Primary health care management in Nigeria

This research sets out to assess if the PHC system in rural Nigeria is effective by testing the research hypothesis: `PHC can be effective if and only if the Health Care Delivery System matches the attitudes and expectations of the Community'. The field surveys to accomplish this task were carried out in IBO, YORUBA, and HAUSA rural communities. A variety of techniques have been used as Research Methodology and these include questionnaires, interviews and personal observations of events in the rural community. This thesis embraces three main parts. Part I traces the socio-cultural aspects of PHC in rural Nigeria, describes PHC management activities in Nigeria and the practical problems inherent in the system. Part II describes various theoretical and practical research techniques used for the study and concentrates on the field work programme, data analysis and the research hypothesis-testing. Part III focusses on general strategies to improve PHC system in Nigeria to make it more effective. The research contributions to knowledge and the summary of main conclusions of the study are highlighted in this part also. Based on testing and exploring the research hypothesis as stated above, some conclusions have been arrived at, which suggested that PHC in rural Nigeria is ineffective as revealed in people's low opinions of the system and dissatisfaction with PHC services. Many people had expressed the view that they could not obtain health care services in time, at a cost they could afford and in a manner acceptable to them. Following the conclusions, some alternative ways to implement PHC programmes in rural Nigeria have been put forward to improve and make the Nigerian PHC system more effective.

Total quality management in English language teaching:a case study in Turkish higher education

The need to improve the management of language learning organizations in the light of the trend toward mass higher education and of the use of English as a world language was the starting point of this thesis. The thesis aims to assess the relevance, adequacy and the relative success of Total Quality Management (TQM) as a management philosophy. Taking this empirical evidence a TQM-oriented management project in a Turkish Higher Education context, the thesis observes the consequences of a change of organizational culture, with specific reference to teachers' attitudes towards management. Both qualitative and quantitative devices are employed to plot change and the value of these devices for identifying such is considered. The main focus of the thesis is the Soft S's (Shared Values, Style, Staff and Skills) of an organization rather than the Hard S's (System, Structure, Strategy). The thesis is not concerned with the teaching and learning processes, though the PDCA cycle (the Action Research Cycle) did play a part in the project for both teachers and the researcher involved in this study of organizational development. Both before the management project was launched, and at the end of the research period, the external measurement devices (Harrison's Culture Specification Device and Hofstede's VSM) were used to describe the culture of the Centre. During the management project, internal measurement devices were used to record the change including middle-management style change (the researcher in this case). The time period chosen for this study was between September 1991 and June 1994. During this period, each device was administered twice within a specific time period, ranging from a year to 32 months.

Demand side management within a regional electricity company

The work presented in this thesis concerns itself with the application of Demand Side Management (DSM) by industrial subsector as applied to the UK electricity industry. A review of the origins of DSM in the US and the relevance of experience gained to the UK electricity industry is made. Reviews are also made of the current status of the UK electricity industry, the regulatory system, and the potential role of DSM within the prevalent industry environment. A financial appraisal of DSM in respect of the distribution business of a Regional Electricity Company (REC) is also made. This financial appraisal highlights the economic viability of DSM within the context of the current UK electricity industry. The background of the work presented above is then followed by the construction of a framework detailing the necessary requirements for expanding the commercial role of DSM to encompass benefits for the supply business of a REC. The derived framework is then applied, in part, to the UK ceramics manufacturing industry, and in full to the UK sanitaryware manufacturing industry. The application of the framework to the UK sanitaryware manufacturing industry has required the undertaking of a unique first-order energy audit of every such manufacturing site in the UK. As such the audit has revealed previously unknown data on the timings and magnitude of electricity demand and consumption attributable to end-use manufacturing technologies and processes. The audit also served to reveal the disparity in the attitudes toward energy services, and thus by implication towards DSM, of manufacturers within the same Standard Industrial Classification (SIC) code. In response to this, attempt is made to identify the underlying drivers which could cause this variation in attitude. A novel approach to the market segmentation of the companies within the UK ceramics manufacturing sector has been utilised to classify these companies in terms of their likelihood to participate in DSM programmes through the derived Energy Services approach. The market segmentation technique, although requiring further development to progress from a research based concept, highlights the necessity to look beyond the purely energy based needs of manufacturing industries when considering the utilisation of the Energy Services approach to facilitate DSM programs.

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.

Shopfloor attitudes towards advanced manufacturing technology:the changing focus of industrial conflict?

