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.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

A mixed method study of organizational culture dimensions of community college faculty library use and perceptions

Because past research has shown faculty as the driving force affecting student academic library use, librarians have tried for decades to engage classroom faculty in library activities. Nevertheless, a low rate of library use by faculty on behalf of their students persists. This study investigated the organizational culture dimensions affecting library faculty demand at a community college. The study employed a sequential quantitative-qualitative research design. A random sample of full-time faculty at a large urban community college responded to a 46-item survey. The survey data showed strong espoused support (84%) for the use of library-based materials but a much lower incidence of putting this construct into practice (46%). Interviews were conducted with 11 full-time faculty from two academic groups, English-Humanities and Engineering-Math-Science. These groups were selected because the survey data resulted in statistically significant differences between the groups pertaining to several key variables. These variables concerned the professors' perceptions of the importance of library research in their discipline, the amount of time spent on the course textbook during a term, the frequency of conversations about the library in the academic department, and the professors' ratings of the librarians' skill in instruction related to the academic discipline. All interviewees described the student culture as the predominant organizational culture at Major College. Although most interview subjects held to high information literacy standards in their courses, others were less convinced these could be realistically practiced, based on a perception of students' poor academic skills, lack of time for students to complete assignments due to their commuter and family responsibilities, and the need to focus on textbook content. Recommended future research would involve investigation of methods to bridge the gap between high espoused value toward information literacy and implementation of information-literate coursework.

A multi-method approach for the assessment of composite indices and rankings

There is growing popularity in the use of composite indices and rankings for cross-organizational benchmarking. However, little attention has been paid to alternative methods and procedures for the computation of these indices and how the use of such methods may impact the resulting indices and rankings. This dissertation developed an approach for assessing composite indices and rankings based on the integration of a number of methods for aggregation, data transformation and attribute weighting involved in their computation. The integrated model developed is based on the simulation of composite indices using methods and procedures proposed in the area of multi-criteria decision making (MCDM) and knowledge discovery in databases (KDD). The approach developed in this dissertation was automated through an IT artifact that was designed, developed and evaluated based on the framework and guidelines of the design science paradigm of information systems research. This artifact dynamically generates multiple versions of indices and rankings by considering different methodological scenarios according to user specified parameters. The computerized implementation was done in Visual Basic for Excel 2007. Using different performance measures, the artifact produces a number of excel outputs for the comparison and assessment of the indices and rankings. In order to evaluate the efficacy of the artifact and its underlying approach, a full empirical analysis was conducted using the World Bank's Doing Business database for the year 2010, which includes ten sub-indices (each corresponding to different areas of the business environment and regulation) for 183 countries. The output results, which were obtained using 115 methodological scenarios for the assessment of this index and its ten sub-indices, indicated that the variability of the component indicators considered in each case influenced the sensitivity of the rankings to the methodological choices. Overall, the results of our multi-method assessment were consistent with the World Bank rankings except in cases where the indices involved cost indicators measured in per capita income which yielded more sensitive results. Low income level countries exhibited more sensitivity in their rankings and less agreement between the benchmark rankings and our multi-method based rankings than higher income country groups.

A Mixed Method Study of Spirituality and the Influence on TB Medication Adherence

Nonadherence to medication for tuberculosis (TB) can lead to new cases of TB and death. Interest in spirituality in healthcare has grown among adult educators, health educators and healthcare workers (Tisdell, 2003). This mixed-method study will explore spirituality and TB medication adherence among African American and Haitian populations.

Using alcohol unit-marked glasses enhances capacity to monitor intake:evidence from a mixed-method intervention trial

AIMS: In the UK, people tend to have poor knowledge of government guidelines for alcohol use, and lack the motivation and skills required to use them to monitor their drinking. The study aim was to determine whether using glasses marked with such guidelines would improve knowledge and attitudes, increase frequency of counting units and lower alcohol intake. METHODS: A total of 450 adults in the UK participated in an intervention vs control study with 1-month follow-up. The intervention group was encouraged to use glasses supplied by the researchers that indicated the unit content of drinks of different strengths and volumes, and stated the intake guidelines. Data were collected online. A further more in-depth interview with 13 intervention group participants enquired into their experiences of using the glasses. RESULTS: Analyses adjusted for baseline variables showed that the intervention improved the following: knowledge of unit-based guidelines, ability to estimate the unit content of drinks, attitudes toward the guidelines and frequency of counting unit intake. However, there was no significant difference in alcohol consumption between the groups at follow-up. Interviews suggested that the glasses encouraged people to think about their drinking and to discuss alcohol with other people. The design of the glasses was not appealing to all, and their initial impact did not always persist. CONCLUSION: Use of unit-marked glasses led to changes in people's reported use of unit-based guidelines to monitor their drinking but, in the short term, no change in consumption. Qualitative data suggested that the glasses could have an impact at the individual level (on knowledge and attitudes) and at a broader level (by prompting discussion of alcohol use).

