Are HRM practices related with patient mortality in NHS hospitals?:A study examining the underlying reasons for such an association

This thesis will report details of two studies conducted within the National Health Service in the UK that examined the association between HRM practices related to training and appraisal with health outcomes within NHS Trusts. Study one represents the organisational analysis of 61 NHS Trusts, and will report training and appraisal practices were significantly associated with lower patient mortality. Specifically, the research will show significantly lower patient mortality within NHS Trusts that: a) had achieved Investors in People accreditation; b) had a formal strategy document relating to training; c) had tailored training policy documents across occupational groups; d) had integrated training and appraisal practices; e) had a high percentage of staff receiving either an appraisal or updated personal development plan. There was also evidence of an additive effect where NHS Trusts that displayed more of these characteristics had significantly lower patient mortality. Study one in this thesis will also report significantly lower patient mortality within the NHS Trusts where there was broad level representation for the HR function. Study two will report details of a study conducted to examine the potential reasons why HR practices may be related to hospital performance. Details are given of the results of a staff attitudinal survey within five NHS Trusts. This study examined will show that a range of developmental activity, the favourability of the immediate work environment (in relation to social support and role stressors) and motivational outcomes are important antecedents to citizenship behaviours. Furthermore, the thesis will report that principles of the demand-control model were adopted to examine the relationship between workplace support and role stressors, and workplace support, influence, and an understanding of role expectation help mitigate against the negative effects of work demands upon motivational outcomes.

Psychosoziale Merkmale der Arbeit, Überforderungserleben und Depressivität

Die vorliegende Studie untersuchte die im Job-Demand-Control-Support-Modell und Effort-Reward-Imbalance-Modell beschriebenen Tätigkeitsmerkmale in Bezug auf Depressivität in einer Stichprobe von 265 Erwerbstätigen. Anhand konfirmatorischer Faktorenanalysen wurden Gemeinsamkeiten und Unterschiede beider Modelle geprüft. Anschließend wurde die Bedeutung der nachweisbaren Tätigkeitsmerkmale für die Vorhersage von Depressivität getestet und untersucht, inwieweit die Effekte durch Überforderungserleben mediiert werden. Die Analysen zeigten, dass die Modelle sowohl gemeinsame (Arbeitsintensität bzw. berufliche Anforderungen) als auch distinkte Arbeitsmerkmale (Tätigkeitsspielraum, Arbeitsplatzsicherheit, beruflicher Status, soziale Anerkennung) erfassen. Hohe Arbeitsintensität, geringe Arbeitsplatzsicherheit und fehlende soziale Anerkennung standen in signifikantem Zusammenhang mit Depressivität. Anders als erwartet war der berufliche Status positiv mit Depressivität assoziiert, während für den Tätigkeitsspielraum keine signifikanten Effekte nachweisbar waren. Das Pfadmodell bestätigte sowohl direkte als auch durch Überforderungserleben vermittelte Zusammenhänge zwischen den Tätigkeitsmerkmalen und Depressivität (39 % Varianzaufklärung). Die Ergebnisse bieten eine Grundlage für die Identifizierung potenzieller Risikofaktoren für das Auftreten depressiver Symptome am Arbeitsplatz. This study examined the job characteristics in the Job-Demand-Control-Support Model and in the Effort-Reward Imbalance Model with regard to depression in a sample of 265 employees. First, we tested by means of confirmatory factor analysis similarities and differences of the two models. Secondly, job characteristics were introduced as predictors in a path model to test their relation with depression. Furthermore, we examined whether the associations were mediated by the experience of excessive demands. Our analyses showed the demand/effort component to be one common factor, while decision latitude and reward (subdivided into the three facets of job security, social recognition, and status-related reward) remained distinctive components. Employees with high job demands/effort, low job security, low social recognition, but high status-related rewards reported higher depression scores. Unexpectedly, status-related rewards were positively associated with depression, while we found no significant effects for decision latitude. The path models confirmed direct as well as mediation effects (through experienced excessive demands) between job characteristics and depression (39 % explained variance in depression). Our results could be useful to identify possible job-related risk factors for depression.