The implementation of advanced manufacturing technology (AMT) in manufacturing organisations is increasing. In many cases the introduction of AMT has been associated with conflict between management and workers. This appears to be due to the potential for AMT to have a de-skilling effect upon job content and, in some instances, leading to job losses. In reality, fears concerning both these issues have reduced and consequently there has been a change away from conflict between management and workers to divisions amongst shopfloor operators. The paper explores some of the processes involved in this change within the context of an engineering case study. More specifically, it is shown that when AMT was introduced into a machining workshop, traditional conflict between management and operators was soon replaced by negative feelings between users and non-users of AMT. The implications of industrial relations suggest the need for more care and attention to the human side of work organisation when implementing new manufacturing technology.

Evaluating the skills strategy through a Graduate Certificate in Management:an experiential learning theory approach

Purpose – The purpose of this paper is to evaluate how a UK business school is addressing the Government's skills strategy through its Graduate Certificate in Management, and to identify good practice and development needs and to clarify how the Graduate Certificate is adapting to the needs of Generation X and Millennial students. The paper also aims to test Kolb and Kolb's experiential learning theory (ELT) in a business school setting. Design/methodology/approach – A case study methodology was adopted. In order to get a cross-section of views and triangulate the data, three focus groups were held, supported by reading documentation about the programme of study. Findings – The skills strategy is not just an ambition for some business schools, but is already part of the curriculum. Generation X and the Millennials have more in common with the positive attitudes associated with older generations than stereotyped views might allow. ELT provides a useful theoretical framework for evaluating a programme of study and student attitudes. Research limitations/implications – The research findings from one case study are reported, limiting the generalisability of the study. Practical implications – Good practice and development needs are identified which support the implementation of the Government's skills strategy and address employer concerns about student skills. Originality/value – New empirical data are reported which supports the use of ELT in evaluating programmes of study and student attitudes to work.

Quality management and performance:a comparison between the UK and Turkey

Purpose: The aim of this article is to detail the correlation between quality management, specifically its tools and critical success factors, and performance in terms of primary operational and secondary organisational performances. Design/methodology/approach: Survey data from the UK and Turkey were analysed using exploratory factor analyses, structural equation modelling and regression analysis. Findings: The results show that quality management has a significant and positive impact on both primary and secondary performances; that Turkish and UK attitudes to quality management are similar; and that quality management is widely practised in manufacturing and service industries but has more statistical emphasis in the manufacturing sector. The main challenge for making quality management practice more effective lies in an appropriate balanced use of the different sorts of the tools and critical success factors. Originality/value: This study takes a novel approach by: (i) exploring the relationship between primary operational and secondary organisational performances, (ii) using service and manufacturing data and (iii) making a cross-country comparison between the UK (a developed economy) and Turkey (a developing economy). Limitations: Detailed contrast provided between only two countries. © 2013 Copyright Taylor and Francis Group, LLC.

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

Objective - To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. Methods - A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. Key findings - One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5–81.2%) and patient education (57.9%; CI 51.2–63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8–62.4%). Most physicians (62.4%; CI 56.8–69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0–39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2–81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2–16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. Conclusion -The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Exploring attitudes towards dietary modification and nutritional supplementation in people with and without age-related macular degeneration

Age-related macular degeneration (AMD) is the leading cause for visual impairment and blindness registration in the developed world. Due to the large amounts of conflicting AMD research on the role of nutrition and antioxidant intake, it is difficult for patients and practitioners to determine which measures can be taken to slow down the disease progression. The aim of this research was to determine the beliefs and knowledge that patients with AMD have about nutrition, to identify whether their condition is preventing them from eating a healthy diet, and to discover what their diet consists of. For the initial study, 158 participants with AMD (mean age 79 ± 7.8 years) and 50 participants without AMD (mean age 67 ± 8 years) were recruited from the Macular Society helpline, or from optometric practice. Participants had a 25 minute telephone interview where a 36-question survey was completed. The survey elicited demographic information, and questions covered the knowledge that participants had on nutrition and their current diet. The results from this survey uncovered three major findings: 1) 100% of AMD participants felt that they do not have enough information and support from eye-care practitioners regarding nutrition, 2) AMD patients are confused over, and display a lack of knowledge of, which foods are beneficial for eye health and when and what nutritional supplements to take, evidenced by 65% of participants not taking the correct dosage 3) AMD patients are not eating enough nutrients that would be beneficial for their condition - consuming an average of 1.4mg of lutein and zeaxanthin rather than the recommended 10mg. A clinical decision-making aid was created as an intervention based upon these findings. The aim of the aid was to help eye-care practitioners give the correct nutritional advice to their patients. Founded on the AREDS 2 inclusion and exclusion criteria, practitioners are able to identify which patients could benefit from a nutritional supplement, and which patients could benefit from dietary modification. An evaluation of the aid with 72 qualified eye-care practitioners exhibited a statistically significant increase in confidence after using the aid for two weeks. An evaluation using 51 student optometrists showed a statistically significant increase in confidence and a statistically significant increase in appropriate management of patients after using the aid. This project has elicited findings that are significant for AMD patient education. It is hoped that through these studies, patients will receive consistent advice about the risk factors for AMD, the link between AMD and nutrition, and the importance of maintaining a healthy, well-balanced diet.