The qualitative research method approach (qurma) : students guide

Qualitative methods are commonly used within the area of Electronic Government as well as other fields in social science. Among students carrying out qualitative approaches in their thesis work, qualitative studies are very common but unfortunately there is often a lack of rigor when using qualitative approaches. Method books discussing qualitative studies are frequent, but they often lack some firm advices about how to actually carry out a qualitative study. There are lots of good advices about interviews and observations. Grounded theory is often mentioned although in rather general terms. The interpretive part is not very thoroughly discussed though. Below we present an outline that might fill the mentioned gap somewhat. Our aim is to give the student a guide in carrying out the qualitative/interpretive approach. By following the ten steps below, students will not only have to prepare the study, they will also find some solid reference support for the necessary steps in the process of research.

Des hommes en mouvement : vers une reconfiguration des modèles masculins? L'exemple de la Suisse

This project is a study of the men's movement in Switzerland, especially regarding organizations seeking to redefine male identity. So far, this topic has been understudied, in Switzerland. The few studies available on the subject mostly adopt a (pro)feminist perspective. Their main purpose is to criticize men's movement participants. What is more, scarce researches on this problem mostly conducted by members of the Swiss men's movement themselves are mainly descriptive and methodologically problematic. In this context, I initiated the first national and sociological study of the men's movement in Switzerland. My main goals are: firstly, to propose a typology of organizations forming the men's movement in Switzerland. Secondly, I develop a sociological analysis of this phenomenon, taking into account in this process especially the characteristics of the Swiss context. Consequently, I adopted a mixed method approach, which included two main research steps: Firstly, I defined a representative sample of men's movement organizations in Switzerland. Based on a content analysis of men's organizations' websites, I was able to distinguish three ideal-types: Radical Criticism of Masculinity, Criticism of Hegemonic Masculinity, Defense of Men and Traditional Masculinity. Based on these three concepts, I subsequently analyzed the discourse on masculinity amongst men's movement organizations. Secondly, I conducted a survey of men's movement participants. This survey was based on the results of the content analysis. In this particular stage, I mainly used factor analysis. My results show that it would be all too simplistic to characterize the men's movement, in Switzerland, as a criticism of women's emancipation. On the contrary, my analysis reveals a more complex picture: The two main factors, which influence the men's movement, in Switzerland, are the contemporary sociological context and the Swiss society's particular features. I find that male roles, on the one hand, depend very much on today's cultural shift from materialistic to self-expression values. On the other hand, male role models reflect a social adaptation process. Moreover, as a reaction to deep changes in contemporary family structures, I observe an individualization process, characterized by separation between parental and conjugal functions that greatly shapes male role models. - Cette thèse analyse le phénomène des hommes en mouvement, dans le contexte de la Suisse. Cet ensemble est formé d'organisations regroupant des hommes impliqués consciemment dans un processus d'actions et de réflexions sur l'identité masculine. La revue de la littérature révèle qu'en Suisse, le sujet des hommes en mouvement est très peu étudié. Jusqu'ici, les rares recherches s'y intéressant adoptent généralement une approche (pro)féministe, dont l'objectif est de dénoncer ce phénomène. En outre, de rares recherches, issues des acteurs mêmes de ce mouvement, proposent une vue descriptive de l'ensemble, mais souffrant de faiblesses méthodologiques. Par notre recherche, nous souhaitons contribuer à l'étude de ce sujet, en initiant la première étude d'envergure nationale portant sur les hommes en mouvement. L'objectif final est de déboucher sur une typologie des organisations réunissant les hommes en mouvement, puis sur une analyse de la spécificité de cet ensemble, dans le contexte suisse. Pour remplir ces objectifs, nous avons mis en place un dispositif de méthodes mixtes, en deux phases. Lors d'une première étape, nous avons sélectionné un échantillon représentatif de la diversité des organisations masculines. Par une analyse de contenu effectuée sur la documentation récoltée sur les sites Internet de ces dernières, nous avons pu, en utilisant une démarche inductive et qualitative, faire émerger trois idéaux-types : Critique radicale de la masculinité, Critique de la masculinité hégémonique, Défense des hommes et de la masculinité traditionnelle. Ces concepts permettent de rendre compte, de manière schématique, des trois types de discours contemporains sur l'identité masculine diffusés par les hommes en mouvement. Lors d'une seconde étape, nous avons réalisé une enquête auprès des membres des organisations masculines. Pour y parvenir, nous avons créé un questionnaire incluant des propositions élaborées à partir des résultats de l'étape précédente. Lors de cette phase, nous avons réalisé une analyse factorielle. Les résultats montrent que le phénomène du mouvement des hommes ne saurait se réduire, en Suisse, à un mouvement de ressac visant à attaquer les droits des femmes. Au contraire, il s'agit d'un phénomène complexe, fortement dépendant du contexte sociologique contemporain et des caractéristiques de la société helvétique. Nous affirmons, entre autres, que les modèles masculins observables dans cet ensemble sont façonnés, d'une part, par une transition culturelle, caractérisée par le passage des valeurs matérialistes aux valeurs d'expression de soi. D'autre part, les modèles masculins prônés par les hommes en mouvement reflètent un processus d'adaptation sociale. En effet, en réaction au contexte de reconfiguration des formes familiales, on assiste à une individualisation des rapports de filiation et au détachement de la fonction parentale et conjugale, qui imprègnent fortement les modèles masculins défendus par ces hommes.

