An evaluation of quinolone prescribing in a group of acute hospitals:Development of an objective measure of usage

Objectives: To develop an objective measure to enable hospital Trusts to compare their use of antibiotics. Design: Self-completion, postal questionnaire with telephone follow up. Sample: 4 hospital trusts in the English Midlands. Results: The survey showed that it was possible to collect data concerning the number of Defined Daily Doses (DDD's) of quinolone antibiotic dispensed per Finished Consultant Episode (FCE) in each Trust.. In the 4 trusts studied the mean DDD/FCE was 0.197 (range 0.117 to 0.258). This indicates that based on a typical course length of 5 days, 3.9% of patient episodes resulted in the prescription of a quinolone antibiotic. Antibiotic prescribing control measures in each Trust were found to be comparable. Conclusion: The measure will enable Trusts to objectively compare their usage of quinolone antibiotics and use this information to carry out clinical audit should differences be recorded. This is likely to be applicable to other groups of antibiotics.

Nations and organizations:a comparative study of English and Indian work-related attitudes and values in matched manufacturing firms

This thesis reports a cross-national study carried out in England and India in an attempt to clarify the association of certain cultural and non-cultural characteristics with people's work-related attitudes and values, and with the structure of their work organizations. Three perspectives are considered to be relevant to the objectives of the study. The contingency perspective suggests that a 'fit' between an organization's context and its structural arrangements will be fundamentally necessary for achieving success and survival. The political economy perspective argues for the determining role of the social and economic structures within which the organization operates. The culturalist perspective looks to cultural attitudes and values of organizational members for an explanation for their organization's structure. The empirical investigation was carried out in three stages in each of the two countries involved by means of surveys of cultural attitudes, work-related attitudes and organizational structures and systems. The cultural surveys suggested that Indian and English people were different from one another with regard to fear of, and respect and obedience to, their seniors, ability to cope with ambiguity, honesty, independence, expression of emotions, fatalism, reserve, and care for others; they were similar with regard to tolerance, friendliness, attitude to change, attitude to law, self-control and self-confidence, and attitude to social differentiation. The second stage of the study, involving the employees of fourteen organizations, found that the English ones perceived themselves to have more power at work, expressed more tolerance for ambiguity, and had different expectations from their job than did the Indian equivalents. The two samples were similar with respect to commitment to their company and trust in their colleagues. The findings also suggested that employees' occupations, education and age had some influences on their work-related attitudes. The final stage of the research was a study of structures, control systems, and reward and punishment policies of the same fourteen organizations which were matched almost completely on their contextual factors across the two countries. English and Indian organizations were found to be similar in terms of centralization, specialization, chief executive's span of control, height and management control strategies. English organizations, however, were far more formalized, spent more time on consultation and their managers delegated authority lower down the hierarchy than Indian organizations. The major finding of the study was the multiple association that cultural, national and contingency factors had with the structural characteristics of the organizations and with the work-related attitudes of their members. On the basis of this finding, a multi-perspective model for understanding organizational structures and systems is proposed in which the contributions made by contingency, political economy and cultural perspectives are recognized and incorporated.

The knowledge-based perspective of risk management in healthcare organisations

The aim of this research is to investigate how risk management in a healthcare organisation can be supported by knowledge management. The subject of research is the development and management of existing logs called "risk registers", through specific risk management processes employed in a N.H.S. (Foundation) Trust in England, in the U.K. Existing literature on organisational risk management stresses the importance of knowledge for the effective implementation of risk management programmes, claiming that knowledge used to perceive risk is biased by the beliefs of individuals and groups involved in risk management and therefore is considered incomplete. Further, literature on organisational knowledge management presents several definitions and categorisations of knowledge and approaches for knowledge manipulation in the organisational context as a whole. However, there is no specific approach regarding "how to deal" with knowledge in the course of organisational risk management. The research is based on a single case study, on a N.H.S. (Foundation) Trust, is influenced by principles of interpretivism and the frame of mind of Soft Systems Methodology (S.S.M.) to investigate the management of risk registers, from the viewpoint of people involved in the situation. Data revealed that knowledge about risks and about the existing risk management policy and procedures is situated in several locations in the Trust and is neither consolidated nor present where and when required. This study proposes a framework that identifies required knowledge for each of the risk management processes and outlines methods for conversion of this knowledge, based on the SECI knowledge conversion model, and activities to facilitate knowledge conversion so that knowledge is effectively used for the development of risk registers and the monitoring of risks throughout the whole Trust under study. This study has theoretical impact in the management science literature as it addresses the issue of incomplete knowledge raised in the risk management literature using concepts of the knowledge management literature, such as the knowledge conversion model. In essence, the combination of required risk and risk management related knowledge with the required type of communication for risk management creates the proposed methods for the support of each risk management process for the risk registers. Further, the indication of the importance of knowledge in risk management and the presentation of a framework that consolidates knowledge required for the risk management processes and proposes way(s) for the communication of this knowledge within a healthcare organisation have practical impact in the management of healthcare organisations.