The relationship between job structure, burnout, and coping methods among public school county bus drivers, bus aides, mechanics, and clerical workers

The purpose of this study was to examine the relationship between the structure of jobs and burnout, and to assess to what extent, if any this relationship was moderated by individual coping methods. This study was supported by the Karasek's (1998) Job Demand-Control-Support theory of work stress as well as Maslach and Leiter's (1993) theory of burnout. Coping was examined as a moderator based on the conceptualization of Lazarus and Folkman (1984). ^ Two overall overarching questions framed this study: (a) what is the relationship between job structure, as operationalized by job title, and burnout across different occupations in support services in a large municipal school district? and (b) To what extent do individual differences in coping methods moderate this relationship? ^ This study was a cross-sectional study of county public school bus drivers, bus aides, mechanics, and clerical workers (N = 253) at three bus depot locations within the same district using validated survey instruments for data collection. Hypotheses were tested using simultaneous regression analyses. ^ Findings indicated that there were statistically significant and relevant relationships among the variables of interest; job demands, job control, burnout, and ways of coping. There was a relationship between job title and physical job demands. There was no evidence to support a relationship between job title and psychological demands. Furthermore, there was a relationship between physical demands, emotional exhaustion and personal accomplishment; key indicators of burnout. ^ Results showed significant correlations between individual ways of coping as a moderator between job structure, operationalized by job title, and individual employee burnout adding empirical evidence to the occupational stress literature. Based on the findings, there are implications for theory, research, and practice. For theory and research, the findings suggest the importance of incorporating transactional models in the study of occupational stress. In the area of practice, the findings highlight the importance of enriching jobs, increasing job control, and providing individual-level training related to stress reduction.^

Perceived occupational stress in nurses working in Ireland

Background: This study examines perceived stress and its potential causal factors in nurses. Stress has been seen as a routine and accepted part of the healthcare worker’s role. The lack of research on stress in nurses in Ireland motivated this study. Aims: The aims of this study are to examine the level of stress experienced by nurses working in an Irish teaching hospital, and investigate differences in perceived stress levels by ward area and associations with work characteristics. Method: A cross-sectional study design was employed, with a two-stage cluster sampling process. A self-administered questionnaire was used to collect the data and nurses were investigated across ten different wards using the Nursing Stress Scale and the Demand Control Support Scales. Results: The response rate was 62%. Using outpatients as a reference ward, perceived stress levels were found to be significantly higher in the medical ward, accident and emergency, intensive care unit and paediatric wards (p<0.05). There was no significant difference between the wards with regard to job strain, however, differences did occur with levels of support; the day unit and paediatric ward reporting the lowest level of supervisor support (p<0.01). A significant association was seen between the wards and perceived stress even after adjustment (p<0.05). Conclusion: The findings suggest that perceived stress does vary within different work areas in the same hospital. Work factors, such as demand and support are important with regard to perceived stress. Job control was not found to play an important role.

Mellanchefers upplevelser av psykosocial arbetsmiljö inom distributions- och logistikverksamhet – en pendling mellan hög aktivitet och låg stress?

Forskarnas genuina intresse för den psykosociala arbetsmiljön med koppling mellanchefer gav upphov till att dyka djupare inom området och belysa centrala delar i form av krav, kontroll och socialt stöd. Framåtskridandet går mot en ökad medvetenhet kring den psykosociala arbetsmiljön, då ohälsan i arbetslivet ökar och Arbetsmiljöverkets nya föreskrift om organisatorisk och social arbetsmiljö är i fokus. I linje med en ökad medvetenhet som sker kring den psykosociala arbetsmiljön vill vi rikta ett särskilt fokus till mellanchefer som bör ha en förmåga att hantera krav både uppifrån och ned. Studien har främst utgått från Robert Karaseks och Töres Theorells Krav – kontroll – stödmodellen. Syftet är att undersöka mellanchefers upplevelse med fokus på den psykosociala arbetsmiljön i ett privat företag inom distributions- och logistikverksamhet. Metoden har bestått av en kvalitativ metod i form av en fallstudie där semistrukturerade intervjuer ligger som grund med åtta respondenter ifrån distributionscentret. Resultatet uppvisar att mellancheferna har en hög grad av inflytande, upplevelsen av arbetskrav varierar men i koppling till befattningen är kraven rimliga. Det sociala stödet upplevs som bra på arbetsplatsen och anses av funktionscheferna som en viktig och central del i arbetet. Slutsatser som har uppnåtts är att funktionscheferna har rimliga krav och upplever en bra nivå av kontroll i arbetet, men att ha en alltför hög kontroll i arbetet kan leda till negativ stress. En balans i pendlingen mellan aktiva arbeten och lågstressarbeten anses vara en fördel för att bevara en god psykosocial arbetsmiljö. Detta för att motverka de negativa effekterna som kan uppstå av att befinna sig inom varje komponent för länge. I studien har det påvisats att företaget anses ha en god psykosocial arbetsmiljö och därmed kan ses som ett gott exempel i arbetslivet.