Validity of the FACIT-Sp to assess spiritual well-being in elderly patients

Among instruments measuring spiritual well-being, the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp-12) is the most widely used instrument in research. It has been validated in patients suffering from cancer or HIV/AIDS, but has rarely been used in elderly patients. The objectives of this study were to determine the psychometric properties and suitability of the FACIT-Spto assess spiritual well-being in hospitalized elderly patients. This cross-sectional study uses a mixed method approach. Subjects were patients (N = 208), aged 65 years and older, consecutively admitted in post-acute rehabilitation. Psychometric properties of the FACITSp were investigated. The internal structure of the FACIT-Sp (factor structure and internal consistency) was assessed. Convergent validity of the FACIT-Sp was assessed using the Spiritual Distress Assessment Tool (SDAT), the question "Are you at peace?" and the Geriatric Depression Scale (GDS). Predictive validity was assessed using length of stay (LOS) and discharge destination. Understanding and interpretation of FACIT-Sp items were consecutively assessed in a sub-sample of 135 patients. Results show that FACIT-Sp scores ranged from 7 to 46 (mean 29.6 ± 7.8); 23.1% of the patients had high spiritual well-being. Cronbach's α was g ood ( 0.85). Item-to-total correlations were all significant (0.34 to 0.73). Principal component analyses performed with 2 or 3 factors were only moderately consistent with previous work. FACIT-Sp correlated with SDAT, "Are you at peace?" and GDS (Rho = −0.45, P < 0.001; 0.51, P < 0.001 and −0.38, P < 0.001). No association was found with LOS or discharge destination. Spontaneous comments about one or more FACIT-Sp items were made by 97/135 (71.9%). Specifically, items that address purpose and meaning in life were frequently found difficult to answer. Analyses suggest that the FACIT-Sp may underestimate spiritual well-being in older patients. In conclusion, despite having acceptable psychometric properties, the FACIT-Sp presents limitations for measurement of spiritual well-being in hospitalized elderly patients.

Development of category planning process in construction business

The aim of this thesis was to develop the category planning process in the case company operating in construction industry. As the interest in the field of research has just recently started to emerge towards the benefits of category management and planning, the theoretical background was derived from literature of subjects with a relation to category planning i.e. procurement strategy, purchasing portfolio model, information flow management and cost analysis. The background for the development of category planning process was derived from retail industry, to where the category planning is more researched. The empirical study was executed with mixed method approach: quantitative data of the categories was analyzed and qualitative data was gathered through semi-structured interview and discussions within the case company. As a result, the category planning process was critically analyzed and development proposals addressed for improving the process description. Additionally a tool was developed based on the empirical study to support the category planning process of the case company.