Management interventions and prosocial behaviours:understanding the mediating mechanisms

Previous research suggests that the attitudes and behaviours of front-line employees (FLEs) significantly influence customers’ evaluations of service quality and customer satisfaction. Therefore, it becomes important to identify the variables that influence FLEs job attitudes and Prosocial ServiceBehaviours (PSBs). The conceptual framework developed from extant literature is presented, which proposes that management interventions (internal communication, training and development and empowerment) have a direct effect on PSBs. In addition, these relationships are mediated by role stress and job attitudes. Implications for service management and future research directions are discussed.

An examination of the UK community pharmacist's role in facilitating patient self-management of cardiovascular disease through lifestyle behaviours

The progression of cardiovascular disease (CVD) is largely modifiable through lifestyle behaviours. UK pharmacists are contractually obliged to facilitate patient self-management of chronic conditions such as CVD. Pharmacists are easily accessible health professionals who are well placed to identify “at risk” patients through medication regimes. Research has identified varying attitudes towards and levels of involvement in pharmacist-led health promotion activity. Given the diverse and exploratory nature of the work, a pragmatic, mixed methods approach was used to explore community pharmacists’ role in facilitating patient self-management of CVD. The thesis presents four studies: a qualitative study with pharmacists; a cross sectional questionnaire of community pharmacists; a systematic review and a qualitative study with patients with CVD. The qualitative study with pharmacists gave an insight into pharmacists’ experiences of giving patients with CVD lifestyle advice and the factors underpinning commonly cited barriers to providing public health services. This informed the development of the cross-sectional questionnaire which identified the predictors of pharmacists’ intentions to give two different types of advice to facilitate patient self-management. The systematic review identified a small number of interventions to prepare pharmacists to facilitate patient lifestyle behaviour change and evaluated the theories and behaviour change techniques used in successful interventions; however due to poor study quality and poor reporting of the interventions limited conclusions about the efficacy of the interventions could reliably be drawn. Finally, the qualitative study gave an insight into the experiences of patients with CVD using community pharmacy services and their expectations of the service they receive from community pharmacists. Recommendations about changes to pharmacy policy and practice in order to support pharmacists’ provision of CVD self-management advice are made.

A lean menedzsment és a leadership jellemzők kapcsolata a hazai vállalati gyakorlatban (Lean management and leadership attributes in the practice of Hungarian firms)

A nemzetközi szakirodalom a vezetőt a lean termelés bevezetésében és fenntartásában is kulcsszereplőként határozza meg. Ennek ellenére nagyon kevés empirikus elemzés vizsgálja a vezetőkkel kapcsolatos kérdéseket. A szerzők a kontingencialista leadership elmélet keretei között a lean termelési rendszer és a vezetési jellemzők kapcsolatát vizsgálják elméleti szempontból és empirikusan egyaránt. Bár a kérdés nem került korábbi munkák fókuszába, az elméleti és empirikus megfontolások alapján egyaránt megállapítható, hogy több vezetési jellemző is szorosan kapcsolható egy jól működő lean termelővállalat vezetőjéhez. Követendő vezetési jellemzőként jelenik meg többek között az együttműködő, a delegáló, a teljesítményorientált vagy fejlődésorientált. Azonosíthatók olyan jellemzők is, amelyek elméletileg nem egyeztethetők össze a lean termelési rendszer logikájával, pl. autokrata, diktatórikus vagy mikrovezető ______ The working paper focuses on two connected research questions: on one hand based on widely accepted literature it systematically maps the ideal leadership style and related leader attributes that help in transforming a company into a real and well-functioning lean organization. On the other hand the paper analyzes whether leaders of companies with more developed lean practice do or do not follow these leadership attributes recommended by literature. The study uses the fourth round of the Hungarian Competitiveness Research Survey from 2009. This study is limited to the analysis of questionnaires filled in by producers that have more than 50 employees (about 65 manufacturing firms). The authors analyze the leadership styles of two managers, namely the CEO and production manager. Results of the empirical analysis revealed astonishing and contradictory attitudes toward ideal leadership attributes of leaders operating in more developed lean companies.

A hazai kis- és közepes vállalatok szociokulturális beállítódása a hofstede-dimenziók mentén = The socio-cultural attitudes of the Hungarianc small and medium enterprises along the Hofstede dimensions

A kis- és közepes vállalkozások (KKV-k) kutatása viszonylag új, és emiatt meglehetősen feltáratlan terület, bár a megjelenő tudományos cikkek és eredmények száma és minősége évről évre jól érzékelhetően nő (Collinson – Shaw, 2001). A KKV-kutatások igen fontos sajátossága továbbá, hogy kifejezetten interdiszciplináris terület, megközelíthető a menedzsment, az innovációkutatás, a marketing, a szervezetszociológia, de akár a pszichológia felől is. Több kutatás is felveti a szociokulturális háttér jelentőségének kérdését KKV-k esetében. A szerzők kutatásuk során kvantitatív felmérést végeztek 200 vállalkozó körében a Hofstedeskála (Hofmeister et al., 2008) felhasználásával, melynek eredményeként kiderült, hogy a KKV-vezetők beállítódása jelentősen különbözik mind a hazai nagyvállalati vezetőktől, mind az általános lakosságtól. Jelen tanulmányunkban bemutatjuk azokat a Hofstede-dimenziókat, amelyek mentén karakteres különbségek jelentkeztek a vállalkozók és a nagyvállalati vezetők, valamint a társadalom összessége között. Az eredmények alapján határozottan kirajzolódnak olyan „vállalkozói” gondolkodásmódbeli sajátosságok, mint a nagyobb versenyszellem, a közvetlenebb, kevésbé hierarchikus működési stílus, a rendkívül erős, rövid távú orientáció, valamint a kockázatvállalás rendhagyóan alacsony foka. _____ Although there has been an increasing academic attention towards small and medium-sized enterprises, it is still a novel research area with a number of unanswered questions. It is also an especially interdisciplinary field as it can be approached from various viewpoints such as management, innovation, marketing, organization sociology or even psychology. Different academic disciplines have studied the influence of socio-cultural factors and concluded that they are relevant aspects of entrepreneurial activity. This paper presents the results of the authors’ quantitative research which aimed at finding patterns in the software of the minds of SME managers where they applied Hofstede’s cultural scale (Hofmeister et al., 2008). Drawing upon data from 200 Hungarian SMEs, the results indicate they have different attitude and way of thinking compared to large company managers and to the general Hungarian population. This paper points out the relevant Hofstede dimensions where significant differences have been revealed. The main finding of the study is that managers of small and medium businesses have a special mindset which can be characterized with higher level competitiveness, more direct and less hierarchic operation, extremely high level of short term orientation and low level of risk taking

A magyar fiatalok jellemzése pénzügyi attitűdjeik és magatartásuk mentén – Vizsgálat a felsőoktatásban tanulók pénzügyi attitűdjeiről és magatartásáról = Characterization of the Hungarian youth with their financial attitudes and behaviours – A survey about the financial behaviour and attitudes of students