Sex timmars arbetsdag –ett modigt beslut : För att bli en attraktiv arbetsgivare

I studien undersöks hur arbetstagarnas arbetstillfredsställelse förändrats vis en arbetstidsförkortning. Arbetstidsförkortningens art är i form av en övergång ifrån åtta timmars arbetsdag till sex timmars arbetsdag med bibehållen heltidslön. Studien har genomförts vid ett mindre privat tjänsteföretag. Studiens syfte är att undersöka hur denna typ av arbetstidsförkortning förhåller sig till arbetstagarnas arbetstillfredsställelse och därmed öka förståelsen för de båda fenomenen. Det framkommer att arbetstagarnas arbetstillfredsställelse har förändrats sedan arbetstidsförkortningen. Gällande enskilda faktorer i arbetet har somliga faktorer minskat medan somliga faktorer ökat. I diskussionen framkommer att det föreligger en risk för ohälsa för arbetstagarna då det råder brist på stöd, minskad kontroll och ökade krav sedan arbetstidsförkortningen införts. Den föreliggande risken för ohälsa kan dock ses som acceptabel med tanke på den varierande arbetsbelastningen vilket innebär att arbetstagarna under perioder får tid för återhämtning. Trots omständigheterna råder en hög global arbetstillfredsställelse vilket i sin tur borde innebära att teorierna som brukats innehåller vissa brister då hänsyn till svängningar i arbetsbelastningen inte tagits. I resultatanalysen framkom tre teman vilka sågs relevanta för arbetstagarna och dess arbetstillfredsställelse. Dessa teman bestod av förändringar i relationer, förändringar i arbetet och förändringar i belöningar. Den teoretiska referensramen för studien innehåller förväntningsteorin, tvåfaktor teorin, kravkontroll- stödmodellen samt ansträngning- belöning- obalansmodellen. Datainsamling har skett med hjälp av fyra semistrukturerade intervjuer då respondenterna bestått av arbetstagare på det valda fallet som studerats. Studien är uppbyggt efter kvalitativ metod och har en fenomenologisk ansats. Studien har utformats i form av en fallstudie.

Effets des contraintes psychosociales au travail sur la détresse psychologique et les absences médicalement certifiées pour problèmes de santé mentale: une étude prospective de 5 ans

