects of the management of change.

Discusses the origins of change in our lives and proposes a pyramidal model to understand these interrelationships. Discusses responses to these changes with particular reference to organizations. Considers some of the models proposed for introducing change, which appear to be developed from the perspective of the organization, rather than the workforce. Finally, considers the factors which need to be taken into account, from a personnel perspective, for change to be introduced to the benefit of all in the organization. The prime consideration, when introducing change, should be respect for the wellbeing of the people involved.

Conflict, Psychological↗
PubMed1997

Cultivating managers of the future.

The concrete experience of pupils and students, together with authentic and authoritative career information, are essential to allow for an educated career or vocational training choice. Such a choice is an essential part of the Government philosophy detailed in recent White Papers. The National Health Service, along with other public bodies, has lacked examples of structured student work placements to provide concrete experiences which have the potential to formally link with academic qualifications and hence provide an easing of access to further vocational development. The article charts the introduction application and evaluation of one such structured and practical scheme. The scheme is based on the "Young Manager" package produced by Henley Distance Learning Ltd and Cambridge Training and Development and piloted by the National Health Service Training Division.

Commerce↗
PubMed1998

Stakeholders' views of management development as a cultural change process in the Health Service.

Illustrates the failure of a competence-based management development programme in a hospital trust to achieve organisational objectives. The approach and content of the management development programme is resisted by participants despite the facilitators drawing on management theory to legitimate it. The question posed in this paper, building on an earlier study by Holman and Hall (1996), is whether the generic approach of competence-based management development is appropriate in the UK NHS. The theoretical inspiration for the research is what may be termed a "processual" or "contextualist" approach which is clearly influenced by "negotiated order" literature.

Health Services Research↗
PubMed2005

The effects of appreciative inquiry interviews on staff in the U.K. National Health Service.

PURPOSE: To obtain preliminary data on the short- and medium-term effects and personal acceptability of appreciative inquiry (AI) in staff development in health care. DESIGN/METHODOLOGY/APPROACH: AI is a non-problem-solving management approach focusing on developing current successes into the future through reflection at individual and group level. Individual one-hour interviews were undertaken with nursing staff on a national paediatric liver in-patient ward. They were asked to recount stories based on their experiences of successful delivery of health care, with active listening, followed by reflection on the process. A total of 32 staff members took part with only two refusals. Data were written and analysed by an open coding method. Follow up was obtained two years later using a written, open question method. FINDINGS: The process was emotional-but well received. Staff described quality in interpersonal interactions, preventing errors and engaging their personal values in their work. No improvement in recruitment or retention was shown but a high level of sickness absence fell significantly during the period of the project. Two years later, significant positive effects were recalled and attributed to the interviews by many respondents. AI appears a cost-effective way of connecting professionals' motivation toward quality in their work with strategic intentions. RESEARCH LIMITATIONS/IMPLICATIONS: The interviewer was a medical consultant and ward manager, implying either that the interviews could have worked as a form of managerial supervision or improvements could be a Hawthorne effect. Other unknown influences were likely to be occurring on the ward during the study period. PRACTICAL IMPLICATIONS: Short AI interventions on an individual basis can change sickness absence, at least while the interventions are continuing. It is an important tool for staff motivation with the potential for connecting strategic with micro-operational levels. AI is an approach to NHS management with wide application including appraisal, personal development and mentoring. It can be a positive introduction to reflective practice. ORIGINALITY/VALUE: AI is gaining recognition for its value in staff and service development in health care. The paper shows service and personal effects, cost-effectiveness and illustrates how to use AI for these purposes.

Attitude of Health Personnel↗
PubMed1995

Making staff aware of risks.

Outlines the essential steps in establishing risk management as an effective process in any organization and relates to management claims, complaints and adverse incidents. Discusses the way to elicit and use information from patients and staff. Emphasizes the need to learn from all those involved in delivery and receipt of care.

Data Collection↗
PubMed2006

New roles in rehabilitation--the implications for nurses and other professionals.

RATIONALE, AIMS AND OBJECTIVES: The development of rehabilitation and intermediate care services, and roles therein, is part of current UK health policy to meet the demands of the ever-growing older population. One new role is the rehabilitation assistant (RA). This is a generic support worker trained at a basic level in nursing, physiotherapy, occupational therapy and social work who works under the supervision of the referring professionals, to deliver integrated rehabilitation programmes. RAs were introduced in one region in the north-west of England to increase the rehabilitation activity for patients. An empirical qualitative study was recently undertaken to evaluate the impact of the RAs from the perspectives of patients and associated nurses, therapists, managers and the RAs. METHODS: Fifty-five semi-structured interviews were used to collect data, which was then inductively analysed into categories and then themes. The categories included variations in role, benefits of role, acceptance and integration of role, difficulties with role, training and retention. This paper focuses on the benefits and difficulties of the role. RESULTS: It was found that patients, professionals and the RAs expressed great satisfaction with the new role. However, barriers to effective rehabilitation were reported owing to ward routines and organizational systems that interrupted and caused inconsistencies with the rehabilitation care programmes for patients. CONCLUSIONS: If it is agreed that the majority of patients (unless end stage terminally ill, unwilling or unable) could benefit from some degree of rehabilitation, then there is an issue around how such skills could be widely implemented. This paper discusses the barriers to effective rehabilitation, the benefits and drawbacks of looking at new ways of working and the need for a unified approach by all care workers in rehabilitative care.

