Determining consumer satisfaction and commitment through self-service technology and personal service usage

This paper expands research into self-service technology in the service encounter. Self-service technology is where customers deliver service themselves using some form of a technological interface. There is still a great deal unknown about self-service technology, in particular its impact on consumer satisfaction and consumer commitment. With that in mind, this empirical study explores the relative impact of self-service technology on consumer satisfaction and on a multidimensional measure of consumer commitment containing affective commitment, temporal commitment and instrumental commitment. The results reveal that in a hotel context personal service still remains very important for assessments of satisfaction, and affective and temporal commitment. What is particularly interesting is that self-service technology, while impacting these constructs, also impacts instrumental commitment. This suggests that positive evaluations of self-service technology may tie consumers into relationships with hotels. A discussion and implications for managers are provided on these and other results, and the paper is concluded with further potential research.

The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

TRial of an Educational intervention on patients' knowledge of Atrial fibrillation and anticoagulant therapy, INR control, and outcome of Treatment with warfarin (TREAT)

Background Atrial fibrillation (AF) patients with a high risk of stroke are recommended anticoagulation with warfarin. However, the benefit of warfarin is dependent upon time spent within the target therapeutic range (TTR) of their international normalised ratio (INR) (2.0 to 3.0). AF patients possess limited knowledge of their disease and warfarin treatment and this can impact on INR control. Education can improve patients' understanding of warfarin therapy and factors which affect INR control. Methods/Design Randomised controlled trial of an intensive educational intervention will consist of group sessions (between 2-8 patients) containing standardised information about the risks and benefits associated with OAC therapy, lifestyle interactions and the importance of monitoring and control of their International Normalised Ratio (INR). Information will be presented within an 'expert-patient' focussed DVD, revised educational booklet and patient worksheets. 200 warfarin-naïve patients who are eligible for warfarin will be randomised to either the intervention or usual care groups. All patients must have ECG-documented AF and be eligible for warfarin (according to the NICE AF guidelines). Exclusion criteria include: aged < 18 years old, contraindication(s) to warfarin, history of warfarin USE, valvular heart disease, cognitive impairment, are unable to speak/read English and disease likely to cause death within 12 months. Primary endpoint is time spent in TTR. Secondary endpoints include measures of quality of life (AF-QoL-18), anxiety and depression (HADS), knowledge of AF and anticoagulation, beliefs about medication (BMQ) and illness representations (IPQ-R). Clinical outcomes, including bleeding, stroke and interruption to anticoagulation will be recorded. All outcome measures will be assessed at baseline and 1, 2, 6 and 12 months post-intervention. Discussion More data is needed on the clinical benefit of educational intervention with AF patients receiving warfarin. Trial registration ISRCTN93952605

Business and social entrepreneurs in the UK:gender, context and commitment

Purpose – The purpose of this paper is to investigate what sort of people become social entrepreneurs, and in what way they differ from business entrepreneurs. More importantly, to investigate in what socio-economic context entrepreneurial individuals are more likely to become social than business entrepreneurs. These questions are important for policy because there has been a shift from direct to indirect delivery of many public services in the UK, requiring a professional approach to social enterprise. Design/methodology/approach – Evidence is presented from the Global Entrepreneurship Monitor (GEM) UK survey based upon a representative sample of around 21,000 adults aged between 16 and 64 years interviewed in 2009. The authors use logistic multivariate regression techniques to identify differences between business and social entrepreneurs in demographic characteristics, effort, aspiration, use of resources, industry choice, deprivation, and organisational structure. Findings – The results show that the odds of an early-stage entrepreneur being a social rather than a business entrepreneur are reduced if they are from an ethnic minority, if they work ten hours or more per week on the venture, and if they have a family business background; while they are increased if they have higher levels of education and if they are a settled in-migrant to their area. While women social entrepreneurs are more likely than business entrepreneurs to be women, this is due to gender-based differences in time commitment to the venture. In addition, the more deprived the community they live in, the more likely women entrepreneurs are to be social than business entrepreneurs. However, this does not hold in the most deprived areas where we argue civic society is weakest and therefore not conducive to support any form of entrepreneurial endeavour based on community engagement. Originality/value – The paper's findings suggest that women may be motivated to become social entrepreneurs by a desire to improve the socio-economic environment of the community in which they live and see social enterprise creation as an appropriate vehicle with which to address local problems.

A study of the relationship between exit, voice, loyalty and neglect and commitment in India

Drawing on exit, voice, loyalty and neglect (EVLN) literature, this study examines direct and interactive associations between organizational-level commitment and team-level commitment and the use of EVLN by managers in India. The study is based on a survey of 200 managers and supervisors from seven Indian firms. The findings on the use of voice are consistent with the past research in Western countries, but challenge the prevailing assumption about the use of voice in high power distance societies. The results also indicate that team-level commitment moderates the association between organizational-level commitment and the use of EVLN.