Contexte : Les effets cumulés des contraintes psychosociales du modèle déséquilibre efforts-reconnaissance (DER) sur la santé mentale sont peu connus. Aussi, peu d’études ont évalué les effets du DER sur des indicateurs objectifs de problèmes de santé mentale (PSM). Enfin, aucune étude prospective antérieure n’a évalué l’effet combiné des contraintes psychosociales du DER et du modèle demande-latitude (DL) et sur les PSM médicalement certifiés. La présente thèse vise à combler ces limites. Objectifs : 1) Mesurer l’effet de l’exposition cumulée au déséquilibre efforts-reconnaissance sur la prévalence de la détresse psychologique sur une période de cinq ans; 2) Mesurer l’effet du déséquilibre efforts-reconnaissance sur l’incidence des absences médicalement certifiées pour PSM sur une période de cinq ans; 3) Évaluer l’effet indépendant et l’effet combiné des contraintes psychosociales des modèles Demande-Latitude et Déséquilibre Efforts-Reconnaissance sur l’incidence des absences médicalement certifiées pour PSM sur une période de cinq ans. Méthodes : La cohorte était constituée de plus de 2000 hommes et femmes occupant des emplois de cols blancs. La collecte des données a été réalisée à trois reprises avec une moyenne de suivi de cinq ans. À chaque temps, les contraintes psychosociales et la détresse psychologique ont été mesurées à l’aide d’instruments validés. Les absences médicalement certifiées pour PSM ont été récoltées à partir des fichiers administratifs des employeurs. Les PSM ont été modélisés à l’aide des régressions log-binomiale et de Cox. Les analyses ont été réalisées séparément chez les hommes et les femmes, en ajustant pour les principaux facteurs de confusion. Résultats : Chez les hommes et les femmes, une exposition chronique au DER sur trois ans était associée à une prévalence plus élevée de la détresse psychologique. Les effets observés à trois ans ont persisté à cinq ans chez les hommes (Rapport de prévalence (RP)=1,91 (1,20–3,04)) et les femmes (RP=2,48 (1,97–3,11)). Ces effets étaient de plus grande amplitude que ceux observés en utilisant l’exposition initiale à l’entrée dans l’étude (de +0,30 à +0,94). Par ailleurs, les hommes et les femmes exposés au DER présentaient un risque plus élevé d’absences médicalement certifiées pour PSM (Risque relatif (RR)=1,38 (1,08–1,76)), comparés aux travailleurs non-exposés. La faible reconnaissance au travail était associée à un risque important d’absences pour PSM chez les hommes (RR=3,04 (1,46–6,33)) mais pas chez les femmes (RR=1,24 (0,90–1,72)). Chez les femmes uniquement, un effet indépendant du « job strain » (RR=1,50 (1,12–2,07)) et du DER (RR=1,34 (0,98–1,84)), ainsi qu’un effet de l’exposition combinée au « job strain » (demande psychologique élevée et faible latitude décisionnelle) et au DER (RR=1,97 (1,40–2,78)) sur le risque d’absences médicalement certifiées pour PSM ont également été observés. Conclusion : Les résultats de cette thèse supportent l’effet délétère de l’exposition au DER sur la prévalence de la détresse psychologique et sur le risque d’absences médicalement certifiées pour PSM chez les hommes et les femmes. Chez les hommes et les femmes, l’exposition cumulée au DER était associée à une prévalence élevée de la détresse psychologique à trois ans et à cinq ans. De plus, les contraintes psychosociales du DER ont été associées aux absences médicalement certifiés pour PSM. Chez les femmes particulièrement, un effet combiné du « job strain » et du DER était associé à un risque plus élevé d’absences médicalement certifiées pour PSM, que l’exposition à un seul des deux facteurs. Ces résultats suggèrent que la réduction des contraintes psychosociales au travail pourrait contribuer à réduire l’incidence des PSM, incluant les absences médicalement certifiées pour PSM.

The Relationship between Job Structure, Burnout, and Coping Methods among Public School county Bus Drivers, Bus Aides, Mechanics, and Clerical Workers

The purpose of this study was to examine the relationship between the structure of jobs and burnout, and to assess to what extent, if any this relationship was moderated by individual coping methods. This study was supported by the Karasek's (1998) Job Demand-Control-Support theory of work stress as well as Maslach and Leiter's (1993) theory of burnout. Coping was examined as a moderator based on the conceptualization of Lazarus and Folkman (1984). Two overall overarching questions framed this study: (a) what is the relationship between job structure, as operationalized by job title, and burnout across different occupations in support services in a large municipal school district? and (b) To what extent do individual differences in coping methods moderate this relationship? This study was a cross-sectional study of county public school bus drivers, bus aides, mechanics, and clerical workers (N = 253) at three bus depot locations within the same district using validated survey instruments for data collection. Hypotheses were tested using simultaneous regression analyses. Findings indicated that there were statistically significant and relevant relationships among the variables of interest; job demands, job control, burnout, and ways of coping. There was a relationship between job title and physical job demands. There was no evidence to support a relationship between job title and psychological demands. Furthermore, there was a relationship between physical demands, emotional exhaustion and personal accomplishment; key indicators of burnout. Results showed significant correlations between individual ways of coping as a moderator between job structure, operationalized by job title, and individual employee burnout adding empirical evidence to the occupational stress literature. Based on the findings, there are implications for theory, research, and practice. For theory and research, the findings suggest the importance of incorporating transactional models in the study of occupational stress. In the area of practice, the findings highlight the importance of enriching jobs, increasing job control, and providing individual-level training related to stress reduction.

Quality demand in vaccination and how to improve service quality under Total Quality Control [论全面质量管理模式下预防接种工作的质量要求与改进对策]

Under the concept of Total Quality Control, based on their experience, the authors discussed potential demand for quality of immunization services and possible solutions to these demands. Abstract in Chinese 全面质量管理(total quality control,TQC)是在20世纪60年代由美国人V,Feigonbaum和J.unan先后提出的新的质量管理观念,众所周知的ISO9000族标准即建立在TQC理念下的质量管理标准,该标准已成为当今世界全球一致、最具权威的质量管理和质量保证的国际规则[1-2].21世纪是质量世纪,推行TQC,不断改进产品和服务质量,目前已成为我国各行各业在不断激烈的市场竞争下完善自我、保证生存和发展的重要手段.实施预防接种是预防和控制传染病,保护人群健康的重要措施,预防接种工作中,产品即预防接种服务,需方(顾客)为接受预防接种服务的广大人群,是产品的消费者.随社会的迅速发展,人们对健康需求的不断提高,对预防接种工作也提出了更高的质量要求.本文对TQC模式下顾客对预防接种服务的质量要求进行了综合分析,并对如何改进服务质量进行了初步探讨.

