"Customer" knowledge management in healthcare

This paper reports on a work-in-progress project on the management of patient knowledge in a UK general hospital. Greater involvement of patients is generally seen as crucial to the effective provision of healthcare in the future. However, this presents many challenges, especially in the light of the ageing population in most developed countries and the consequent increasing demand for healthcare. In the UK, there have been many attempts to increase patient involvement by the systematisation of patient feedback, but typically they have not been open to academic scrutiny or formal evaluation, nor have they used any knowledge management principles. The theoretical foundations for this project come first from service management and thence from customer knowledge management. Service management stresses the importance of the customer perspective. Healthcare clearly meets the definitions of a service even though it may also include some tangible elements such as surgery and provision of medication. Although regarding hospital patients purely as "customers" is a viewpoint that needs to be used with care, application of the theory offers potential benefits in healthcare. The two main elements we propose to use from the theory are the type of customer knowledge and its relationship to attributes of the quality of the service provided. The project is concerned with investigating various knowledge management systems (KMS) that are currently in use (or proposed) to systematise patient feedback in an NHS Trust hospital, to manage knowledge from and to a lesser extent about patients. The study is a mixed methods (quantitative and qualitative) action research investigation intended to answer the following three research questions: • How can a KMS be used as a mechanism to capture and evaluate patient experiences to provoke patient service change • How can the KMS assist in providing a mechanism for systematising patient engagement? • How can patient feedback be used to stimulate improvements in care, quality and safety?

The political discourse and material practice of technology enhanced learning

Technology discloses man’s mode of dealing with Nature, the process of production by which he sustains his life, and thereby also lays bare the mode of formation of his social relations, and of the mental conceptions that flow from them (Marx, 1990: 372) My thesis is a Sociological analysis of UK policy discourse for educational technology during the last 15 years. My framework is a dialogue between the Marxist-based critical social theory of Lieras and a corpus-based Critical Discourse Analysis (CDA) of UK policy for Technology Enhanced Learning (TEL) in higher education. Embedded in TEL is a presupposition: a deterministic assumption that technology has enhanced learning. This conceals a necessary debate that reminds us it is humans that design learning, not technology. By omitting people, TEL provides a vehicle for strong hierarchical or neoliberal, agendas to make simplified claims politically, in the name of technology. My research has two main aims: firstly, I share a replicable, mixed methodological approach for linguistic analysis of the political discourse of TEL. Quantitatively, I examine patterns in my corpus to question forms of ‘use’ around technology that structure a rigid basic argument which ‘enframes’ educational technology (Heidegger, 1977: 38). In a qualitative analysis of findings, I ask to what extent policy discourse evaluates technology in one way, to support a Knowledge Based Economy (KBE) in a political economy of neoliberalism (Jessop 2004, Fairclough 2006). If technology is commodified as an external enhancement, it is expected to provide an ‘exchange value’ for learners (Marx, 1867). I therefore examine more closely what is prioritised and devalued in these texts. Secondly, I disclose a form of austerity in the discourse where technology, as an abstract force, undertakes tasks usually ascribed to humans (Lieras, 1996, Brey, 2003:2). This risks desubjectivisation, loss of power and limits people’s relationships with technology and with each other. A view of technology in political discourse as complete without people closes possibilities for broader dialectical (Fairclough, 2001, 2007) and ‘convivial’ (Illich, 1973) understandings of the intimate, material practice of engaging with technology in education. In opening the ‘black box’ of TEL via CDA I reveal talking points that are otherwise concealed. This allows me as to be reflexive and self-critical through praxis, to confront my own assumptions about what the discourse conceals and what forms of resistance might be required. In so doing, I contribute to ongoing debates about networked learning, providing a context to explore educational technology as a technology, language and learning nexus.

The role of pharmacists in caring for young people with chronic illness

Purpose - To explore the perceived and potential roles of pharmacists in the care of young people aged 10-24 years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals and lay advocates. Methods - A sequential mixed methods study design comprising: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners, and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. Results - The high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were: developing generic healthcare skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information, and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider healthcare team. Conclusions - This study has led to the identification of specific enhancements to pharmacy services for young people which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication.