The role of line managers in employee career management:an attachment theory perspective

Line managers increasingly play a key role in organizational career development systems, yet few studies have examined the nature of this role or its implications for employee career attitudes and behaviors. In two studies, we used attachment theory to explore this issue. In Study 1, in-depth interviews (N = 20) showed that employees viewed career management as a relational process in which line managers are expected to act as ‘caregiver’ to support individualized career development. Study 2 was a large-scale international survey (N = 891). Participants scoring higher on attachment avoidance in their line manager relationships reported more negative perceptions of career growth opportunities, lower participation in organizational career development activities and higher turnover intentions. Trust in the organization partially mediated the relationship. Theoretical and practical implications for HRM are discussed.

A probabilistic model for trust and reputation

This paper concerns the problem of agent trust in an electronic market place. We maintain that agent trust involves making decisions under uncertainty and therefore the phenomenon should be modelled probabilistically. We therefore propose a probabilistic framework that models agent interactions as a Hidden Markov Model (HMM). The observations of the HMM are the interaction outcomes and the hidden state is the underlying probability of a good outcome. The task of deciding whether to interact with another agent reduces to probabilistic inference of the current state of that agent given all previous interaction outcomes. The model is extended to include a probabilistic reputation system which involves agents gathering opinions about other agents and fusing them with their own beliefs. Our system is fully probabilistic and hence delivers the following improvements with respect to previous work: (a) the model assumptions are faithfully translated into algorithms; our system is optimal under those assumptions, (b) It can account for agents whose behaviour is not static with time (c) it can estimate the rate with which an agent's behaviour changes. The system is shown to significantly outperform previous state-of-the-art methods in several numerical experiments. Copyright © 2010, International Foundation for Autonomous Agents and Multiagent Systems (www.ifaamas.org). All rights reserved.

Growth aspirations and social capital:young firms in a post-conflict environment

This article explores the growth aspirations of owners and managers of young firms in a post-conflict economy by focusing on social capital. It treats social capital as a multidimensional, multilevel phenomenon, studying the effects of discussion network characteristics, trust in institutions, generalised trust in people and local ethnic pluralism. We argue that in a post-conflict country, ethnic pluralism is indicative of local norms of tolerance towards experimentation and risk taking which support growth aspirations. It also distinguishes between the aspirations of hired managers and owners-managers. The empirical counterpart and hypotheses testing rely on survey evidence drawn from young businesses in Bosnia and Herzegovina.

Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.

An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Uneasy lies the head that bears the trust:the effects of feeling trusted on emotional exhaustion

The construct of feeling trusted reflects the perception that another party is willing to accept vulnerability to one's actions. Although this construct has received far less attention than trusting, the consensus is that believing their supervisors trust them has benefits for employees' job performance. Our study challenges that consensus by arguing that feeling trusted can be exhausting for employees. Drawing on Stevan Hobfoll's conservation of resources theory, we develop a model in which feeling trusted fills an employee with pride a benefit for exhaustion and performance while also increasing perceived workload and concerns about reputation maintenance burdens for exhaustion and performance. We test our model in a field study using a sample of public transit bus drivers in London, England. Our results suggest that feeling trusted is a double-edged sword for job performance, bringing with it both benefits and burdens. Given that recommendations for managers generally encourage placing trust in employees, these results have important practical implications.

Leader trustworthy behavior and organizational trust:the role of the immediate manager for cultivating trust

Drawing from both trust-building theory and interpersonal trust literature, we investigate how trust between a leader and follower may be leveraged to influence organizational trust. We also explore the mediating mechanisms of this link and test a potential moderator. A cross-sectional, multi-foci design was adopted and participants were 201 employees within a public sector organization. Leader trustworthy behavior was found to predict organizational trust, mediated by trustworthiness perceptions and trust in the leader. Support for the boundary condition was found; namely, when leaders were more senior, the relationship between trustworthy behavior and organizational trust was stronger. The findings suggest that leaders can meaningfully influence organizational trust perceptions through the enactment of trustworthy behavior, although the strength of this effect varied as a function of their position.

