Illusions of team working in health care

Purpose: The ubiquity and value of teams in healthcare are well acknowledged. However, in practice, healthcare teams vary dramatically in their structures and effectiveness in ways that can damage team processes and patient outcomes. The aim of this paper is to highlight these characteristics and to extrapolate several important aspects of teamwork that have a powerful impact on team effectiveness across healthcare contexts. Design/methodology/approach: The paper draws upon the literature from health services management and organisational behaviour to provide an overview of the current science of healthcare teams. Findings: Underpinned by the input-process-output framework of team effectiveness, team composition, team task, and organisational support are viewed as critical inputs that influence key team processes including team objectives, leadership and reflexivity, which in turn impact staff and patient outcomes. Team training interventions and care pathways can facilitate more effective interdisciplinary teamwork. Originality/value: The paper argues that the prevalence of the term "team" in healthcare makes the synthesis and advancement of the scientific understanding of healthcare teams a challenge. Future research therefore needs to better define the fundamental characteristics of teams in studies in order to ensure that findings based on real teams, rather than pseudo-like groups, are accumulated. © Emerald Group Publishing Limited.

Team working in intensive care:current evidence and future endeavors

Purpose of review: It has recently been argued that the future of intensive care medicine will rely on high quality management and teamwork. Therefore, this review takes an organizational psychology perspective to examine the most recent research on the relationship between teamwork, care processes, and patient outcomes in intensive care. Recent findings: Interdisciplinary communication within a team is crucial for the development of negotiated shared treatment goals and short-team patient outcomes. Interventions for maximizing team communication have received substantial interest in recent literature. Intensive care coordination is not a linear process, and intensive care teams often fail to discuss how to implement goals, trigger and align activities, or reflect on their performance. Despite a move toward interdisciplinary team working, clinical decision-making is still problematic and continues to be perceived as a top-down and authoritative process. The topic of team leadership in intensive care is underexplored and requires further research. Summary: Based on findings from the most recent research evidence in medicine and management, four principles are identified for improving the effectiveness of team working in intensive care: engender professional efficacy, create stable teams and leaders, develop trust and participative safety, and enable frequent team reflexivity.

From words to action:visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital

Purpose: The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. Design/methodology/approach: A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Findings: Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. Research limitations/implications: The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. Practical implications: The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Social implications: Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. Originality/value: The authors draw on solid theoretical frameworks - the complexity theory, team effectiveness model and the social identity theory - to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level. © Emerald Group Publishing Limited.

Working with the public sector:SME medical device innovation and pre-procurement

Healthcare providers are under ever increasing pressure to deliver more technologically advanced care without increasing costs. Innovation is essential (Darzi, 2008), and for this healthcare providers rely on innovation within commercial companies. SMEs have an important part to play in this sector (NHS Supply Chain Parliamentary Brief, 2013). Collaboration between SME suppliers and the NHS for innovation forms the focus of this paper. We examine the academic literature on interorganizational innovation including academic insights from the areas of forward commitment procurement (Environmental Innovation Advisory Group, 2003-2008), pre-commercial procurement (Bos & Corvers, 2007), innovation and SMEs. We then explore practice, first from a policy and business sector perspective. Second, we present evidence from fifteen cases of interorganizational innovation projects involving SMEs and UK healthcare providers. Our findings show much effort is being put into creating opportunities for more interorganizational innovation of medical devices. Working across organizational boundaries presents added complexity to the innovation environment and process, and the challenge of developing high-quality cross-boundary group interaction.

Content vs. process in the HRM-performance relationship:an empirical examination

This study investigates the impact of a human resource management (HRM) system, which integrates both content and process of human resource (HR) practices, on organizational performance, through collective employee reactions. The analysis is based on a sample of 1,250 Greek employees working in 133 public- and private-sector organizations, which operate in the present context of severe financial and economic crises. The findings of the structural equation modeling suggest that content and process are two inseparable faces of an HRM system that help to reveal a comprehensive picture of the HRM-organizational performance relationship. Based on the findings that collective employee reactions mediate the HRM content (i.e., organizational performance relationship) and HRM process moderates the HRM content (i.e., employee reactions relationship), the study has several theoretical and practice implications. © 2014 Wiley Periodicals, Inc.