Doing business in India

On its independence in 1947, India was among the two most industrialized nations in Asia. Since then it adopted a “mixed economy” approach that hindered its national growth and the optimum utilization of its immense resources (both natural and human). To re-establish itself as an economic force in the region, India liberalized its economy in early 1990s. The adoption of the “free market economy” model has created great opportunities for foreign businesses. This article provides useful information on the complex business environment, aimed to help foreign businessmen and investors to develop a good understanding on key background knowledge for being successful in India. It reviews Indian historical development, political structure and climate, international relations, and economy and foreign trade. India's infrastructure, legal framework, socio-cultural set-up, competitive environment, as well as market structure and potential are also analyzed. © 2001 John Wiley & Sons, Inc.

HRM systems of Indian call centres:an exploratory study

This paper initially highlights the rapid growth in the call centre (CC) sector in developing countries like India. It then makes a case for the investigation of human resource management (HRM) systems of call centres in India. The analysis is based on a two-phase empirical study. Phase one examines the nature and pattern of HRM systems and phase two the emerging issue of attrition in Indian call centres. A mixed research approach comprising in-depth interviews and questionnaire survey was adopted to conduct the investigation. Against the established norms of Indian organizations, the findings highlight the existence of formal, structured and rationalized HRM systems. Core reasons for the increasing levels of attrition are highlighted. The analysis further provides useful information both for academics and practitioners and opens avenues for future research.

The dynamics of HRM systems in Indian BPO firms

This paper highlights the context within which business process outsourcing (BPO) has rapidly grown in India and the critical need to investigate the dynamics of human resource management (HRM) practices and systems in this sector. Using a mixed-method approach involving both in-depth interviews and self-completing questionnaires, we analyze the nature of HRM systems in BPO organizations operating in India. The analysis is based on a sample of 51 BPO companies, a majority of which are located near the capital of New Delhi. The results focus on the nature and structure of work and organization of Indian BPOs, as well as the strategic role played by HRM in such organizations. Furthermore, the findings highlight the way specific HRM practices such as recruitment, performance appraisal, training and development, and compensations are implemented. Our study suggests the existence of formal, structured, and rationalized HRM systems in Indian BPOs. A number of insights related to HRM policies and practices are shared by the HR managers interviewed shedding more light on the inner workings of the Indian BPO companies and their challenges. The analysis provides original and useful information to both academics and practitioners and opens avenues for future research on the nature of HRM systems and practices in the Indian BPO industry.

Multi-criteria logistics distribution network design using SAS/OR

This paper explores the use of the optimization procedures in SAS/OR software with application to the contemporary logistics distribution network design using an integrated multiple criteria decision making approach. Unlike the traditional optimization techniques, the proposed approach, combining analytic hierarchy process (AHP) and goal programming (GP), considers both quantitative and qualitative factors. In the integrated approach, AHP is used to determine the relative importance weightings or priorities of alternative warehouses with respect to both deliverer oriented and customer oriented criteria. Then, a GP model incorporating the constraints of system, resource, and AHP priority is formulated to select the best set of warehouses without exceeding the limited available resources. To facilitate the use of integrated multiple criteria decision making approach by SAS users, an ORMCDM code was implemented in the SAS programming language. The SAS macro developed in this paper selects the chosen variables from a SAS data file and constructs sets of linear programming models based on the selected GP model. An example is given to illustrate how one could use the code to design the logistics distribution network.

Unresolved issues and new challenges in teaching English to young learners:the case of South Korea

The introduction of languages, especially English, into the primary curriculum around the world has been one of the major language-in-education policy developments in recent years. In countries where English has been compulsory for a number of years, the question arises as to what extent the numerous and well-documented challenges faced by the initial implementation of early language learning policies have been overcome and whether new challenges have arisen as policies have become consolidated. This article therefore focuses on South Korea, where English has been compulsory in primary school since 1997. The issues raised by the introduction of English into the primary curriculum are reviewed and the current situation in South Korea is investigated. The results of a mixed methods study using survey data from 125 Korean primary school teachers, together with data from a small-scale case study of one teacher are presented. The study shows that, while some of the initial problems caused by the introduction of early language learning appear to have been addressed, other challenges persist. Moreover, the data reveal the emergence of a number of new challenges faced by primary school teachers of English as they seek to implement government policy. © 2013 © 2013 Taylor & Francis.