Patients’ and physicians’ experiences of atrial fibrillation and anticoagulation therapy:a qualitative journey

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF) however it is often underutilized and sometimes refused by patients. This programme of work included a meta-synthesis and two inter-linking studies aiming to explore patients’ and physicians’ experiences of AF and OAC. Methods: A meta-synthesis of qualitative evidence was conducted which informed the empirical work. Semi-structured individual interviews were utilised. Study 1: Three AF patient sub-groups were interviewed; accepted (n=4), refused (n=4), or discontinued (n=3) warfarin. Study 2: Four physician sub-groups (n=4 each group) prescribing OAC to AF patients were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Data was analysed using interpretative phenomenological analysis. Results: Study 1: Three over-arching themes comprised patients’ experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients’ reflections. Patients commented on the relief and reassurance experienced during the consultation but they perceived the decision making process mostly led by the physician. Lack of education and take-home materials distributed during the initial consultation was highlighted. Patients who had experienced stroke themselves or were caregivers, were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Warfarin monitoring was challenging for patients, however some patients perceived it as beneficial as it served to enhance patient-physician relationship. Study 2: Two over-arching themes emerged from physicians’ experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians’ approach to the consultation style shifted through a continuum of compliance-adherence-concordance during the consultation. They aimed for concordance, however challenges such as time and the perceived patient trust in them as the expert, led to physicians adopting a paternalistic approach. Physicians also pointed out challenges associated with guideline adherence and the need to adopt a multi-disciplinary approach, where other health professionals could provide on-going education. Conclusion: This programme of work has illustrated the benefit of taking an in depth phenomenological approach to understanding the lived experience of the physician-patient consultation. Together with the meta-synthesis, this work has strengthened the evidence base and demonstrated that there is a need to target patients' and physicians' ability to communicate with each other in a comprehensible way.

The early career researcher's toolkit:translating tissue engineering, regenerative medicine and cell therapy products

Although the importance of translation for the development of tissue engineering, regenerative medicine and cell-based therapies is widely recognized, the process of translation is less well understood. This is particularly the case among some early career researchers who may not appreciate the intricacies of translational research or make decisions early in development which later hinders effective translation. Based on our own research and experiences as early career researchers involved in tissue engineering and regenerative medicine translation, we discuss common pitfalls associated with translational research, providing practical solutions and important considerations which will aid process and product development. Suggestions range from effective project management, consideration of key manufacturing, clinical and regulatory matters and means of exploiting research for successful commercialization.

How leadership and commitment influence bank employees' adoption of their bank's values

Retail banking is facing many challenges, not least the loss of its customers' trust and loyalty. The economic crisis is forcing banks to examine their relationships with stakeholders and to offer greater reassurance that their brand promises will be delivered. More than ever, banks need to stand for something positive and valued by stakeholders. One way to achieve this is through paying more attention to brand values. Our article explores how values are adopted by employees within a bank. When employees 'live' their brand's values, their behaviour during customer interactions reflects this, encouraging the strengthening of customer relationships. Specifically, we test the relationship between leadership style, employee commitment, and the adoption of values. Data was collected from a survey of 438 branch employees in a leading Irish retail bank. The study found that a structured and directive leadership style was effective at encouraging the adoption of the bank's values. Moreover, when employees are committed to the organisation, this has a significant impact on their adoption of values. Thus, this study supports the literature which suggests that leadership and commitment are prerequisites for values adoption. © 2011 Springer Science+Business Media B.V.

Regulatory foci and organisational commitment

We use regulatory focus theory to derive specific predictions regarding the differential relationships between regulatory focus and commitment. We estimated a structural equation model using a sample of 520 private and public sector employees and found in line with our hypotheses that (a) promotion focus related more strongly to affective commitment than prevention focus, (b) prevention focus related more strongly to continuance commitment than promotion focus, (c) promotion and prevention focus had equally strong effects on normative commitment. Implications of these findings for the three-component model of commitment, especially the ‘dual nature’ of normative commitment, as well as implications for human resources management and leadership are discussed.

How brand attribute typicality and consumer commitment moderate the influence of comparative advertising

This study examines how product attribute typicality and brand commitment influence the effects of comparative versus non-comparative ads on brand attitudes. Employing perspectives from the literatures on typicality and commitment, the study examines the effects of commitment to the comparison brand on the effectiveness of comparative versus non-comparative advertising. A between-informants experiment uses data from 466 student informants. It is hypothesized that (a) when the attribute under consideration is typical (atypical), among comparison brand committed informants, a non-comparative ad is more (no more) persuasive than a comparative ad, (b) when the attribute under consideration is typical, among comparison brand non-committed informants, a comparative ad is more persuasive than a non-comparative ad, and (c) when the attribute under consideration is atypical, among comparison brand non-committed informants, a comparative ad is likely to be more persuasive than a non-comparative ad, but the effect will be weaker than in the case of a typical attribute. Hypothesis (a) is supported while (b) has directional support. The results support a three-way interaction between consumer commitment, attribute typicality, and type of advertisement. The findings are relevant to a variety of contexts, such as markets characterized by high levels of market share and commitment for the market leader as well as fragmented markets where market share and commitment levels are low.