Automated Problem Domain Cognition Process in Information Systems Design

An automated cognitive approach for the design of Information Systems is presented. It is supposed to be used at the very beginning of the design process, between the stages of requirements determination and analysis, including the stage of analysis. In the context of the approach used either UML or ERD notations may be used for model representation. The approach provides the opportunity of using natural language text documents as a source of knowledge for automated problem domain model generation. It also simplifies the process of modelling by assisting the human user during the whole period of working upon the model (using UML or ERD notations).

A lean elvek alkalmazása az egészségügyi folyamatok fejlesztésében = Applying lean principles in healthcare process development

A fejlett társadalmak egészségügyi szolgáltató rendszerei napjainkban kettős kihívással néznek szembe: miközben a társadalom a szolgáltatási színvonal emelkedését, a hibák számának a csökkenését várja el, addig a költségvetési terhek miatt a költségcsökkentés is feltétlenül szükséges. Ez a kihívás nagyságában összevethető azzal, amellyel az USA autóipara nézett szembe az 1970-es évektől. A megoldást az autóipar esetében a konkurens „lean” menedzsment elvek és eszközök megértése és alkalmazása jelentette. A tanulmány arra keresi a választ, hogy vajon lehetséges-e ennek a megoldásnak az alkalmazása az egészségügy esetében is. A cikk az egészségügy problémájának bemutatása után tárgyalja a lean menedzsment kialakulását és hogy milyen módon került köztudatba. A tanulmány második felében a szakirodalomban fellelhető, a témával kapcsolatos tapasztalatokat foglalja össze, majd levonja a következtetéseket. = In developed societies healthcare service systems are facing double challenge; society expects service level to rise and the number of mistakes to drop, but at the same time, because of the overloaded budgets, cutting cost is also absolutely necessary. This challenge compares to the one the US automotive industry was facing in the 1970-s. In case of the automotive industry the solution was the comprehension and application of the principles and the tools of lean management. This study aims to answer the question whether it is possible to apply this solution also in the case of the healthcare system. The article first introduces the problems in the healthcare system, than describes the formation of lean management concept and its wide spread. The second half of the study summarizes the available knowledge in the literature and drives conclusions.

Az online-fogyasztói elégedettség mérésére alkalmas skála tesztelése és véglegesítése a vállalati döntéshozók támogatása céljából (Testing and finalizing a scale for measuring online consumer satisfaction to support the companies decision making process)

A versenyképesség, illetve a gazdaságos működés elengedhetetlen feltétele a fogyasztói elégedettség, melynek egyik meghatározó eleme az észlelt és elvárt minőség közti kapcsolat. A minőségi elvárások az internettel, mint napjaink egyik meghatározó csatornájával kapcsolatban is megfogalmazódtak már, így kapott jelentős szerepet az online szolgáltatásminőség meghatározása, illetve ezzel összekapcsolódva az online-fogyasztói elégedettségmérés. A tanulmány célja, hogy szakirodalmi áttekintést nyújtson a témában, és a szakirodalomból ismert E-S-QUAL és E-RecS-QUAL online-fogyasztói elégedettségmérésre szolgáló skálát megvizsgálja, érvényességét a magyar körülmények között letesztelje, és a szükségesnek látszó módosítások elvégzésével egy Magyarországon használható skálát hozzon létre. Az online-fogyasztók elégedettségmérésének alapjaként az online szolgáltatásminőség fogyasztói érzékelésével, illetve értékelésével kapcsolatos elméleteket járja körbe a tanulmány, és ezután kerül sor a különböző mérési módszerek bemutatására, kiemelt szerepet szánva az E-S-QUAL és E-RecS-QUAL skálának, mely az egyik leginkább alkalmazott módszernek számít. Az áttekintés középpontjában azok a honlapok állnak, melyeken vásárolni is lehet, a kutatást pedig az egyik jelentős hazai online könyvesbolt ügyfélkörében végeztem el. ______ Over the last decade the business-to-consumer online market has been growing very fast. In marketing literature a lot of studies have been created focusing on understanding and measuring e-service quality (e-sq) and online-customer satisfaction. The aim of the study is to summarize these concepts, analyse the relationship between e-sq and customer’s loyalty, which increases the competitiveness of the companies, and to create a valid and reliable scale to the Hungarian market for measuring online-customer satisfaction. The base of the empirical study is the E-S-QUAL and its second scale the E-RecS-QUAL that are widely used multiple scales measuring e-sq with seven dimensions: efficiency, system availability, fulfilment, privacy, responsiveness, compensation, and contact. The study is focusing on the websites customers use to shop online.