Medication -related adverse events in older people with dementia:causes and possible solutions

This submission for a PhD by previously published work is based upon six publications in peer reviewed journals, reflecting a 9-year research programme. My research has shown, in a coherent and original way, the difficulty in treating people with dementia with safe and effective medication whilst providing research-founded guidance to develop mechanisms to optimise medication choice and minimise iatrogenic events. A wide range of methods, including systematic reviews, meta-analysis, randomised controlled trials (RCTs), quantitative research and mixed methods were used to generate the data, which supported the exploration of three themes. The first theme, to understand the incidence and causes of medication errors in dementia services, identified that people with dementia may be more susceptible to medication-related iatrogenic disease partly due to inherent disease-related characteristics. One particular area of concern is the use of anti-psychotics to treat the Behavioural and Psychological Symptoms of Dementia (BPSD). The second and third themes, respectively, investigated a novel pharmacological and health services intervention to limit anti-psychotic usage. The second phase found that whilst the glutamate receptor blocker memantine showed some promise, further research was clearly required. The third phase found that anti-psychotic usage in dementia may be higher than official figures suggest and that medication review linking primary and secondary care can limit such usage. My work has been widely cited, reflecting a substantial contribution to the field, in terms of our understanding of the causes of, and possible solutions to limit, medication-related adverse events in people with dementia. More importantly, this work has already informed clinical practice, patients, carers and policy makers by its demonstrable impact on health policy. In particular my research has identified key lines of enquiry for future work and for the development of my own personal research programme to reduce the risk associated with medication in this vulnerable population.

Metaphors in spoken academic discourse in german and english

Metaphors have been increasingly associated with cognitive functions, which means that metaphors structure how we think and express ourselves. Metaphors are embodied in our basic physical experience, which is one reason why certain abstract concepts are expressed in more concrete terms, such as visible entities, journeys, and other types of movement, spaces etc. This communicative relevance also applies to specialised, institutionalised settings and genres, such as those produced in or related to higher education institutions, among which is spoken academic discourse. A significant research gap has been identified regarding spoken academic discourse and metaphors therein, but also given the fact that with increasing numbers of students in higher education and international research and cooperation e.g. in the form of invited lectures, spoken academic discourse can be seen as nearly omnipresent. In this context, research talks are a key research genre. A mixed methods study has been conducted, which investigates metaphors in a corpus of eight fully transcribed German and English L1 speaker conference talks and invited lectures, totalling to 440 minutes. A wide range of categories and functions were identified in the corpus. Abstract research concepts, such as results or theories are expressed in terms of concrete visual entities that can be seen or shown, but also in terms of journeys or other forms of movement. The functions of these metaphors are simplification, rhetorical emphasis, theory-construction, or pedagogic illustration. For both the speaker and the audience or discussants, anthropomorphism causes abstract and complex ideas to become concretely imaginable and at the same time more interesting because the contents of the talk appear to be livelier and hence closer to their own experience, which ensures the audience’s attention. These metaphor categories are present in both the English and the German sub corpus of this study with similar functions.

Culture and behaviour in the English National Health Service:overview of lessons from a large multimethod study

Background - Problems of quality and safety persist in health systems worldwide. We conducted a large research programme to examine culture and behaviour in the English National Health Service (NHS). Methods - Mixed-methods study involving collection and triangulation of data from multiple sources, including interviews, surveys, ethnographic case studies, board minutes and publicly available datasets. We narratively synthesised data across the studies to produce a holistic picture and in this paper present a highlevel summary. Results - We found an almost universal desire to provide the best quality of care. We identified many 'bright spots' of excellent caring and practice and high-quality innovation across the NHS, but also considerable inconsistency. Consistent achievement of high-quality care was challenged by unclear goals, overlapping priorities that distracted attention, and compliance-oriented bureaucratised management. The institutional and regulatory environment was populated by multiple external bodies serving different but overlapping functions. Some organisations found it difficult to obtain valid insights into the quality of the care they provided. Poor organisational and information systems sometimes left staff struggling to deliver care effectively and disempowered them from initiating improvement. Good staff support and management were also highly variable, though they were fundamental to culture and were directly related to patient experience, safety and quality of care. Conclusions - Our results highlight the importance of clear, challenging goals for high-quality care. Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that staff feel valued, respected, engaged and supported.

