The link between the management of employees and patient mortality in acute hospitals

The relationship between human resource management practices and organizational performance (including quality of care in health-care organizations) is an important topic in the organizational sciences but little research has been conducted examining this relationship in hospital settings. Human resource (HR) directors from sixty-one acute hospitals in England (Hospital Trusts) completed questionnaires or interviews exploring HR practices and procedures. The interviews probed for information about the extensiveness and sophistication of appraisal for employees, the extent and sophistication of training for employees and the percentage of staff working in teams. Data on patient mortality were also gathered. The findings revealed strong associations between HR practices and patient mortality generally. The extent and sophistication of appraisal in the hospitals was particularly strongly related, but there were links too with the sophistication of training for staff, and also with the percentages of staff working in teams.

The relationship between parental perceptions of diabetes and glycaemic control

Aim: To measure the relationship between perceived child competence, parental self-efficacy, and children's glycaemic control. Methods: Cross-sectional outpatient based questionnaire survey of 78 parents of children aged 6-12 years with insulin dependent diabetes mellitus, diagnosed for at least one year. Parental perceptions of their child's competence were assessed, together with parental perceptions of their own self-efficacy in managing their child's diabetes. Glycaemic control was assessed by the average annual HbA 1C level. Results: The response rate was 64.5% (51 parents); 82% were mothers and the socioeconomic class and ethnicity spread was representative of the general population. The mean age of the children was 10 years and duration of diabetes 4.4 years. Poorer glycaemic control was associated with higher perceived child competence, together with lower perceived age of responsibility, lower perceived seriousness, and less frequent blood tests. Higher parental self-efficacy and higher perceived child competence predicted a higher level of normalisation, as did lower perceived seriousness, a lower perceived parental responsibility for management, and a less protective style of parenting. Conclusion: Parents' perceptions of their children's diabetes are significantly related to glycaemic control; however, those who appear more competent at managing diabetes may overestimate their child's capabilities, leading to poorer glycaemic control.

eHealth as a challenge to `expert' power: a focus group study of internet use for health information and management

Objective To investigate current use of the internet and eHealth amongst adults. Design Focus groups were conducted to explore participants' attitudes to and reasons for health internet use. Main outcome measures The focus group data were analysed and interpreted using thematic analysis. Results Three superordinate themes exploring eHealth behaviours were identified: decline in expert authority, pervasiveness of health information on the internet and empowerment. Results showed participants enjoyed the immediate benefits of eHealth information and felt empowered by increased knowledge, but they would be reluctant to lose face-to-face consultations with their GP. Conclusions Our findings illustrate changes in patient identity and a decline in expert authority with ramifications for the practitioner–patient relationship and subsequent implications for health management more generally.

Shareholder or stakeholder management:strategies for performance optimisation

This paper is based upon the findings of a CIMA research project into the way which corporate performance is affected by the performance measurement system adopted. It compares and contrasts the techniques in use in a sample of large companies that use a variety of techniques. We have classified these techniques into 3 types: • Value based management techniques • Stakeholder management techniques • Traditional accounting techniques. The analysis traces the interactions between corporate objectives, decision making criteria, performance measurement systems, and executive incentive schemes in order to develop an understanding of the effects of such techniques upon corporate performance. This paper seeks to provide some answers to the following two questions: • What approach leads to superior performance for a firm? • What is different between these approaches when they are used in practice, as distinct from theory? In doing so we have drawn upon both contingency theory and sociobiology theory to develop a framework for understanding the relationship between the choke of performance measurement system and the resulting performance.

The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

Rules for mapping a conceptual model onto various data base management systems. Available in 2 volumes.

The design and implementation of data bases involve, firstly, the formulation of a conceptual data model by systematic analysis of the structure and information requirements of the organisation for which the system is being designed; secondly, the logical mapping of this conceptual model onto the data structure of the target data base management system (DBMS); and thirdly, the physical mapping of this structured model into storage structures of the target DBMS. The accuracy of both the logical and physical mapping determine the performance of the resulting systems. This thesis describes research which develops software tools to facilitate the implementation of data bases. A conceptual model describing the information structure of a hospital is derived using the Entity-Relationship (E-R) approach and this model forms the basis for mapping onto the logical model. Rules are derived for automatically mapping the conceptual model onto relational and CODASYL types of data structures. Further algorithms are developed for partly automating the implementation of these models onto INGRES, MIMER and VAX-11 DBMS.