Bizalom és kockázat a kapcsolatokban – egy kísérlet eredményei = Relationship between trust and risk - results of an experiment

Műhelytanulmányunkban a diadikus kapcsolatokat állítjuk az elemzés középpontjába. A Budapesti Corvinus Egyetem másodéves, gazdálkodástudományi alapszakjaira járó hallgatóiból véletlenszerűen alakított kétoldalú kapcsolatokban a felek egymás iránt érzett bizalmi szintje és különböző szintű kockázat melletti konkrét cselekvése közötti kapcsolatot vizsgáltuk. Előzetes várakozásaink szerint a felek egymás iránt érzett bizalmi szintje befolyásolja, hogy különböző kockázati szintek mellett hogyan fognak a kapcsolatban szereplő egyének viselkedni. Empirikus elemzésünk során a közgazdaságtanban is elfogadott kísérlet eszközét választottuk, s konkrét adatainkat, megfigyeléseinket e módszertannal gyűjtöttük össze. Az így kapott mintát a Magyarországon a gazdálkodás-, illetve közgazdaságtudományban tudomásunk szerint eddig még nem használt diadikus adatelemzés speciális statisztikai módszertanát alkalmazva vizsgáltuk. Műhelytanulmányunk célja volt ezért az is, hogy ennek a hálózati gazdaság építőkövének, a kapcsolatnak a vizsgálatára alkalmas elemzési módszertannak az ismertetését is megtegyük. _______ In the working paper we have focused on the analysis of trust in dyadic relationships. We have assumed that trust is a kind of coordinating mechanism in these relationships, the existence of which influences interaction between dyadic partners. We carried out an experiment with the help of bachelor students studying at the Budapest Corvinus University. Our hypothesis was that medium and high level of trust will influence the willingness to take more risky decisions. These experiments have been realized in concrete personal dyads; therefore the applied statistical analysis was the dyadic analysis that is a new analytical method developed for analyzing such dyadic problem settings.

Law Enforcement Actions in Urban Spaces Governed by Violent Non-State Entities: Lessons from Latin America

In response to a crime epidemic afflicting Latin America since the early 1990s, several countries in the region have resorted to using heavy-force police or military units to physically retake territories de facto controlled by non-State criminal or insurgent groups. After a period of territory control, the heavy forces hand law enforcement functions in the retaken territories to regular police officers, with the hope that the territories and their populations will remain under the control of the state. To a varying degree, intensity, and consistency, Brazil, Colombia, Mexico, and Jamaica have adopted such policies since the mid-1990s. During such operations, governments need to pursue two interrelated objectives: to better establish the state’s physical presence and to realign the allegiance of the population in those areas toward the state and away from the non-State criminal entities. From the perspective of law enforcement, such operations entail several critical decisions and junctions, such as: Whether or not to announce the force insertion in advance. The decision trades off the element of surprise and the ability to capture key leaders of the criminal organizations against the ability to minimize civilian casualties and force levels. The latter, however, may allow criminals to go to ground and escape capture. Governments thus must decide whether they merely seek to displace criminal groups to other areas or maximize their decapitation capacity. Intelligence flows rarely come from the population. Often, rival criminal groups are the best source of intelligence. However, cooperation between the State and such groups that goes beyond using vetted intelligence provided by the groups, such as a State tolerance for militias, compromises the rule-of-law integrity of the State and ultimately can eviscerate even public safety gains. Sustaining security after initial clearing operations is at times even more challenging than conducting the initial operations. Although unlike the heavy forces, traditional police forces, especially if designed as community police, have the capacity to develop trust of the community and ultimately focus on crime prevention, developing such trust often takes a long time. To develop the community’s trust, regular police forces need to conduct frequent on-foot patrols with intensive nonthreatening interactions with the population and minimize the use of force. Moreover, sufficiently robust patrol units need to be placed in designated beats for substantial amount of time, often at least over a year. Establishing oversight mechanisms, including joint police-citizens’ boards, further facilities building trust in the police among the community. After disruption of the established criminal order, street crime often significantly rises and both the heavy-force and community-police units often struggle to contain it. The increase in street crime alienates the population of the retaken territory from the State. Thus developing a capacity to address street crime is critical. Moreover, the community police units tend to be vulnerable (especially initially) to efforts by displaced criminals to reoccupy the cleared territories. Losing a cleared territory back to criminal groups is extremely costly in terms of losing any established trust and being able to recover it. Rather than operating on a priori determined handover schedule, a careful assessment of the relative strength of regular police and criminal groups post-clearing operations is likely to be a better guide for timing the handover from heavy forces to regular police units. Cleared territories often experience not only a peace dividend, but also a peace deficit – in the rise new serious crime (in addition to street crime). Newly – valuable land and other previously-inaccessible resources can lead to land speculation and forced displacement; various other forms of new crime can also significantly rise. Community police forces often struggle to cope with such crime, especially as it is frequently linked to legal business. Such new crime often receives little to no attention in the design of the operations to retake territories from criminal groups. But without developing an effective response to such new crime, the public safety gains of the clearing operations can be altogether lost.