International environmental and development policy cooperation and the transition process of the Central and Eastern European countries

The political and economic changes in countries of the Central and Eastern European region during the recent two decades had significant implications on their participation in international environmental policy-making. These changes were motivated by the changing international political priorities and economic interests, realization of their part in the "common but differentiated responsibility" for the global environmental processes and the relatively modest capacities for international development cooperation. The situation of these countries was acknowledged by the international community by granting specific provisions to these "economies in transition" in international environmental policy mechanisms. In spite of the rapidly diverging external relations of the various groups of these countries, to some extent and in different forms the transition phase is still prevailing and has its effect on the ongoing international environmental negotiations. The paper describes the background of these changes, demonstrates the specific provisions for these countries that made possible their participation in the common efforts to tackle the emerging global and regional environmental problems by acceding to the relevant international mechanisms.

A kínai reformfolyamat politikai gazdaságtani logikája (The politico-economic logic of the Chinese reform process)

Kína az elmúlt több mint három évtizedben szegény, elmaradott országból a világgazdaság egyik legfontosabb szereplője lett. Szocialista rendszerét egy sajátos kapitalista rendszer váltotta fel, miközben politikai struktúrája lényegében változatlan maradt. A folyamatok során a vezetés mindvégig ügyelt arra, hogy a kommunista párt egyeduralmát semmi se veszélyeztethesse, ugyanakkor megfelelő források álljanak rendelkezésre hatalma megtartásához. A tanulmány a kínai reformfolyamatot politikai gazdaságtani szempontból vizsgálja, különös figyelmet szentelve az intézményi változásoknak. Bemutatja, milyen okok és tényezők álltak a reformok elindításának hátterében, milyen változások következtek be a szereplők érdekviszonyaiban a reformok előrehaladtával, és mire lehet számítani a reformok jövőjét illetően. Úgy tűnik, hogy a jelenlegi rendszer érdekviszonyai a reformok folytatása ellen hatnak, ellehetetlenítve a piacgazdaság intézményrendszerének további kiépítését. A járadékok és privilégiumok az elitet abban sem teszik érdekeltté, hogy komolyabb politikai reformokat hajtson végre, így a kialakuló csapdahelyzet megakadályozza az átmenet kiteljesedését. ____ In the last three decades China has risen from being a poor and underdeveloped country to being one of the most important players in the world economy. Its planned economy has been replaced by a capitalist system, but its political structure has remained essentially unchanged. The leaders during the reform process have sought constantly to avert dangers to the rule of the Communist Party and gain access to valuable resources that allow power to be retained. The study approaches the Chinese reform process from a politico-economic point of view, focusing primarily on institutional changes. It reveals the main factors behind the various phases of reform, the constantly changing interests of the players, and the possible future of the process. It seems that under the current authoritarian regime, there are vested interests working against a continuation of the reforms and precluding full establishment of the institutional framework of a market economy. The elite is also deterred from implementing serious political reforms by the current rents and privileges. This leads to a trap that prevents completion of the transition process.

