Large scale organisational intervention to improve patient safety in four UK hospitals:mixed method evaluation

Objectives: To conduct an independent evaluation of the first phase of the Health Foundation's Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design: Mixed method evaluation involving five substudies, before and after design. Setting: NHS hospitals in United Kingdom. Participants: Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention: The SPI1 was a compound (multicomponent) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results: Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration - monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items) - there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for "difference in difference" 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from17%(63) to13%(49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening.

Requirements Management and Acquisition Management experiences in Spanish Public Administrations

As a part of the activities of the first Symposium on Process Improvement Models and Software Quality of the Spanish Public Administration, working groups were formed to discuss the current state of the Requirements Management and Supplier Agreement Management processes. This article presents general results and main contributions of those working groups. The results have allowed the obtention of a preliminary appraisal of the current state of these two processes in the Spanish Public Administration.

A gazdasági válság hatása a vállalati stratégiákra – Magyar és szlovák tapasztalatok (Influence of the economic crisis on corporate strategy – Experiences in Hungary and Slovakia)

A tanulmány a jelenlegi gazdasági válság jellemzőit a vállalatok szintjén elemzi, továbbá vizsgálja annak következményeit a válság utáni lehetséges növekedésre. A tanulmány támaszkodik a nemzetközi szakirodalomban tárgyalt tapasztalatokra a válságokból való kilábalás példái alapján, amelyek a korábbi – 1980 és 2002 közötti – válságok során jelentkeztek. Magyarországi és szlovákiai empirikus vizsgálati tapasztalatok ismertetésére kerül sor arra vonatkozóan, hogy miként reagáltak a vállalatok a jelenlegi gazdasági recesszióra. A tanulmány elemzi a magyar és a szlovák vállalatok által a válság alatt követett stratégiák hatását a kereslet megélénkülése esetén adódó növekedési lehetőségek kihasználása szempontjából. A tanulmány illusztrációként bemutatja egy innovatív szlovákiai internetszolgáltató vállalat példáját. _______ The paper analyses the characteristics of the economic crisis at the level of companies, and the consequences for possibilities of growth after the crisis. The authors build on the experiences discussed in international literature concerning recovery after the previous crises between 1980 and 2002. The paper summarizes the empirical research findings on enterprise level reactions to the present economic recession. The focus of analysis is connected to the question of inluence of strategies on capabilities for realizing the growth options after the crisis. The paper – as an illustrative example – describes the strategic behaviour of an innovativ internet service company in Slovakia.

Island diasporas: Perceptions of Indo-Caribbean protégés regarding the effects of their cross-cultural mentoring experiences in the United States

Mentoring is defined as an "intense caring relationship in which persons with more experience work with less experienced persons to promote both professional and personal development" (Caffarella, 1992, p. 38). It is "a powerful emotional, and passionate interaction whereby the mentor and protégé experience...intellectual growth and development" (Galbraith & Zelenak, 1991, p. 126). In cross-cultural mentoring, mentors and protégés from different cultures confront social and cultural identities, goals, expectations, values, and beliefs (Cross & Lincoln, 2005) to "achieve a higher level of potency in education and society" (Mullen, 2005, p. 6). Cross-cultural mentoring research explores attitudes, behaviors, linguistics and motivators of the more visible racial and ethnic groups in the U.S. (Elmer, 1986, Ulmer, 2008). The cross-cultural mentoring experiences of Indo-Caribbeans in the U.S. are obscured from the research despite their rich socio-historic culture. The purpose of this phenomenological study was to explore the perceptions of Indo-Caribbean protégés regarding the effects of their cross-cultural mentoring experiences in the United States. Phenomenology is "the systematic attempt to uncover and describe...the internal meaning structures, of lived experience [by studying the] particulars or instances as they are encountered" (Van Manen, 1990, p. 10). Criterion and snowball sampling were used to recruit 15 participants. A semi-structured interview guide was used to gather data and Creswell's (2007) simplified version of Moustakas's (1994) Modification of the Stevick-Colaizzi-Keen Method of Analysis of Phenomenological Data was used to analyze the data. Three themes emerged: (a) "Sitting at the feet of gurus" taught protégés how to accept guidance, (b) Guru-Shishya: Learning and Discipleship, ways that protégés perceived mentors' guidance related to work, skill acquisition, and social or emotional support, and (c) Samavartan sanskar: Building Coherence, helped protégés understand, manage and find meaning. Protégés' goals and professional expectations determined what they wanted from cross-cultural mentoring relationships and what they were willing to endure within those relationships. Since participants valued achievement and continuous improvement, mentor support was integral to making meaning and developing a sense of coherence in their lives. Implications regarding cross-cultural mentoring relationships together with recommendations for future research conclude the study.

