Work stressors, strains and hospital unit performance

Hospital employees who work in an environment with zero tolerance to error, face several stressors that may result in psychological, physiological, and behavioural strains, and subsequently, in suboptimal performance. This thesis includes two studies which investigate the stressor-to-strain-to-performance relationships in hospitals. The first study is a cross-sectional, multi-group investigation based on secondary data from 65,142 respondents in 172 acute/specialist UK NHS trusts. This model proposes that senior management leadership predicts social support and job design which, in turn, moderate stressors-to-strains across team structure. The results confirm the model's robustness. Regression analysis provides support for main effects and minimal support for moderation hypotheses. Therefore, based on its conclusions and inherent limitations, study one lays the framework for study two. The second study is a cross-sectional, multilevel investigation of the strain-reducing effects of social environment on externally-rated unit-level performance based on primary data from 1,137 employees in 136 units, in a hospital in Malta. The term "social environment" refers to the prediction of the moderator variables, which is to say, social support and decision latitude/control, by transformational leadership and team climate across hospital units. This study demonstrates that transformational leadership is positively associated with social support, whereas team climate is positively associated with both moderators. At the same time, it identifies a number of moderating effects which social support and decision latitude/control, both separately and together, had on specific stressor-to-strain relationships. The results show significant mediated stressor-to-strain-to-performance relationships. Furthermore, at the higher level, unit-level performance is positively associated with shared unit-level team climate and with unit-level vision, the latter being one of the five sub-dimension of transformational leadership. At the same time, performance is also positively related to both transformational leadership and team climate when the two constructs are tested together. Few studies have linked the buffering effects of the social environment in occupational stress with performance. Therefore, this research strives to make a significant contribution to the occupational stress and performance literature with a focus on hospital practice. Indeed, the study highlights the wide-ranging and far-reaching implications that these findings provide for theory, management, and practice.

The interactive effect of workplace stressors and mood on creativity and implementation activities: a dual level approach

This thesis analyses the impact of workplace stressors and mood on innovation activities. Based on three competitive frameworks offered by cognitive spreading activation theory, mood repair perspective, and mood-as-information theory, different sets of predictions are developed. These hypotheses are tested in a field study involving 41 R&D teams and 123 individual R&D workers, and in an experimental study involving 54 teams of students. Results of the field study suggest that stressors and mood interact to predict innovation activities in such a way that with increasing stressors a high positive ( or negative) mood is more detrimental to innovation activities than a low positive (or negative) mood, lending support to the mood repair perspective. These effects are found for both individuals and teams. In the experimental study this effect is replicated and potential boundary conditions and mediators are tested. In addition, this thesis includes the development of an instrument to assess creativity and implementation activities within the realm of task-related innovative performance.

Work-related stressors and psychological strain in the sales force:the role of intrinsic and extrinsic motivation

The contemporary workplace appears rife with psychological strain, which can have considerable deleterious outcomes to the firm and the individual. However, research on strain in the sales force is underdeveloped. This paper reports the results of a study of the antecedents and consequences of psychological strain in the sales force, with particular attention to the roles of role ambiguity, emotional exhaustion, and intrinsic and extrinsic motivation. Emotional exhaustion is found to increase strain. Intrinsic motivation reduces strain under conditions of relatively high role ambiguity, but leads to more strain under conditions of low role ambiguity. Strain is found to have a J-shaped relationship with turnover intentions, and is linearly related to lower job satisfaction and lower job performance.

Workplace duties or opportunities? Challenge stressors, regulatory focus, and creativity

Previous research has produced contradictory findings about the impact of challenge stressors on individual and team creativity. Based on the challenge-hindrance stressors framework (LePine, Podsakoff, & LePine, 2005) and on regulatory focus theory (Higgins, 1997), we argue that the effect of challenge stressors on creativity is moderated by regulatory focus. We hypothesize that while promotion focus strengthens a positive relationship between challenge stressors and creativity, prevention focus reinforces a negative relationship. Experimental data showed that high demands led to better results in a creative insight task for individuals with a strong trait promotion focus, and that high demands combined with an induced promotion focus led to better results across both creative generation and insight tasks. These results were replicated in a field R&D sample. Furthermore, we found that team promotion focus moderated the effect of challenge stressors on team creativity. The results offer both theoretical insights and suggest practical implications. © 2013 Elsevier Inc.

Positive mood is not always good:the role of team mood and work stressors for creative work performance

Presentation of an abstract

The impact of stressors and regulatory focus on creativity:a dual level of analysis

Presentation

Positive mood is not always good:the role of team mood and work stressors for creative work performance

Presentation of an abstract

Attentional demand and cost responsibility as stressors in shopfloor jobs

Two studies were conducted to test for the effects of attentional demand and cost responsibility on psychological strain. One was a field experiment involving operators of computer-based manufacturing equipment, and the other was a cross-sectional investigation of employees in a wide range of jobs. The results showed increased strain only for those in jobs high on both attentional demand and cost responsibility. Implications for job design for new manufacturing technologies are discussed.