Attitude of Health Personnel↗
PubMed1989

The relationships among labor-force participation, service-sector employment, and underemployment.

"In this study, it is argued [that] underemployment is both affected by and affects the labor-force participation rate (LFPR) and the level of service employment. Interestingly, the analysis reveals that service employment lowers the LFPR and raises underemployment. In turn, underemployment increases the LFPR as more secondary workers are pushed into the labor market in an effort to support their households. Thus, secondary workers are not pulled into the labor market by the availability of service jobs, but are rather pushed into these jobs by the condition of underemployment that is brought on by the growing concentration of low-paying service jobs....A three-equation simultaneous equation model is developed to test our hypotheses [and] three-stage least squares...estimates of this model for the 100 largest [U.S.] metropolitan areas are presented...."

Americas↗
PubMed1989

Demographic change, labour force dynamics and employment: new problems and old politics?

The paper examines the problems for social protection and economic growth that arise from the development of a dualistic labor force-- divided into a privileged core and a disadvantaged periphery--created by the dynamic interaction of labor supply rigidities and rapid technological growth. It concluded that reforms of labor market institutions have to be introduced in order to solve the existing problems.

Demography↗
PubMed2003

The Southern Rural Access Program and Alabama's Rural Health Leaders Pipeline: a partnership to develop needed minority health care professionals.

Rural Health Leaders Pipeline programs are intended to increase the number of youth interested in and pursuing health professions in rural communities. This paper presents 2 complementary approaches to Rural Health Leaders Pipeline programs. Two different organizations in Alabama recruit students from 18 specified counties. One organization is a rural, community-based program with college freshmen and upperclassmen from rural communities. Students shadow health professionals for 6 weeks, attend classes, visit medical schools, complete and present health projects, and receive support from online tutors. The second organization is a university-based program that supplements an existing 11th grade-medical school rural medicine pipeline with 10 minority students from rural communities who have graduated from high school and plan to enter college as premedical students in the following academic year. Students participate in classes, tutorials, seminars, and other activities. Students earn college credits during the 7-week program, maintain contact with program staff during the school year, and by performance and interest can continue in this pipeline program for a total of 4 consecutive summers, culminating in application to medical school. Each organization provides stipends for students. Early experiences have been positive, although Rural Health Leaders Pipeline programs are expensive and require long-term commitments.

Adolescent↗
PubMed1994

Careers in academic general practice: problems, constraints, and opportunities.

Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and post-graduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.

Academic Medical Centers↗
PubMed2004

Occupational injuries identified by an emergency department based injury surveillance system in Nicaragua.

OBJECTIVES: To identify and describe the work related injuries in both the formal and informal work sectors captured in an emergency department based injury surveillance system in Managua, Nicaragua. SETTING: Urban emergency department in Managua, Nicaragua serving 200-300 patients per day. METHODS: Secondary analysis from the surveillance system data. All cases indicating an injury while working and seen for treatment at the emergency department between 1 August 2001 and 31 July 2002 were included. There was no exclusion based on place of occurrence (home, work, school), age, or gender. RESULTS: There were 3801 work related injuries identified which accounted for 18.6% of the total 20 425 injures captured by the surveillance system. Twenty seven work related fatalities were recorded, compared with the 1998 International Labor Organization statistic of 25 occupational fatalities for all of Nicaragua. Injuries occurring outside of a formal work location accounted for more than 60% of the work related injuries. Almost half of these occurred at home, while 19% occurred on the street. The leading mechanisms for work related injuries were falls (30%), blunt objects (28%), and stabs/cuts (23%). Falls were by far the most severe mechanism in the study, causing 37% of the work related deaths and more than half of the fractures. CONCLUSIONS: Occupational injuries are grossly underreported in Nicaragua. This study demonstrated that an emergency department can be a data source for work related injuries in developing countries because it captures both the formal and informal workforce injuries. Fall prevention initiatives could significantly reduce the magnitude and severity of occupational injuries in Managua, Nicaragua.

Accidents, Home↗
PubMed1987

The effect of women's labor force participation on the distribution of income in the United States.

The effect of women's labor force participation on income distribution in the United States is reviewed. "Because the wives of highly paid men participate less in the labor force, the earnings of working wives make the distribution of pretax, money income more equal for families than it might otherwise be. Although there is considerable speculation that future developments in women's labor force participation may foster greater inequality, the empirical results are mixed." The factors that need to be considered in future research are outlined.

Americas↗
PubMed1983

The WHO collaborative study on strategies for extending mental health care, III: Evaluative design and illustrative results.

Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.

Attitude of Health Personnel↗
PubMed1989

Metropolitan population size and economic well-being.

A multi-equation recursive model is specified wherein the level and inequality of income in US metropolitan areas are functions of population, labor force characteristics, industrial structure, and occupational structure. Parameters are estimated for a 1980 sample of 120 standard metropolitan statistical areas representative of all population sizes. These parameters suggest that metropolitan areas of 1.9 million population demonstrate on average the greatest inequality, ceteris paribus. Population proved not to be strongly correlated with per capita income, either directly or indirectly.

Americas↗