Technology transfer to developing countries : the case of physical asset management in South Africa

This research investigates technology transfer (TT) to developing countries, with specific reference to South Africa. Particular attention is paid to physical asset management, which includes the maintenance of plant, equipment and facilities. The research is case based, comprising a main case study (the South African electricity utility, Eskom) and four mini-cases. A five level framework adapted from Salami and Reavill (1997) is used as the methodological basis for the formulation of the research questions. This deals with technology selection, and management issues including implementation and maintenance and evaluation and modifications. The findings suggest the Salami and Reavill (1997) framework is a useful guide for TT. The case organisations did not introduce technology for strategic advantage, but to achieve operational efficiencies through cost reduction, higher quality and the ability to meet customer demand. Acquirers favour standardised technologies with which they are familiar. Cost-benefit evaluations have limited use in technology acquisition decisions. Users rely on supplier expertise to compensate for poor education and technical training in South Africa. The impact of political and economic factors is more evident in Eskom than in the mini-cases. Physical asset management follows traditional preventive maintenance practices, with limited use of new maintenance management thinking. Few modifications of the technology or R&D innovations take place. Little use is made of explicit knowledge from computerised maintenance management systems. Low operating and maintenance skills are not conducive to the transfer of high-technology equipment. South African organisations acquire technology as items of plant, equipment and systems, but limited transfer of technology takes place. This suggests that operators and maintainers frequently do not understand the underlying technology, and like workers elsewhere, are not always inclined towards adopting technology in the workplace.

The impact of the language barrier on the management of multinational companies : a case study and survey, based exploration of the impact of the language barrier on the strategies, policies and systems by which multinational companies manage their subsidaries

The thesis begins with a conceptual model of the way that language diversity affects the strategies, organisation and subsidiary control policies of multinational companies. The model is based solely on the researcher'’ personal experience of working in a variety of international management roles, but in Chapter 2 a wide-ranging review of related academic literature finds evidence to support the key ideas. The model is developed as a series of propositions which are tested in a comparative case study, refined and then re-tested in a global survey of multinational subsidiaries. The principal findings of the empirical phases of the thesis endorse the main tenets of the model: - That language difference between parent and subsidiary will impair communication, create mistrust and impede relationship development. - That subsequently the feelings of uncertainty, suspicion and mistrust will influence the decisions taken by the parent company. - They will have heightened sensitivity to language issues and will implement policies to manage language differences. - They will adopt low-risk strategies in host countries where they are concerned about language difference. - They will use organisational and manpower strategies to minimise the consequences and risks of the communications problems with the subsidiary. - As a consequence the level of integration and knowledge flow between parent and subsidiary will be curtailed. - They will adopt styles of control that depend least on their ability to communicate with their subsidiary. Although there is adequate support for all of the above conclusions, on some key points the evidence of the Case Studies and Survey is contradictory. The thesis, therefore, closes with an agenda for further research that would address these inconsistencies.

Buyer-supplier relationships in advanced manufacturing technology acquisition and implementation : a study in Malaysia