Voltage regulation, power balancing and battery storage discharge control by smart demand side management and multi-objective decision making

A novel intelligent online demand side management system is proposed for peak load management. The method also regulates the network voltage, balances the power in three phases and coordinates the battery storage discharge within the network. This method uses low cost controllers with low bandwidth two-way communication installed in costumers' premises and at distribution transformers to manage the peak load while maximizing customer satisfaction. A multi-objective decision making process is proposed to select the load(s) to be delayed or controlled. The efficacy of the proposed control system is verified through an event-based developed simulation in Matlab.

On-demand generation and removal of alginate biocompatible microvalves for flow control in microfluidics

[EN] This paper describes, for the first time, the use of alginate hydrogels as miniaturised microvalves within microfluidic devices. These biocompatible and biodegradable microvalves are generated in situ and on demand, allowing for microfluidic flow control. The microfluidic devices were fabricated using an origami inspired technique of folding several layers of cyclic olefin polymer followed by thermocompression bonding. The hydrogels can be dehydrated at mild temperatures, 37◦C, to slightly open the microvalve and chemically erased using an ethylenediaminetetraacetic acid disodium salt (EDTA) solution, to completely open the channel, ensuring the reusability of the whole device and removal of damaged or defective valves for subsequent regeneration.

A Smart Grid Information System for Demand Side Participation: Remote Control of Domestic Appliances to Balance Demand

Due to the intermittent nature of renewable generation it is desirable to consider the potential of controlling the demand-side load to smooth overall system demand. The architecture and control methodologies of such a system on a large scale would require careful consideration. Some of these considerations are discussed in this paper; such as communications infrastructure, systems architecture, control methodologies and security. A domestic fridge is used in this paper as an example of a controllable appliance. A layered approach to smart-grid is introduced and it can be observed how each smart-grid component from physical cables, to the end-devices (or smart-applications) can be mapped to these set layers. It is clear how security plays an integral part in each component of the smart-grid so this is also an integral part of each layer. The controllable fridge is described in detail and as one potential smart-grid application which maps to the layered approach. A demonstration system is presented which involves a Raspberry Pi (a low-power, low-cost device representing the appliance controller).

Coordinating Inventory Control and Pricing Strategies with Random Demand and Fixed Ordering Cost: The Finite Horizon Case

We analyze a finite horizon, single product, periodic review model in which pricing and production/inventory decisions are made simultaneously. Demands in different periods are random variables that are independent of each other and their distributions depend on the product price. Pricing and ordering decisions are made at the beginning of each period and all shortages are backlogged. Ordering cost includes both a fixed cost and a variable cost proportional to the amount ordered. The objective is to find an inventory policy and a pricing strategy maximizing expected profit over the finite horizon. We show that when the demand model is additive, the profit-to-go functions are k-concave and hence an (s,S,p) policy is optimal. In such a policy, the period inventory is managed based on the classical (s,S) policy and price is determined based on the inventory position at the beginning of each period. For more general demand functions, i.e., multiplicative plus additive functions, we demonstrate that the profit-to-go function is not necessarily k-concave and an (s,S,p) policy is not necessarily optimal. We introduce a new concept, the symmetric k-concave functions and apply it to provide a characterization of the optimal policy.

Coordinating Inventory Control and Pricing Strategies with Random Demand and Fixed Ordering Cost: the Infinite Horizon Case

We analyze an infinite horizon, single product, periodic review model in which pricing and production/inventory decisions are made simultaneously. Demands in different periods are identically distributed random variables that are independent of each other and their distributions depend on the product price. Pricing and ordering decisions are made at the beginning of each period and all shortages are backlogged. Ordering cost includes both a fixed cost and a variable cost proportional to the amount ordered. The objective is to maximize expected discounted, or expected average profit over the infinite planning horizon. We show that a stationary (s,S,p) policy is optimal for both the discounted and average profit models with general demand functions. In such a policy, the period inventory is managed based on the classical (s,S) policy and price is determined based on the inventory position at the beginning of each period.