Exploring the experiences of nurses who care for children who have Acute Life Threatening Events (ALTE) in hospital

This thesis presents a program of work designed to explore and describe what the experience of caring for a child who has an Acute Life Threatening Event (ALTE) is like for the nurses. An ALTE may include a cardiac arrest, respiratory arrest or unplanned admission for a ward to the Paediatric Intensive Care unit. Using the MRC framework for the development of complex interventions, this information was then coupled with theory to develop the PREPARE and SUPPORT interventions. Given the wide-ranging and exploratory nature of this research, a pragmatic, mixed design approach was used to address the aims and objectives of the thesis. The mixed design approach included: a systematic literature review; international survey of practice; interviews with nurses and doctors using Interpretative Phenomenological Analysis; development, refinement and evaluation of interventions during a feasibility study. Two studies were identified through the systematic review which aimed to evaluate the effectiveness of debriefing. The studies did not provide evidence to support the use of these interventions within healthcare. The international survey of practice demonstrated hospitals were using interventions to both prepare and support nurses for these events. The preparatory interventions were clinically focused and the majority of the supportive interventions included a debrief. The interventions were not being evaluated for effectiveness. The interviews conducted with nurses and doctors provided insight into what that experience was like for the participants. Using the MRC framework, this evidence was coupled with theory to develop the PREPARE and SUPPORT interventions. A multidisciplinary working party used an iterative process to refine and evaluate the interventions and study procedures were explored through a feasibility study. The pragmatic, mixed design approach demonstrated how the empirical evidence was coupled with theory and clinical expertise to develop interventions for use within the healthcare environment.

Nerding out on Twitter:fun, patriotism and #curiosity

This paper presents an analysis of tweets collected over six days before, during and after the landing of the Mars Science Laboratory, known as Curiosity, in the Gale Crater on the 6th of August 2012. A sociological application of web science is demonstrated by use of parallel coordinate visualization as part of a mixed methods study. The results show strong, predominantly positive, international interest in the event. Scientific details dominated the stream, but, following the successful landing, other themes emerged such as fun, and national pride.

The role of wisdom in organisational leadership

This thesis begins with a review of the literature on wisdom models, theories of wise leadership, and existing wisdom measures. It continues with a review of how the concept of wisdom may add value to existing leadership models, highlighting the need to empirically identify the characteristics of wise leaders and develop a wise leadership measure. A nomological framework for wise leadership is then presented. Based on a review of the wisdom and leadership paradigms, a mixed-methods research design is described for three studies to define the characteristics of wise leadership in organisations; identify specific leadership challenges that might require wise responses; and to develop the wise leadership measure comprising of vignettes. The first study involves critical incident interviews with 26 nominated wise leaders and 23 of their nominators, which led to the identification of nine wise leadership dimensions which include Strong Ethical Code, Strong Judgement, Optimising Positive Outcomes, Managing Uncertainty, Strong Legacy, Leading with Purpose, Humanity, Humility, and Self-Awareness. The second study includes critical incident interviews with 20 leaders about organisational challenges associated with the nine dimensions, to elucidate the wise leadership measure. The third study includes the design of 45 vignettes based on organisational challenges that measure the nine wise leadership dimensions. The measure is then administered to 250 organisational leaders to establish its construct validity, leading to the selection of 18 vignettes forming the final wise leadership measure. Theoretical, methodological and practical implications of this research are then discussed with recommendations for future research.

UK and US board director perceptions of the significance of gender and racial diversity on board governance

This mixed-methods study examines the perceptions and opinions of United Kingdom FTSE 350, and US Fortune 500 board of director members regarding the significance of gender and racial diversity on board governance. Perceptions were gathered from eighty-two directors using self-reported surveys and semi-structured interviews. This thesis provides: (1) an opportunity to investigate the perceptions (opinions) of directors regarding the effects of board gender and racial diversity on new board appointments and on the dynamics of board decision making (2) an opportunity to investigate the perception (opinions) of directors regarding the effects of social capital, new board appointments and the dynamics of board decision making, and (3) an opportunity to investigate comparatively the differences between UK and US director perceptions regarding the effects of board gender and racial diversity on new board appointments and board decision making. My findings indicate that directors believe that expertise and experience are by far the most important attributes when decisions on the selection of new directors are being considered. While US directors report observing tangible benefits to gender and racial diversity, for their firms, as well as a willingness to consider diversity as an attribute in the selection process; most UK directors were strongly opposed to positive discrimination measures.1 A majority of directors do not believe that their own demographic characteristics, such as race or gender were attributes to their being selected to a board position; however white males perceive that these attributes were considered attributes to the appointment of diverse directors. Moreover, in the United Kingdom, male directors reported that they may be at a disadvantage for board selection when compared to their female counterparts, hence advocating for a selection process with minimal considerations of the demographic characteristics of new directors. Directors do not seem to consider diverse social capital of directors when making board appointments. Instead, US directors were more likely to be assisted in board appointments by their having similar social capital, and UK directors indicated that they only consider director expertise, and that expertise is considered to ensure a broad mix of skills and professional experience on the board.