This thesis reports the results of research into the connections between transaction attributes and buyer-supplier relationships (BSR) in advanced manufacturing technology (AMT) acquisitions and implementation. It also examines the impact of the different patterns of BSR on performance. Specifically, it addresses the issues of how the three transaction attributes; namely level of complexity, level of asset specificity, and level of uncertainty, can affect the relationships between the technology buyer and suppler in AMT acquisition and implementation, and then to see the impact of different patterns of BSR on the two aspect of performance; namely technology and implementation performance. In understanding the pohenomena, the study mainly draws on and integrates the literature of transaction cost economics theory,buyer-supplier relationships and advanced manufacturing technology as a basis of theoretical framework and hypotheses development.data were gathered through a questionnaire survey with 147 responses and seven semi-structured interviews of manufacturing firms in Malaysia. Quantitative data were analysed mainly using the AMOS (Analysis of Moment Structure) package for structural equation modeling and SPSS (Statistical Package for Social Science) for analysis of variance (ANOVA). Data from interview sessions were used to develop a case study with the intention of providing a richer and deeper understanding on the subject under investigation and to offer triangulation in the research process. he results of the questionnaire survey indicate that the higher the level of technological specificity and uncertainty, the more firms are likely to engage in a closer relationship with technology suppliers.However, the complexity of the technology being implemented is associated with BSR only because it is associated with the level of uncertainty that has direct impact upon BSR.The analysis also provides strong support for the premise that developing strong BSR could lead to an improved performance. However, with high levels of transaction attribute, implementation performance suffers more when firms have weak relationships with technology suppliers than with moderate and low levels of transaction attributes. The implications of the study are offered for both the academic and practitioner audience. The thesis closes with reports on its limitations and suggestions for further research that would address some of these limitations.

Human resource management, employee attitudes and business performance in Post Office Ltd

Whilst a consistent link between the adoption of human resource management (HRM) practices by organisations and their performance has been confirmed by numerous studies, there is a need for greater understanding of why such effects occur. Recently, the attention of researchers has shifted towards understanding the so-called ‘black box’ linking HRM and business performance. This study focuses on this area of research by testing processes through which HRM may affect performance, in particular the process of HR implementation, mediation mechanisms, and fit with internal and external boundary conditions. This research was based on a sample of 136 Post Office branches in the UK and investigated the role of HR implementation, employee attitudes and competitive environment. The study revealed that HR implementation, a climate for service, job satisfaction and effective organisational commitment predicted independent measures of economic and service performance in branches. Employee attitudes moderated the relationship between implemented HRM and service performance, and both job satisfaction and commitment were found to mediate relationships between a climate for service and service performance. Finally, relative levels of competition faced by branches moderated the relationship between employee attitudes and sales. The findings demonstrate how the process of HR implementation, interactions with employee attitudes and moderation by external competition all influence the impact of HR systems on service and economic performance outcomes. These results illustrate the need for greater attention to processes of internal and external fit within HRM research in order to develop theory relating to why HR systems affect performance.

Motivation and the gift relationship

This thesis proposes a theory of Motivation to Work, as a particular condition of general motivation, using the Maussian concept of the Gift to explain the operation of Lacanian Desire. Specifically, it argues that de-motivation stems from Gift rejection. However, as the arguments are not paradigmatically commensurable with managerialist theories, it has been necessary to establish the epistemological tradition of which this work is representative, namely, Critical Theory and Post-Structuralism/Post- Modernism. In distinction to the managerialist explanations of motivation, management and work, behaviourist theories of motivation are characterised as more properly a concern with psychological incentives, management in its current socio-historic institutionalised form as a process of social domination and work as a social experience of domination, but also as a forum for social life generally. However, as such a view receives little theoretical or empirical confirmation from managerialist literature, it is argued that it is necessary to broaden the catchment area of relevant writing, and that the literary arts have more insight than orthodox science. This is supported by reference to modern literary theory in terms of the Form/Content distinction. Central to this argument is the ontological concept of Difference and its `political' use in maintaining social domination by privileging certain forms over others. Having established the basis on which to articulate this theory of motivation, the Lacanian concept of Desire is explored, together with its relevance to motivation and management/organisation theory. The theory of the Gift Relationship is then explicated and developed, together with some of its popular sociological conceptualisations, and an argument made for an understanding in terms of its psychological signficance in explaining the operationalisation of Lacanian Desire. This is related to the work situation and to its relevance for organisational management. In conclusion, its utility is considered, as are some potential criticisms of the arguments put forward.