Abolishing the Audit Commission:framing, discourse coalitions and administrative reform

The abolition of the Audit Commission in England raises questions about how a major reform was achieved with so little controversy, why the agency lacked the institutional stickiness commonly described in the literature on organisational reform and why it did not strategise to survive. In this paper, we apply argumentative discourse analysis to rich empirical data to reveal the pattern and evolution of storylines and discourse coalitions, and the ways in which these interact with and affect the practices of Parliament, the media and the Audit Commission itself. Our analysis shows that the politics of administrative reform are as much about discursive framing and the ability of pro-reformers to gain discursive structuration and institutionalisation as they are about the material resources available to a newly elected government and its ministers. Questions of technical feasibility are unlikely to derail a reform initiative once its promoters gain discursive ascendency.

Florida International University Appoints College of Medicine Founding Dean, Former Chancellor of LSU's Health Sciences Center boasts Impressive Research and Administrative Experience

Press Release from Florida International University 's Office of Media Relations announcing the appointment of Dr. John Rock as founding Dean of Florida International University 's College of Medicine.

Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

Assessing administrative and political factors in implementing a living wage ordinance

Since 2000, the number of living wage ordinances has steadily increased throughout the country. While most of the current research has focused on the beneficial outcomes of living wages, little has been published on their administrative practices. To address this shortcoming, this study focused on the identification of key administrative and political factors involved impacting the implementation of living wage ordinances in Miami-Dade and Broward Counties. The study utilized a triangulation of interviews, surveys, and direct observation. The author conducted interviews of administrators and members of the living wage oversight boards in both counties and observed the monthly meetings held by each county's oversight board from January 2006 to June 2007. These findings were buttressed with a national survey of senior staff in other living wage communities. The study utilized descriptive statistics, Chi Square, Cronbach's Alpha, and Spearman's Rank Correlation Coefficient (Spearman's rho). Interviews indicated that administrators in Dade and Broward are seriously under-staffed and budgeted. Ambiguities in the enabling ordinances have lead to loopholes that undermine implementation and accountability for participating contractors. Survey results showed that policy ambiguity, organizational politics, and a lack of organizational capacity were significant negative factors in the implementation process while an organizational culture emphasizing consistent enforcement was a positive factor. Without the proper inputs, an organization hinders itself from meeting its outputs and outcomes. This study finds that Broward and Miami-Dade Counties do not provide the necessary administrative support to implement a living wage effectively – in stark contrast to the high hopes and strong political support behind their passage. For a living wage to succeed, it first needs an organizational culture committed to providing the necessary resources for implementation as well as transparent, consistent accountability mechanisms.

Comparative administrative reform: The rhetoric and reality of the Civil Service reform programs in Uganda and Tanzania

Administrative reform is a challenging endeavor for both developed and developing countries alike. For developing countries, the challenge is greater because numerous reforms are implemented concurrently sometimes under conditions of resource scarcity and political instability. So far there is no consensus as to what makes some reforms succeed and others fail. The current study seeks to fill that gap by offering an empirical comparative analysis of the administrative reforms initiated in Uganda and Tanzania since the early 1990s. The purpose of the study is to explain the similarities and differences, and give reasons for the successes and failures of the reform programs in the two countries. It focuses on four major areas; the size of the civil service, pay reform, capacity building, and ethics and accountability. Data were collected via in-depth face to face interviews with 35 key government officials and the content analysis of various documents. The results indicate that the reforms generated initial substantial reduction in the size of the public services in both countries. In Uganda, the traditional civil service was reduced from 140,500 in 1990 to 41,730 in 2004; while in Tanzania Ministries, Departments, and Agencies were reduced by 25%. Pay reform has generated substantial increases in civil servants' salaries in both countries but in Uganda, the government has not been able to abide by the pay strategy while in Tanzania the strategy guides the increments. Civil Service capacity building efforts have focused on enhancing the skills of the personnel. Training needs assessments were undertaken in all ministries in Uganda and a training policy was formulated. In Tanzania, the training needs assessments are still under way and a training policy has not yet been developed. Ethics and accountability are great challenges in both countries, but in Tanzania, there is more political will and commitment to improve the integrity of the civil service. The findings reveal that although Uganda started the reform with much more rigor and initial success, Tanzania has surpassed it and has a more stable, consistent, and promising reform record. This is because Uganda's leadership lacks political legitimacy. The country has since the late 1990s experienced a civil war in the northern and western parts of the country while Tanzania has benefitted from relative peace and high level political legitimacy.