Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study

Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues. Design: Qualitative study using focus groups and indepth interviews. Setting: Primary care in Northern Ireland. Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time. Main outcome measures: Participants' views about their own and colleagues' health. Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise. Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

Informalilty in the Social and Culture Life in the City Centre of Nairobi

We live in a world of advanced technology, stiff global competition and rapid transformation of all facets of life and as a result architecture has not been spared. These transformations affect the social relations, cultural consumption and political economy that have influenced the manner in which people perform in and out of space in the city centres. The residents have adopted strategies for negotiating through the spaces sanitized by authorities and other agents. The public spaces provide the background materials for informal urban practices that are sometimes deemed illegal yet are necessary for animating the city spaces. Cities market themselves ecstatically beyond the baroque with a more visible presence of the contending parties through trademarks, public relations invasively advertised in streets, monuments (signature buildings or projects), and language. This paper comes out of a research carried out in Nairobi in February and March 2007. It examined how the notions of globalisation are reflected in the life in the city centre; the impacts on the quality of life of users of the city centre and how informal urbanism has developed as copying strategy to deal with the transformations due to liberalization and globalization.

Agitating for a design and regeneration agenda in a postconflict city: the case of Belfast

Introduction

Belfast has been a focus of academic attention for the last forty years with most interest centred on various aspects of ‘the Troubles’. Where there has been interest in the built environment, it has largely been about how the ‘security situation’ impacted directly on architecture and on the design and layout of social housing. This paper seeks to go beyond this to explore how the political- administrative culture of ‘the Troubles’ interacted with ‘normal’ market forces to shape the central area of the city, and to consider the responses of a recently formed activist group, known as the Forum for Alternative Belfast (hereafter referred to as the Forum). The paper is written by three of the directors of the Forum.1 Moreover, the empirical research presented here was undertaken by the Forum as part of a campaign to address issues relating to the design, layout and quality of Belfast’s built environment. In the longstanding tradition of participant observation working within an action-research paradigm, the participants have attempted to offer an account that is evidentially and purposefully selfcritical and reflective. It is of course recognised that while this approach offers many positive attributes, such as phenomenological access through immersion in the project, it also has the potential to bring compromise on research detachment and objectivity.2 To address the latter, the authors have attempted
to avoid polemical argument, and to support claims with primary or secondary research evidence. The authors also acknowledge that action-research has a chequered history; however, they would argue
that their approach is faithful to a concept that sees ‘research’ defined as understanding and ‘action’ defined as seeking change. The Forum’s very purpose is to seek change, but to do this requires evidence, collaboration and demonstration. And in this sense, it is a learning process for all participants, including the research activists, government officials, community organisations and students. The authors also recognise the complexity of factors that affect urban management and change, particularly in a city such as Belfast, which has had to cope with political violence for over thirty years. And they appreciate that in the context of conflict, governance is skewed to cope with political realities. Hamdi reminds us, however, that in practice there is an ‘important dialectic between top-down planning, with its formal and designed laws and structures, and bottom-up selforganizing collectivism—those “quantum and emergent systems” which Jane Jacobs argued long ago give cities their life and order.’3

A Framework for Stakeholder Management and Corporate Culture

Purpose: This paper investigates the link between two knowledge areas that have not been previously linked conceptually; stakeholder management and corporate culture. Focussing on the UK Construction Industry, the research study demonstrates mutual dependency of each of these areas on the other and establishes a theoretical framework with real potential to impact positively upon industry.

Design/methodology/approach: The study utilises both qualitative and quantitative data collection and then analysis to produce results contributing to the final framework. Semi-structured interviews were used and analysed through a cognitive mapping procedure. The result of this stage, set in the context of previous research, facilitated a questionnaire to be developed which helped gather quantitative values from a larger sample to enhance the final framework.

Findings: The data suggests that stakeholder management and corporate culture are key areas of an organisation’s success, and that this importance will only grow in future. A clearly identifiable relationship was established between the two theoretical areas and a framework developed and quantified.

Originality/value: It is evident that change is needed within the UK Construction Industry. Companies must employ ethical and social stakeholder management and manage their corporate culture like any other aspect of their business. Successfully doing this will lead to more successful projects, better reputation and survival. The findings of this project begin to show how change may occur and how companies might intentionally deploy advantageous configurations of corporate culture and stakeholder management.

Organizational culture predicts job satisfaction and perceived clinical effectiveness in pediatric primary care practices

Background: In recent years, there has been a growing understanding that organizational culture is related to an organization's performance. However, fewstudies have examined organizational culture in medical group practices. Objectives: The purpose of this study was to examine the relationship of organizational culture on provider job satisfaction and perceived clinical effectiveness in primary care pediatric practices. Research Design: This cross-sectional study included 36 primary care pediatric practices located in Connecticut. Participants: There were 374 participants in this study, which included 127 clinicians and 247 nonclinicians. Measures: Office managers completed a questionnaire that recorded staff and practice characteristics; all participants completed the Organizational Culture Scale, a questionnaire that assessed the practice on four cultural domains (i.e., group, developmental, rational, and hierarchical), and the Primary Care Organizational Questionnaire that evaluated perceived effectiveness and job satisfaction. Results: Hierarchical linear models using a restricted maximum likelihood estimation method were used to evaluate whether the practice culture types predicted job satisfaction and perceived effectiveness. Group culture was positively associated with both satisfaction and perceived effectiveness. In contrast, hierarchical and rational culture were negatively associated with both job satisfaction and perceived effectiveness. These relationships were true for clinicians, nonclinicians, and the practice as a whole. Conclusions: Our study demonstrates that practice culture is associated with job satisfaction and perceived clinical effectiveness and that a group culture was associated with high job satisfaction and perceived effectiveness. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Citizenship and Structured Dependency: the implications of policy design for senior political power