Quality of outsourced IT services in different degrees of offshoring

The Finnish IT service market can be described to be at a turning point. The clients are ever more interested on services delivered from offshore but certain issues keep them cautious. There is a lack of knowledge on what implications different degrees of offshoring have on service quality. Although there has been significant amount of research related to both service quality and offshoring, several questions are unanswered, terminology remains ambivalent and research findings are inconsistent. The study focuses on the interception of these two fields. The purpose of the study is to learn more about service quality in different degrees of offshoring. At the same time it aims to contribute in narrowing the research gaps. The degree of offshoring can be divided to three delivery modes: onshore, collaboration and offshore. The study takes a mixed method approach where the quantitative and qualitative phases are executed sequentially. First data was gathered from incident management system. Resolution time in different degrees of offshoring was analyzed with Kruskal-Wallis and Jonckheere-Terpstra tests. In addition, the compliance to Service Level Agreement (SLA) in different degrees of offshoring was examined with cross tabulation. The findings from the quantitative analysis suggested that the services with offshore delivery mode perform the best in terms of promptness and SLA compliance. However, several issues were found related to the data and for that reason, the findings should be considered with prudence. After the quantitative analysis, the study moved on to qualitative data collection and analysis. Four semi-structured interviews were held. The interviewees represented different organizational roles and had experiences from different delivery modes. Several themes were covered in the interviews, including: the concept of quality, the subjectivity or objectivity of service quality, expectations and prejudices towards offshore deliveries, quality produced in India, proactiveness of offshore resources, quality indicators and the scarcity of collaborative deliveries. Several conclusions can be made from the empirical research. Firstly, the quality in different delivery modes was found to be controversial topic. Secondly, in the collaborative delivery covered in the study, the way tasks and resources are allocated seem to cause issues. On the other hand inexperienced offshore resources are assigned to the delivery and on the other hand only routine tasks are assigned to the resources. This creates a self-enforcing loop that results in low motivation, low ownership and high employee turnover in offshore. Nevertheless, this issue is not characteristic only to collaborative deliveries but rather allocation of tasks and resources. Moreover, prejudices were identified to affect the perceived service quality in non-predictable way. The research also demonstrated that there is a need in focal company for further data gathering and analysis.

A Temporal Analysis of Emotions in Girls' Secondary School Physical Education Games and Fitness Classes

Female enthusiasm towards engaging in physical education (PE) significantly decreases with age as it provides females with positive and negative emotional experiences. This study examined emotions within four grade nine female PE soccer and fitness classes (N = 67). Emotional patterns were studied over time and across two units of instruction and in relation to student grades. A mixed-method approach was utilized assessing the state emotions of shame, enjoyment, anxiety, and social physique anxiety (SPA). Results revealed unsatisfactory internal consistency for shame and thus it was removed. Statistical analysis revealed no significant changes in emotions over time, whereas qualitative analysis found that state emotions were inconsistent. Statistical analysis indicated that students in the fitness classes reported significantly higher levels of anxiety and SPA on the final class (p < .01). Qualitative analysis signaled different origins and themes of students‟ emotions. No predictive relationship between emotion and students‟ grade was found.

An Exploration of Professors’ Use of Twitter in Higher Education

Scant research has explored how professors in Canadian universities use Twitter as a teaching tool or to augment knowledge about their subject disciplines. This case study employed a mixed-method approach to examine how professors in an Ontario university use Twitter. Using a variation of the technology acceptance model, the survey (n = 17) found that professor participants—41.2% of whom use Twitter—perceive Twitter as somewhat useful as a teaching tool, not useful for finding and sharing information, and not useful for personal use. Participants’ gender and number of years teaching are not indicators of Twitter use. Furthermore, the level of support from peers and the university may be reasons why some do not use Twitter or have stopped using Twitter. Face-to-face interviews (n = 3) revealed that Twitter is not used in classrooms or lecture halls, but predominantly as a means of sharing information with students and colleagues. Another deterrent to using Twitter is not knowing who to follow. Findings indicate that some professors at this university embrace Twitter, but not necessarily as an in-class teaching tool. The challenge and the advantage of using Twitter is to discover and follow people who tweet material and to select relevant material to pass along to students and colleagues. Professor participants in the study found a use for the social network as a means to increase student engagement, create virtual information-exchange communities, and enrich their own learning.

An Ontario-Developed Online Special Education Teacher Course Model for China

This study investigated the effectiveness of an Ontario-developed online Special Education teacher training course as a model for in-service teacher professional development in China. The study employed a mixed method approach encompassing both a quantitative survey and a qualitative research component to gather perceptions of Chinese and Canadian teachers, educational administrators, and teacher-educators who have intensive experience with online education, Special Education, and teacher preparation programs both in China and Canada. The study revealed insufficient understanding of Special Education among the general Chinese population, underdevelopment of Special Education teacher preparation in China, and potential benefits of using a Canadian online teacher training course as a model for Special Education in China. Based on the literature review and the results of this study, it is concluded that online Canadian Special Education teacher in-service courses can set an example for Chinese Special Education teacher training. A caveat is that such courses would require localized modifications, support of educational authorities, and pilot testing.

A Masters Student’s Journey: Trying to Balance Two Eyes of Research

This project is about a reflective research journey taken by a Masters student in the Child and Youth Studies Department at Brock University in St. Catharines Ontario. This journey consisted of a mixed method approach using the qualitative method of autoethnography along with the Indigenous research method of storytelling. The research was done using the concept of two-eyed seeing which consisted of trying to balance the two eyes of research: Indigenous and Western. The Non-Aboriginal researcher not only reflected on her own learning journey but also the lessons she learned from the voices of 48 women from Six Nations of the Grand River Territory. Like the trickster character Coyote, the researcher struggled, stumbled and was transformed by this journey.