Service employee clusters in banking:exploring Ind's typology considering behaviour, commitment and attitude about leadership

Purpose: Ind suggests front line employees can be segmented according to their level of brand-supporting performance. His employee typology has not been empirically tested. The paper aims to explore front line employee performance in retail banking, and profile employee types. Design/methodology/approach: Attitudinal and demographic data from a sample of 404 front line service employees in a leading Irish bank informs a typology of service employees. Findings: Champions, Outsiders and Disruptors exist within retail banking. The authors provide an employee profile for each employee type. They found Champions amongst males, and older employees. The highest proportion of female employees surveyed were Outsiders. Disruptors were more likely to complain, and rated their performance lower than any other employee type. Contrary to extant literature, Disruptors were more likely to hold a permanent contract than other employee types. Originality/value: The authors augment the literature by providing insights about the profile of three employee types: Brand Champions, Outsiders and Disruptors. Moreover, the authors postulate the influence of leadership and commitment on each employee type. The cluster profiles raise important questions for hiring, training and rewarding front line banking employees. The authors also provide guidelines for managers to encourage Champions, and curtail Disruptors. © Emerald Group Publishing Limited.

Inhaled human insulin (Exubera®):clinical profile and patient considerations

Inhaled human insulin (Exubera®) is a rapid-acting regular human insulin administered by oral inhalation before meals. It provides a non-invasive alternative to multiple subcutaneous injections for the treatment of hyperglycemia in adult patients with type 1 and type 2 diabetes. Compared with subcutaneous rapid-acting insulin analogs, Exubera provides equivalent HbA1c control. As a monotherapy or in combination with oral agents, Exubera also provides greater glycemic control than oral agents alone, at least in patients with high levels of HbA1c. Exubera demonstrates improved patient satisfaction compared with subcutaneous insulin or oral agents alone. When offered as a treatment option together with standard treatments in uncontrolled patients naive to insulin, Exubera increases acceptance of insulin therapy three-fold compared with patients offered standard regimens only. Exubera is well tolerated in comparison to subcutaneous insulin, with a similar incidence of mild to moderate hypoglycemia. Although cough is a common adverse effect early in therapy, this leads to treatment discontinuations in less than 1% of patients. Despite an increased incidence of insulin antibodies compared with subcutaneous administration, and a consistent but minor impact on pulmonary function, long-term safety data of up to 4 years continue to support the safety profile of Exubera.

Good practice guide in learning and teaching

This is the second edition of our Aston Business School (ABS) Good Practice Guide and the enthusiasm of the contributors appears undiminished. I am again reminded that I work with a group of very committed, dedicated and professional colleagues. Once again this publication is produced to celebrate and promote good teaching across the School and to offer encouragement to those imaginative and innovative staff who continue to wish to challenge students to learn to maximum effect. It is hoped that others will pick up some good ideas from the articles contained in this volume. Contributors to this Guide were not chosen because they are the best teachers in the School, although they are undoubtedly all amongst my colleagues who are exponents of enthusiastic and inspiring approaches to learning. The Quality Unit approached these individuals because they declared on their Annual Module Reflection Forms that they were doing something interesting and worthwhile which they thought others might find useful. Amongst those reading the Guide I am sure that there are many other individuals who are trying to operate similar examples of good practice in their teaching, learning and assessment methods. I hope that this publication will provoke these people into providing comments and articles of their own and that these will form the basis of next year’s Guide. It may also provoke some people to try these methods in their own teaching. The themes of the articles this year can be divided into two groups. The first theme is the quest to help students to help themselves to learn via student-run tutorials, surprise tests and mock examinations linked with individual tutorials. The second theme is making learning come to life in exciting practical ways by, for example, hands-on workshops and simulations, story telling, rhetorical questioning and discussion groups. A common theme is one of enthusiasm, reflection and commitment on behalf of the lecturers concerned. None of the approaches discussed in this publication are low effort activities on the part of the facilitator, but this effort is regarded as worthwhile as a means of creating greater student engagement. As Biggs (2003)[1] says, in his similarly inspiring way, students learn more the less passive they are in their learning. (Ref). The articles in this publication bear witness of this and much more. Since last year Aston Business School has launched its Research Centre in Higher Education Learning and Management (HELM) which is another initiative to promote excellent learning and teaching. Even before this institution has become fully operational, at least one of the articles in this publication has seen the light of day in the research arena and at least two others are ripe for dissemination to a wider audience via journal publication. More news of our successes in this activity will appear in next year’s edition. May I thank the contributors for taking time out of their busy schedules to write the articles this summer, and to Julie Green who runs the ABS Quality Unit, for putting our diverse approaches into a coherent and publishable form and for chasing us when we have needed it! I would also like to thank Ann Morton and her colleagues in the Centre for Staff Development who have supported this publication. During the last year the Centre has further stimulated the learning and teaching life of the School (and the wider University) via their Learning and Teaching Week and sponsorship of Teaching Quality Enhancement Fund (TQEF) projects. Pedagogic excellence is in better health at Aston than ever before – long may this be because this is what life in HE should be about.

A review of non-pharmacological and pharmacological management of seasonal and perennial allergic conjunctivitis

Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents.