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.

Professional standards research:job satisfaction and innovation

Job satisfaction is a significant predictor of organisational innovation – especially where employees (including shop-floor workers) experience variety in their jobs and work in a single-status environment. The relationship between job satisfaction and performance has long intrigued work psychologists. The idea that "happy workers are productive workers" underpins many theories of performance, leadership, reward and job design. But contrary to popular belief, the relationship between job satisfaction and performance at individual level has been shown to be relatively weak. Research investigating the link between job satisfaction and creativity (the antecedent to innovation) shows that job dissatisfaction promotes creative outcomes. The logic is that those who are dissatisfied (and have decided to stay with the organisation) are determined to change things and have little to lose in doing so (see JM George & J Zhou, 2002). We were therefore surprised to find in the course of our own research into managerial practices and employee attitudes in manufacturing organisations that job satisfaction was a highly significant predictor of product and technological innovation. These results held even though the research was conducted longitudinally, over two years, while controlling for prior innovation. In other words, job satisfaction was a stronger predictor of innovation than any pre-existing orientation organisations had towards working innovatively. Using prior innovation as a control variable, as well as a longitudinal research design, strengthened our case against the argument that people are satisfied because they belong to a highly innovative organisation. We found that the relationship between job satisfaction and innovation was stronger still where organisations showed that they were committed to promoting job variety, especially at shop-floor level. We developed precise instruments to measure innovation, taking into account the magnitude of the innovation both in terms of the number of people involved in its implementation, and how new and different it was. Using this instrument, we are able to give each organisation in our sample a "score" from one to seven for innovation in areas ranging from administration to production technology. We found that much innovation is incremental, involving relatively minor improvements, rather than major change. To achieve sustained innovation, organisations have to draw on the skills and knowledge of employees at all levels. We also measured job satisfaction at organisational level, constructing a mean "job satisfaction" score for all organisations in our sample, and drawing only on those companies whose employees tended to respond in a similar manner to the questions they were asked. We argue that where most of the workforce experience job satisfaction, employees are more likely to collaborate, to share ideas and aim for high standards because people are keen to sustain their positive feelings. Job variety and single-status arrangements further strengthen the relationship between satisfaction and performance. This makes sense; where employees experience variety, they are exposed to new and different ideas and, provided they feel positive about their jobs, are likely to be willing to try to apply these ideas to improve their jobs. Similarly, staff working in single-status environments where hierarchical barriers are reduced are likely to feel trusted and valued by management and there is evidence (see G Jones & J George, 1998) that people work collaboratively and constructively with those they trust. Our study suggests that there is a strong business case for promoting employee job satisfaction. Managers and HR practitioners need to ensure their strategies and practices support and sustain job satisfaction among their workforces to encourage constructive, collaborative and creative working. It is more important than ever for organisations to respond rapidly to demands of the external environment. This study shows the positive association between organisational-level job satisfaction and innovation. So if a happy workforce is the key to unlocking innovation and organisations want to thrive in the global economy, it is vital that managers and HR practitioners pay close attention to employee perceptions of the work environment. In a world where the most innovative survive it could make all the difference.

The impact of buddying on psychological capital, work engagement and turnover intentions:an empirical study of socialization in the professional services sector

This article reports on a study investigating the impact of new employees' satisfaction with buddying on work engagement and explores the role of psychological capital in mediating this relationship. The study took place within a professional services organization wherein data were collected from 78 graduate newcomers in receipt of buddying. Satisfaction with buddying was found to have a positive relationship to both work engagement and psychological capital. The satisfaction with the buddy/work engagement relationship was fully mediated by psychological capital, providing support for Saks & Gruman's (2011) socialization resources theory. The results underscore the valuable role buddying can play as part of organizational socialization from a positive organizational behavior perspective. The research contributes to the growing evidence that positively oriented human resource practices can develop personal resources of newcomers within organizations. Recommendations are made for how the organization can improve and build upon this resource, thus developing the psychological capital of newcomers. © 2012 Wiley Periodicals, Inc.

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

The relationship between high-sensitivity CRP and polyclonal Free Light Chains as markers of inflammation in chronic disease

Introduction: Serum concentrations of polyclonal free light chains (FLC) represent the activity of the adaptive immune system. This study assessed the relationship between polyclonal FLC and the established marker of innate immunity, C-reactive protein (CRP), in chronic and acute disease. Methods: We utilized four cross-sectional chronic disease patient cohorts: chronic kidney disease (CKD), diabetes, vasculitis and kidney transplantation; and a longitudinal intensive care case series to assess the kinetics of production in acute disease. Results: There was a weak association between polyclonal FLC and high-sensitivity CRP (hs-CRP) in the study cohorts. A longitudinal assessment in acute disease showed a gradual increase in FLC concentrations over time, often when CRP levels were falling, demonstrating clear differences in the response kinetics of CRP and FLC in this setting. Conclusion: Polyclonal FLC and hs-CRP provide independent information as to inflammatory status. Prospective studies are now required to assess the utility of hs-CRP and polyclonal FLC in combination for risk stratification in disease populations. © 2013 John Wiley & Sons Ltd.

Globalisation, markets and healthcare policy:redrawing the patient as consumer

Although the last two decades have seen the healthcare systems of most developed countries face pressure for major reform, the impact of this reform on the relationship between empowerment, consumerism and citizen’s rights has received limited research attention. Globalisation, Markets and Healthcare Policy sets out to redress this imbalance. This book explores the extent to which globalisation and commercialisation relate to current and emerging health policies. It also looks at the implications for citizens, patients and social rights, as well as how policy making interacts with the interests of global and European trade and economic policies. Topics discussed include: •How the impact of globalisation on health systems is apparent in the influence of international actors and European policies. •How the impact of globalisation is mediated by national priorities and policies and is therefore reflected in diverse influences. •How commercialisation of health is presented as benefiting citizens and patients but has the potential to undermine the aims and values inherent in health systems. •How the role of citizens' interests, social rights, patient’s rights and priorities of patient and public involvement need to be separated from commercialisation, choice and consumerism in health care. Essential reading for policy makers and students of public policy, politics, law and health services, Globalisation, Markets and Healthcare Policy will also appeal to those interested in patient involvement international healthcare, international relations, trans-national organisations and the EU.

Multiple component patient safety intervention in English hospitals:controlled evaluation of second phase

Objective: To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design: A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting: NHS hospitals in England. Participants: Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results: One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in error rates either over time or between control and SPI2 hospitals. The explicit case note review of perioperative care showed that adherence rates for two of the four perioperative standards targeted by SPI2 were already good at baseline, exceeding 94% for antibiotic prophylaxis and 98% for deep vein thrombosis prophylaxis. Intraoperative monitoring of temperature improved over time in both groups, but this was not significant (1.8, 0.4 to 7.6; P=0.279), and there were no additional effects of SPI2. A dramatic rise in consumption of soap and alcohol hand rub was similar in control and SPI2 hospitals (P=0.760 and P=0.889, respectively), as was the corresponding decrease in rates of Clostridium difficile and meticillin resistant Staphylococcus aureus infection (P=0.652 and P=0.693, respectively). Mortality rates of medical patients included in the case note reviews in control hospitals increased from 17.3% (42/243) to 21.4% (24/112), while in SPI2 hospitals they fell from 10.3% (24/233) to 6.1% (7/114) (P=0.043). Fewer than 8% of deaths were classed as avoidable; changes in proportions could not explain the divergence of overall death rates between control and SPI2 hospitals. There was no significant difference in the rate of change in mortality in intensive care. Patients' satisfaction improved in both control and SPI2 hospitals on all dimensions, but again there were no significant changes between the two groups of hospitals. Conclusions: Many aspects of care are already good or improving across the NHS in England, suggesting considerable improvements in quality across the board. These improvements are probably due to contemporaneous policy activities relating to patient safety, including those with features similar to the SPI, and the emergence of professional consensus on some clinical processes. This phenomenon might have attenuated the incremental effect of the SPI, making it difficult to detect. Alternatively, the full impact of the SPI might be observable only in the longer term. The conclusion of this study could have been different if concurrent controls had not been used.

Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.

The scrutinized priest:women in the Church of England negotiating professional and sacred clothing regimes

This article examines the integration of women priests in the Church of England through the lens of dress. Clothing is a salient dynamic in occupational cultures, particularly in relation to the regulation of gendered bodies. Women's ordination to the priesthood was only sanctioned in 1992. Complex clothing regimes are negotiated, for ordination bestows upon the priest certain clothing rights and responsibilities. However, such attire has traditionally been associated only with the male body, creating tension in relation to women's appropriation of this sacred and professional dress. Based on in-depth interviews with 17 Anglican clergy women, this article will focus both on the scrutiny the women experienced in relation to their clothing choices, as well as the relationship the women themselves negotiated with their clothes. It will be argued that as representatives of both a sacred and professional domain, clothing had to be carefully managed by clergy. Dress functioned as a key test in women's integration into the organization, often operating as a constraining and exclusionary mechanism. © 2013 John Wiley & Sons Ltd.

Relationship between sunlight and the age of onset of bipolar disorder:an international multisite study

Background - The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. We previously found that a large increase in sunlight in springtime was associated with a lower age of onset. This study extends this analysis with more collection sites at diverse locations, and includes family history and polarity of first episode. Methods - Data from 4037 patients with bipolar I disorder were collected at 36 collection sites in 23 countries at latitudes spanning 3.2 north (N) to 63.4 N and 38.2 south (S) of the equator. The age of onset of the first episode, onset location, family history of mood disorders, and polarity of first episode were obtained retrospectively, from patient records and/or direct interview. Solar insolation data were obtained for the onset locations. Results - There was a large, significant inverse relationship between maximum monthly increase in solar insolation and age of onset, controlling for the country median age and the birth cohort. The effect was reduced by half if there was no family history. The maximum monthly increase in solar insolation occurred in springtime. The effect was one-third smaller for initial episodes of mania than depression. The largest maximum monthly increase in solar insolation occurred in northern latitudes such as Oslo, Norway, and warm and dry areas such as Los Angeles, California. Limitations - Recall bias for onset and family history data. Conclusions - A large springtime increase in sunlight may have an important influence on the onset of bipolar disorder, especially in those with a family history of mood disorders.

Patient involvement in primary care mental health:a focus group study

Background: Patient involvement in health care is a strong political driver in the NHS. However in spite of policy prominence, there has been only limited previous work exploring patient involvement for people with serious mental illness. Aim: To describe the views on, potential for, and types of patient involvement in primary care from the perspectives of primary care health professionals and patients with serious mental illness. Design of study: Qualitative study consisting of six patient, six health professional and six combined focus groups between May 2002 and January 2003. Setting: Six primary care trusts in the West Midlands, England. Method: Forty-five patients with serious mental illness, 39 GPs, and eight practice nurses participated in a series of 18 focus groups. All focus groups were audiotaped and fully transcribed. Nvivo was used to manage data more effectively. Results: Most patients felt that only other people with lived experience of mental illness could understand what they were going through. This experience could be used to help others navigate the health- and social-care systems, give advice about medication, and offer support at times of crisis. Many patients also saw paid employment within primary care as a way of addressing issues of poverty and social exclusion. Health professionals were, however, more reluctant to see patients as partners, be it in the consultation or in service delivery. Conclusions: Meaningful change in patient involvement requires commitment and belief from primary care practitioners that the views and experiences of people with serious mental illness are valid and valuable.

A patient's perspective:the impact of adverse drug reactions on patients and their views on reporting

What is known and objective: Adverse drug reactions to prescribed medication are relatively common events. However, the impact such reactions have on patients and their attitude to reporting such events have only been poorly explored. Previous studies relying on self-reporting patients indicate that altruism is an important factor. In the United Kingdom, patient reporting started in 2005; though, numbers of serious reports remain low. Method: A purposive sample of fifteen patients who had been admitted to an inner city hospital with an adverse drug reaction were interviewed using a semi-structured questionnaire. Patients were asked to relate in their own words their experience of an adverse drug reaction. Patient's reactions to the information leaflet, adherence to treatment and use of other sources of information on medication were assessed. Interviews were recorded, and a thematic analysis of patients'responses was performed. Results and discussion: Analysis of the patient interviews demonstrated the reality of being admitted to hospital is often a frightening process with a significant emotional cost. Anger, isolation, resentment and blame were common factors, particularly when medicines had been prescribed for acute conditions. For patients with chronic conditions, a more phlegmatic approach was seen especially with conditions with a strong support networks. Patients felt that communication and information should have been more readily available from the health care professional who prescribed the medication, although few had read the patient information leaflet. Only a minority of patients linked the medication they had taken to the adverse event, although some had received false reassurance that the drug was not related to their illness creating additional barriers. In contrast to previous studies, many patients felt that adverse drug reporting was not their concern, particularly as they obtained little direct benefit from it. The majority of patients were unaware of the Yellow Card Scheme in the UK for patient reporting. Even when explained, the scheme was felt too cold and impersonal and not a patient's 'job'. What is new and conclusion: Patients having a severe adverse drug reaction following an acute illness felt negative emotions towards their health care provider. Those with a chronic condition rationalized the event and coped better with its impact. Neither group felt that reporting the adverse reaction was their responsibility. Encouraging patients to report remains important but expecting patients to report solely for altruistic purposes may be unrealistic. © 2011 Blackwell Publishing Ltd.

Trait emotional intelligence and translation:a study of professional translators

A study of 155 professional translators was carried out to examine the relationship between trait emotional intelligence (trait EI) and literary translation, job satisfaction and career success. Participants were surveyed and their answers were correlated with scores from an emotional intelligence measure, the TEIQue. The analysis revealed that literary and non-literary translators have different trait EI profiles. Some significant correlations were found between trait EI and the variables of job satisfaction, career success, and literary translation experience. This is the first study to examine the effect of EI on translator working practices. Findings illustrate that trait EI may be predictive of some aspects of translator behaviour and highlight the relevance of exploring the emotional intelligence of professional translators.

An examination of the relationship of governance structure and performance: Evidence from banking companies in Bangladesh

Corporate governance has become increasingly important in developed and developing countries just after a series of corporate scandals and failures in a number of countries. Corporate governance structure is often viewed as a means of corporate success despite prior studies reveal mixed, somewhere conflicting and ambiguous, and somewhere no relationship between governance structure and performance. This study empirically investigates the relationship between corporate governance mechanisms and financial performance of listed banking companies in Bangladesh by using two multiple regression models. The study reveals that a good number of companies do not comply with the regulatory requirements indicating remarkable shortfall in corporate governance practice. The companies are run by the professional managers having no duality and no ownership interest for which they are compensated by high remuneration to curb agency conflict. Apart from some inconsistent relationship between some corporate variables, the corporate governance mechanisms do not appear to have significant relationship with financial performances. The findings reveal an insignificant negative impact or somewhere no impact of independent directors and non-independent non-executive directors on the level of performance that strongly support the concept that the managers are essentially worthy of trust and earn returns for the owners as claimed by stewardship theory. The study provides support for the view that while much emphasis on corporate governance mechanisms is necessary to safeguard the interest of stakeholders; corporate governance on its own, as a set of codes or standards for corporate conformance, cannot make a company successful. Companies need to balance corporate governance mechanisms with performance by adopting strategic decision and risk management with the efficient utilization of the organization’s resources.

An investigation of the relationship between historical reform initiatives and Blueprint 2000: A System of School Improvement and Accountability

The modern rhetoric of reform in education has been in the forefront since the 1980s, but it has now taken on a new meaning, a greater importance to both students and teachers, a new urgency for change, and a sense of hope that this time reform will truly make a difference. The major purpose of this study was to compare historical reform initiatives to the current Florida state initiative, Blueprint 2000: A System of School Improvement and Accountability.^ Five questions were considered: (1) how similar were historical and current reform initiatives; (2) what aspects of reform were actually accomplished; (3) what are the elements of a profession; (4) what implications might this research have for university programs and inservice training programs regarding their role in the preparation of teachers; and, (5) what implications might research have on the promotion of professional practice. ^