African-American Experiences in the Workplace: Miseducation Goes a Long Way

The purpose of this study was to learn how Blacks believe race affects their workplace interactions with Whites and why. The most compelling finding of the study: participants believed mis-education influenced workplace interactions. The implications of the study: how the relationship between racism, racial identity and education affects workplace interactions.

Teachers' experiences in and perceptions of their 12th-grade British literature classrooms

The purpose of this study was to understand the experiences and perceptions of 12th-grade literature teachers about curriculum, Post-Colonial literature, and students. Theories posed by Piaget (1995), Vygotsky (1995), and Rosenblatt (1995) formed the framework for this micro-ethnographic study. Seven teachers from public and private schools in South Florida participated in this two-phase study; three teachers in Phase I and four in Phase II. All participants completed individual semi-structured interviews and demographic surveys. In addition, four of the teachers were observed teaching. The analysis yielded three themes and two sub-themes: (a) knowledge concerned teachers' knowledge of British literature content and Post-Colonial authors and their literature; (b) freedom described teachers' freedom to choose how to teach their content. Included in this theme was dilemmas associated with 12th-grade classrooms which described issues that were pertinent to the 12th-grade teacher and classroom that were revealed by the study; and (c) thoughts about students described teachers' perceptions about students and how literature might affect the students. Two subthemes of knowledge were as follows:(1) text complexity described teacher responses to a Post-Colonial text's complexity and (2) student desirability/teachability described teachers' perception about how desirable Post-Colonial texts would be to students and whether teachers would be willing to teach these texts. The researcher offers recommendations for understanding factors associated with 12th-grade teachers perceptions and implications for enhancing the 12th-grade experience for teachers and curriculum, based on this study: (a) build teacher morale and capacity, (b) treat all students as integral components of the teaching and learning process; teachers in this study thought teaching disenfranchised learners was a form of punishment meted out by the administration, and (c) include more Post-Colonial authors in school curricula in colleges and schools as most teachers in this study did not study this type of literature nor knew how to teach it.

Clinician perceptions of factors that enhance patient compliance in physical therapy

The purpose of this study was to determine physical therapists utilization of methods to increase compliance with home exercise programs, and to determine their perceptions of barriers patients have to completing exercise programs. The secondary purpose of this study was to describe the association, if any, between therapists' age, participation in exercise and/or lifestyle changes and the utilization of methods to increase exercise compliance. A sample of 73 physical therapists attending the American Physical Therapy Association Combined Sections Meeting were surveyed for this study. This study found that barriers listed by patients were similar to those found in the literature. This study also found that a significant association, p = .015, existed between therapists engaging in behavioral changes and use of lifestyle activities.

Még egyszer a "rendszerparadigmáról". Tisztázás és kiegészítések a posztszocialista régió tapasztalatainak fényében = About the system paradigm once again: Clarification and additions in the light of experiences in the post-socialist region

A paradigma kifejezést Thomas Kuhn honosította meg a tudományfilozófiában: így nevezte el azt a sajátos szemléletmódot, ahogyan egy kutatási irányzat rátekint vizsgálata tárgyára. Azonos paradigmát használó kutatók hasonló kérdésekre keresik a választ, hasonló módszereket és fogalmakat alkalmaznak. A szerző 1999-ben publikált cikkében vezette be a "rendszerparadigma" kifejezést, amely a társadalomban működő rendszereket helyezi a vizsgálat középpontjába. A tanulmány a posztszocialista átalakulás során szerzett tapasztalatok alapján fejleszti tovább a korábbi cikkben kifejtett elméleti gondolatokat. Az első rész a szocialista és a kapitalista rendszert hasonlítja össze; leírja fő jellemzőiket, majd megállapítja, hogy Észak-Korea és Kuba kivételével az egykori szocialista országokban meghonosodott a kapitalista rendszer. A második rész a politikai-kormányzati formák szerint tipologizálja a kapitalizmus változatait. Három markáns típust különböztet meg: a demokráciát, az autokráciát és a diktatúrát. Huntington a demokratizálás harmadik hullámáról írt. A tanulmány arra a következtetésre jut, hogy ez a hullám elapadt, a 47 posztszocialista ország lakosságának mindössze egytizede él demokráciában, a többiben autokrácia vagy diktatúra uralkodik. A harmadik rész Magyarországra alkalmazza a kialakított fogalmi és elemzési apparátust: itt kapitalizmus van, a politikai-kormányzati forma autokrácia - lényeges közös jellemzők mutathatók ki más kapitalista országokkal, illetve más autokráciákkal. Ez összefér azzal a felismeréssel, hogy egyes - nem alapvető jelentőségű - vonások egyediek, "hungarikumok", különböznek minden más ország tulajdonságaitól. _____ The expression paradigm, introduced into the philosophy of science by Thomas Kuhn for the way a research trend views the subject examined, denotes a case where researchers pursue similar questions by similar methods with similar concepts. The author introduced the expression system paradigm" in a 1999 article centred on the systems operating in society. This paper takes those theoretical ideas further, based on experience in the post-socialist transformation. The first part compares the socialist and capitalist systems and their main features, establishing that all former socialist countries but North Korea and Cuba have embraced the capitalist system. The second adds a typology of the varieties of capitalism by politico-governmental form, marking three types: democracy, autocracy and dictatorship. Huntington writes of a third wave of democratization, which this study concludes has ceased. Democracy reigns in only 10 per cent of the 47 post-socialist countries, autocracy or dictatorship in the others. The third part applies this conceptual and analytical framework to Hungary, where capitalism prevails, with autocracy as its politico-governmental form. It shows strongly similar features to other capitalist countries and other autocracies. This is compatible with recognizing that some features of less than fundamental importance are specific to Hungary and differ from those elsewhere.

Understanding Adolescents’ Positive and Negative Developmental Experiences in Sport

The purpose of this study was to gain understanding of adolescents’ positive and negative developmental experiences in sport. Twenty-two purposefully sampled adolescent competitive swimmers participated in a semistructured qualitative interview. Content analysis led to the organization of meaning units into themes and categories (Patton, 2002). Athletes suggested their sport involvement facilitated many positive developmental experiences (i.e., related to challenge, meaningful adult and peer relationships, a sense of community, and other life experiences) and some negative developmental experiences (i.e., related to poor coach relationships, negative peer influences, parent pressure, and the challenging psychological environment of competitive sport). Findings underline the important roles of sport programmers, clubs, coaches, and parents in facilitating youths’ positive developmental experiences in sport, while highlighting numerous important directions for future research. Implications for coach training and practice are outlined.

Local festivals, social capital and sustainable destination development: experiences in East London

This paper explores the nature of social capital arising from engagement in local festivals and the implications of this for the social sustainability of an emerging destination. Two case studies are developed from a longitudinal research project which investigates local festivals staged in the Hackney Wick and Fish Island area adjacent to Queen Elizabeth Olympic Park in East London, UK between 2008 and 2014. This area has been directly affected by extensive development and regeneration efforts associated with the staging of the London 2012 Olympic Games. The two festivals considered here respond to the challenges and opportunities arising for local people as the area changes. One festival aims to foster a sense of community by creating shared experiences and improving communication across diverse groups. The other draws together the cultural community, links them to the opportunities arising as the area emerges as a destination, and attracts visitors. These festivals increase social capital in the area, but its distribution is very uneven. The accrual of social capital exacerbates existing inequalities within the host community, favouring the “haves” at the expense of the “have nots”. There are tensions between the development of social capital and social sustainability in this emerging destination.

Paternalism and Competent Patient Choice in the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People

In 2016 physicians in Ontario will be granted the authority to refer patients with gender dysphoria for sex reassignment surgery. In order to be granted this authority physicians must be trained in the World Professional Association for Transgender Health’s Standards of Care, which outlines healthcare procedures for the treatment of gender dysphoria and provides background information concerning transgender health. The Standards of Care require that patients undergo a process of 12 months of continuous living in a gender role that is congruent with their gender identity prior to being given access to sex reassignment surgery. While this requirement can sometimes be helpful it can also cause more harm than benefit. This paper argues that the requirement is strongly paternalistic in its current form and should no longer be mandatory in most cases.

The importance of patient involvement in stroke rehabilitation

OBJECTIVE: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD: Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. RESULTS: The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. CONCLUSIONS: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.