This paper argues that the structured dependency thesis must be extended to incorporate political power. It outlines a political framework of analysis with which to identify who gains and who loses from social policy. I argue that public policy for older people is a product not only of social structures but also of political decision-making. The Schneider and Ingram (1993) ‘ target populations’ model is used to investigate how the social construction of groups as dependent equates with lower levels of influence on policy making. In United Kingdom and European research, older people are identified as politically quiescent, but conversely in the United States seniors are viewed as one of the most influential and cohesive interest groups in the political culture. Why are American seniors perceived as politically powerful, while older people in Europe are viewed as dependent and politically weak? This paper applies the ‘target populations’ model to senior policy in the Republic of Ireland to investigate how theoretical work in the United States may be used to identify the significance of senior power in policy development. I conclude that research must recognise the connections between power, politics and social constructions to investigate how state policies can influence the likelihood that seniors will resist structured dependency using political means.

Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention

Blood culture contamination (BCC) has been associated with unnecessary antibiotic use, additional laboratory tests and increased length of hospital stay thus incurring significant extra hospital costs. We set out to assess the impact of a staff educational intervention programme on decreasing intensive care unit (ICU) BCC rates to <3% (American Society for Microbiology standard). BCC rates during the pre-intervention period (January 2006-May 2011) were compared with the intervention period (June 2011-December 2012) using run chart and regression analysis. Monthly ICU BCC rates during the intervention period were reduced to a mean of 3·7%, compared to 9·5% during the baseline period (P < 0·001) with an estimated potential annual cost savings of about £250 100. The approach used was simple in design, flexible in delivery and efficient in outcomes, and may encourage its translation into clinical practice in different healthcare settings.

Going above and beyond: how sustainability culture and entrepreneurial orientation drive social sustainability supply chain practice adoption

Purpose
– This paper aims to examine what drives the adoption of different social sustainability supply chain practices. Research has shown that certain factors drive the adoption of environmental sustainability practices but few focus on social supply chain practices, delineate which practices are adopted or what drives their adoption.

Design/methodology/approach
– The authors examine the facilitative role of sustainability culture to explain the adoption of social sustainability supply chain practices: basic practices, consisting of monitoring and management systems and advanced practices, which are new product and process development and strategic redefinition. The authors then explore the role played by a firm’s entrepreneurial orientation in shaping and reinforcing the adoption of social sustainability supply chain practices. A survey of 156 supply chain managers in multiple industries in Ireland was conducted to test the relationship between the variables.

Findings
– The findings show that sustainability culture is positively related to all the practices, and entrepreneurial orientation impacts and moderates social sustainability culture in advanced social sustainability supply chain adoption.

Research limitations/implications
– As with any survey, this is a single point in time with a single respondent. Implications for managers include finding the right culture in the organisation to implement social sustainability supply chain management practices that go beyond monitoring to behavioural changes in the supply chain with implications beyond the dyad of buyer and supplier to lower tier suppliers and the community surrounding the supply chain.

Practical implications
– The implications for managers include developing and fostering cultural attributes in the organisation to implement social sustainability supply chain management practices that go beyond monitoring suppliers to behavioural changes in the supply chain with implications beyond the dyad of buyer and supplier to lower tier suppliers and the community surrounding the supply chain.

Originality/value
– This is the first time, to the authors’ knowledge, that cultural and entrepreneurial variables have been tested for social sustainability supply chain practices, giving them new insights into how and why social sustainability supply chain practices are adopted.

Understanding breast health awareness in an Arabic culture: qualitative study protocol

AIM: To explore breast health awareness and the early diagnosis and detection methods of breast cancer from the perspective of women and primary healthcare providers in the Jizan region of the Kingdom of Saudi Arabia.

BACKGROUND: Although there is a high incidence of advanced breast cancer in young women in the Kingdom of Saudi Arabia, there is no standardized information about breast self-examination, or is there a national screening programme involving clinical breast examination and mammography available.

DESIGN: Qualitative exploratory study.

METHODS: Data collection will consist of 36 face-to-face semi-structured interviews: 12 with general practitioners; 12 with nurses at primary healthcare centres and with 12 women who attend the health centres. This study will be carried out in eight states across the Jizan region (four rural and four urban) to reflect the cultural diversity of Jizan. The data will be analysed using thematic content analysis. Research Ethics Committee approval was obtained in June 2015.

DISCUSSION: While we understand the enablers and barriers to breast health awareness outside of Saudi culture, in the Kingdom of Saudi Arabia, particularly in rural populations such as Jizan, there is a lack of research. This study will add positively to the international knowledge base of this topic. The findings will give evidence and inform policy about women and healthcare providers' experiences in Jizan, in a society where such topics are taboo.