A pénzügyi piacok és termékek egyre komplexebbé válnak, ami együtt jár a pénzügyeket illető információs szakadék mélyülésével is – a lakosság egyre kevésbé képes pénzügyeiről körültekintő döntéseket hozni. Jelen tanulmány a magyar felsőoktatásban tanuló fiatalokat pénzügyi attitűdjeik mentén szegmentálja és jellemzi, annak érdekében, hogy hozzájáruljon a pénzügyi kultúra szintjét növelő programok sikerességéhez, legyen az állami indíttatású (pénzügyi edukáció) vagy a versenyszféra által vezérelt. A vizsgált fiatalok alapvetően három csoportba sorolhatók: (1) Konzervatívak, (2) Lázadók és (3) Tapasztaltak. A Konzervatívakra a stabil morális értékrend, alacsony kockázatvállalási hajlandóság jellemző, céljaik között egyaránt találunk rövid és hosszú távúakat is – informáltságuk, és ebből eredően pénzügyi ismeretszintjük alacsony, a hitelekkel szembeni attitűdjük negatív. A Lázadók csoportjára az „Élj a mának!” magatartás a jellemző, vagyis rövid távú céljaik vannak, kevésbé tudatosak, pénzügyi ismeretszintjük alacsony, ugyanakkor nyitottak az újdonságokra és a kockázatvállalási szintjük magasabb a másik két csoporténál. A Tapasztaltak csoportjára a tudatosság és a pénzügyi megfontoltság a jellemző – pénzügyi ismeretszintjük magasabb a másik két csoporténál. Náluk a hosszú távú célok dominálnak, de alacsony kockázatvállalási hajlandóság mellett. _____ Financial markets and financial instruments have become more and more complex in the last decades. Unfortunately, financial literacy of population cannot keep up with the innovation activity of financial sector. By segmenting and describing Hungarian young adults along their financial attitudes, the aim of this study is to provide recommendations to the programs aiming to enhance the development of financial literacy. According to the authors’ results, 18-25 year-old young adults can be categorized as (1) conservatives, (2) rebels and (3) experienced. Conservatives can be characterized by stable moral and values, low risktaking willingness and inappropriate financial knowledge. Both short and long term goals can be explored among their preferences. Conservatives have negative attitude to bank loans. The rebels can be described by the ancient Latin saying: “Carpe Diem”. They have short-term goals and the future financial stability is not an issue for them – their financial literacy is low. However, rebels are open-minded and their risk-taking willingness is greater than the other two group members. Despite of the low level of risk-taking willingness, the highest level of financial literacy is showed by the experienced group. They have long-term goals and are able to receive information about complex financial instruments.

A hazai kis- és középvállalkozások elektronikus banki ügyintézéssel kapcsolatos szokásai, attitűdjei és jövőképei (E-banking habits, attitudes and vision of the hungarian small and medium enterprises)

A közelmúltban készült kutatásban a szerzők azt vizsgálták, hogy a kis- és középvállalkozásokban az elektronikus banki ügyintézéssel kapcsolatban milyen szokásaik, attitűdjeik és jövőképeik alakultak ki. A több mint ötszáz KKV-vezetővel készült interjú alapján elmondható, hogy a vállalkozás elektronikus ügyintézéssel kapcsolatos hozzáállása egyáltalán nem, vagy csak nagyon gyenge mértékben hozható összefüggésbe a cég objektív tulajdonságaival, például a létszámmal, az árbevétellel vagy a tevékenységi körrel. Egyértelműen látszik, hogy már az elektronikus banki ügyintézéssel kapcsolatos fogalmak értelmezése is problémát jelent a KKV-vezetők egy részénél. A tudásbeli hiányosságok pedig egyértelműen befolyásolják az e-banking attitűdöt és a használati szokásokat, pedig az elektronikus csatornákat használók elégedettsége minden vizsgált bank ügyfeleinek esetében 80% fölötti értékeket mutat. Így a legfontosabb kérdés az, hogy miként lehetne megértetni a „Szkeptikusok”-kal és a „Mérlegelők”-kel, hogy érdemes a „Haladók” klaszterébe tartozni. Az ügyfélelégedettség sikertényezői egyértelműen a biztonság, az időben és térben széles körű elérhetőség és az egyszerű használat. A válaszadók jövőképe szerint a banki szolgáltatások igénybevétele egyre inkább eltolódik majd az elektronikus csatornák irányába. Jelen cikkben a kutatás legfontosabb tanulságait mutatják be a szerzők. _________ The authors’ research was conducted to explore the ebanking attitudes, habits and vision of small and medium enterprises. By the interviews of more than 500 managers of SMEs, it is concluded that e-banking attitudes are not, or not significantly related to the objective characteristics of the enterprises, e.g. to the number of employment, the revenues or its activities. It became clear, that the interpretation of the specific e-banking terms means an important problem for some managers. The deficiencies of knowledge have direct effects on e-banking attitude and the use of electronic banking methods of the enterprises, although the value of the satisfaction level is above 80% among the customers of each examined banks. Thus, the main objective is to explain to the “Scepticals” and the “Considerers” the benefits of the “Progressives” cluster. The most important success factors of customer satisfaction are safety, availability in time and space and ease of use. According to the vision of the respondents, banking services will probably be shifted towards e-channels. In this study, the most important findings of our researches were summarized.