Self -regulated learning: The role of a journal in the learning process for students and teachers

A fundamental goal of education is to equip students with self-regulatory capabilities that enable them to educate themselves. Self directedness not only contributes to success in formal instruction but also promotes lifelong learning (Bandura, 1997). The area of research on self-regulated learning is well grounded within the framework of psychological literature attributed to motivation, metacognition, strategy use and learning. This study explored past research and established the purpose of teaching students to self-regulate their learning and highlighted the fact that teachers are expected to assume a major role in the learning process. A student reflective writing journal activity was sustained for a period of two semesters in two fourth-grade mathematics classrooms. The reflective writing journal was analyzed in search of identifying strategies reported by students. Research questions were analyzed using descriptive statistics, frequency counts, cross-tabs and chi-square analyses. ^ Results based on student-use of the journals and teacher interviews indicated that the use of a reflective writing journal does promote self-regulated learning strategies to the extent which the student is engaged in the journaling process. Those students identified as highly self-regulated learners on the basis of their strategy use, were shown to consistently claim to learn math “as well or better than planned” on a weekly basis. Furthermore, good self-regulators were able to recognize specific strategies that helped them do well and change their strategies across time based on the planned learning objectives. The perspectives of the participating teachers were examined in order to establish the context in which the students were working. The effect of “planned change” and/or the resistance to change as established in previous research, from the teachers point of view, was also explored. The analysis of the journal data did establish a significant difference between students who utilized homework as a strategy. ^ Based on the journals and interviews, this study finds that the systematic use of metacognitive, motivational and/or learning strategies can have a positive effect on student's responsiveness to their learning environment. Furthermore, it reflects that teaching students “how to learn” can be a vital part of the effectiveness of any curriculum. ^

The use of treatment process variables to differentiate between completers and dropouts for a guided self -change adolescent substance abuse intervention

This study documented differences between substance using adolescent participants who either completed or dropped out of a brief motivational intervention. Therapeutic alliance, working alliance and patient involvement were used to describe differences in treatment process ratings in a sample of majority Latino males who either (a) completed a adolescent substance abuse intervention called Alcohol Treatment Targeting Adolescents In Need (ATTAIN) or (b) dropped out after the first or second Guided Self-Change therapy session. Fifteen-minute segments were copied from the midpoint of previously recorded audio-tapes of Guided Self-Change therapy sessions. Raters were trained to a criterion level of interrater reliability for both the Working Alliance Inventory-Short and Vanderbilt Psychotherapy Process Scale. Correlations among Working Alliance Inventory- Short and Vanderbilt Psychotherapy Process Scale subscales reflected a general similarity in the assignment of ratings to client-therapist dyads. Findings underscore why these concepts are often used interchangeably in the treatment process literature. The Vanderbilt Psychotherapy Process Scale patient participation subscale demonstrated substantial empirical differentiation from overall therapeutic alliance. Discriminant function analysis demonstrated the Working Alliance Inventory-Short goal subscale and the Vanderbilt Psychotherapy Process Scale patient participation and therapist warmth and friendliness subscales as successful classifiers of groups of mostly Latino youth based on completion status. Follow-up logistic regression analyses confirmed major findings and successfully predicted group membership. Treatment process constructs can be used as clinical tools to identify participants who may be susceptible to dropping out of treatment services. Further investigation of treatment process may enhance understanding of the influence of alliance between clients and Guided Self-Change therapists. Investigating the role of treatment process as a critical component of brief motivational interventions for substance-using adolescents will inform both practitioners and researchers regarding the effectiveness of community-based substance abuse interventions for adolescents.

Women demonstrate for disability payments for working pregnant women [at Rockefeller's Office]

General note: Title and date provided by Bettye Lane.