The application of remote sensing to the management of urban wildlife habitats

The project set out with two main aims. The first aim was to determine whether large scale multispectral aerial photography could be used to successfully survey and monitor urban wildlife habitats. The second objective was to investigate whether this data source could be used to predict population numbers of selected species expected to be found in a particular habitat type. Panchromatic, colour and colour infra-red, 1:2500 scale aerial photographs, taken in 1981 and 1984, were used. For the orderly extraction of information from the imagery, an urban wildlife habitat classification was devised. This was based on classifications already in use in urban environments by the Nature Conservancy Council. Pilot tests identified that the colour infra-red imagery provided the most accurate results about urban wildlife habitats in the study area of the Blackbrook Valley, Dudley. Both the 1981 and 1984 colour infra-red photographs were analysed and information was obtained about the type, extent and distribution of habitats. In order to investigate whether large scale aerial photographs could be used to predict likely animal population numbers in urban environments, it was decided to limit the investigation to the possible prediction of bird population numbers in Saltwells Local Nature Reserve. A good deal of research has already been completed into the development of models to predict breeding bird population numbers in woodland habitats. These models were analysed to determine whether they could be used successfully with data extracted from the aerial photographs. The projects concluded that 1:2500 scale colour infra-red photographs can provide very useful and very detailed information about the wildlife habitats in an urban area. Such imagery can also provide habitat area data to be used with population predictive models of woodland breeding birds. Using the aerial photographs, further investigations into the relationship between area of habitat and the breeding of individual bird species were inconclusive and need further research.

Budgeting, budgetary control and management information in the highways departments

The need for an adequate information system for the Highways Departments in the United Kingdom has been recognised by the report of a committee presented to the Minister of Transport in 1970, (The Marshall Report). This research aims to present a comprehensive information system on a sound theoretical basis which should enable the different levels of management to execute their work adequately. The suggested system presented in this research covers the different functions of the Highways Department, and presents a suggested solution for problems which may occur during the planning and controlling of work in the different locations of the Highways Department. The information system consists of:- 1. A coding system covering the cost units, cost centres and cost elements. 2. Cost accounting records for the cost units and cost centres. 3. A budgeting and budgetary control system covering, the different planning methods and procedures which are required for preparing the capital expenditure budget, the improvement and maintenance operation flexible budgets and programme of work, the plant budget, the administration budget, and the purchasing budget. 4. A reporting system which ensures that the different levels of management are receiving relevant and timely information. 5. The flow of documents which covers the relationship between the prime documents, the cost accounting records, budgets, reports and their relation to the different sections and offices within the department. A comprehensive cost units, cost centres, and cost elements codes together with a number of examples demonstrating the results of the survey, and examples of the application and procedures of the suggested information system have been illustrated separately as appendices. The emphasis is on the information required for internal control by management personnel within the County Council.

The development and operation of the effective interpersonal relationship skills relevant to career development problems from staff assessment at an industrial research laboratory

This study concerns the application of a model of effective interpersonal relationships to problems arising from staff assessment at I.C.I. Ltd. Corporate Laboratory between 1972 and 1974. In collaboration with academic and industrial supervision, the study commenced with a survey of management and supervisor opinions about the effectiveness of current staff (work) relationships, with particular reference to the problem of recognising and developing creative potential. This survey emphasised a need to improve the relationships between staff in the staff assessment context. A survey of research into creativity emphasised the importance of the interpersonal environment for obtaining creative behaviour in an organisation context. A further survey of theories of how inter­personal behaviour related to personal creativity (therapeutic psychology) provided a model of effective interpersonal behaviour (Carkhuff, 1969) that could be applied to the organisation context of staff assessment. The objective of the project was redefined as a need to improve the conditions of interpersonal behaviour in relation to certain (career development) problems arising from staff assessment practices. In order to demonstrate the application of the model of effective interpersonal behaviour, the research student recorded interviews between himself and members of staff designed to develop and operate the dimensions of the model. Different samples of staff were used to develop the 'facilitative' and the 'action oriented' dimensions of bahaviour, and then for the operation of a helping programme (based on vocational guidance tests). These interactions have been analysed, according to the scales of measurement in the model ana the results are presented in case study form in this thesis. At each stage of the project, results and conclusions were presented to the sponsoring organisation (e.g. industrial supervisor) in order to assess their (subjective) opinion of relevance to the organ­ isation. Finally, recommendations on further actions towards general improvement of the work relationships in the laboratory were presented in a brief report to the sponsor.