Medicines management across the primary-hospital healthcare interface: a study of paediatric patients

A comparison of medicines management documents in use by NHS organisations in the West Midlands confirms that there are important differences between the primary care and hospital sectors in respect to medicines management interface issues. Of these, two aspects important to paediatric patients have been studied. These are the transfer of information as a patient is admitted to hospital, and access to long-term medicines for home-patients. National guidance provided by NICE requires medication reconciliation to be undertaken on admission to hospital for adults. A study of paediatric admissions, reported in this thesis, demonstrates that the clinical importance of this process is at least as important for children as for adults, and challenges current UK guidance. The transfer of essential medication information on hospital admission is central to the medication reconciliation process. Two surveys of PCTs in 2007 and again in 2009 demonstrate that very few PCTs provide guidance to GPs to support this process. Provision of guidance is increasing slowly but remains the exception. The provision of long-term medicines for children at home is hindered by this patient population often needing unlicensed drugs. Further studies demonstrate that primary care processes regularly fail to maintain access to essential drugs and patients and their carers frequently turn to hospitals for help. Surveys of hospital medical staff (single site) and hospital nurses (six UK sites) demonstrates the activity these healthcare workers perform to help children get the medicines they need. A similar survey of why carers turn to a hospital pharmacy department for urgent supplies (usually termed rescue-medicines) adds to the understanding of these problems and supports identifying service changes. A large survey of community pharmacies demonstrates the difficulties they have when dispensing hospital prescriptions and identifies practical solutions. This programme concludes by recommending service changes to support medication management for children.

An exploratory study of management accounting and control systems in a developing country

This thesis reports on the results of case studies in four commercial banks in Nigeria. The study focuses how management accounting and control systems (MCS) operate in the four banks. The study is motivated by the dearth of literature on management accounting practices in the developing world in general and in Nigeria in specific. The case study approach adopted in conducting the research was useful in exploring the dynamics of the MCS in the organisations. Data was gathered from two sources. First, semi-structured interviews were conducted with managers at the head office, regional office and branches of each bank. The participants were selected from different backgrounds and managerial levels to provide broader understanding of the operations of the MCS. Second, various internal and external documents were reviewed to provide supporting evidence for the interview results. New institutional sociology (NIS) provided the theoretical framework to understand the results. NIS provided explanations for how the MCS in the four banks were shaped by diverse external and internal factors. The key factors identified as shaping the operations of the MCS were the need to comply with the regulatory environment (coercive isomorphism), the need to maintain social and cultural support (normative isomorphism) and the need to imitate successful organisations in order to appear legitimate (mimetic isomorphism). The study also examines the interplay between the institutional forces, market forces and infra-organisational power relations. This analysis is necessary to overcome the criticism of NIS that it downplays the role of market forces, agency and intra-organisational relations. The findings of the study have implications for understanding the operations of MCS in the developing world.

Managing careers and managing fairness : an organisational justice theory perspective on employee evaluations of, and reactions to, organisational career management practices

This thesis presents the results of a multi-method investigation of employee perceptions of fairness in relation to their career management experiences. Organisational justice theory (OJT) was developed as a theoretical framework and data were gathered via 325 quantitative questionnaires, 20 semi-structured interviews and the analysis of a variety of company documents and materials. The results of the questionnaire survey provided strong support for the salience of employee perceptions of justice in regard to their evaluations of organisational career management (OCM) practices, with statistical support emerging for both an agent-systems and interaction model of organisational justice. The qualitative semi-structured interviews provided more detailed analysis of how fairness was experienced in practice, and confirmed the importance of the OJT constructs of fairness within this career management context. Fairness themes to emerge from this analysis included, equity, needs, voice, bias suppression, consistency, ethicality, respect and feedback drawing on many of the central tenants of distributive, procedural, interpersonal and information justice. For the career management literature there is empirical confirmation of a new theoretical framework for understanding employee evaluations of, and reactions to, OCM practices. For the justice literatures a new contextual domain is explored and confirmed, thus extending further the influence and applicability of the theory. For practitioners a new framework for developing, delivering and evaluating their own OCM policies and systems is presented.

Management role in employee participation:a comparative study of multi-national enterprises in India and the U.K.

This research is an Anglo-Indian comparative case study. It studies managerial action in the participation arena of two British multi-nationals i.e. Cadbury Limited and ICI plc. The research was carried out in matched pairs of factories of the above named companies, located in the Midlands of the UK and in Bombay in India. The data for this research was collected through semi-structured interviews with managers and non-management actors, study of company documents and non-participant observation of some participation forums. The research conceptualises the idea of a `participation arena' consisting of the structures, processes, purposes and dynamics of participation. This arena is visualised as broadly reflecting the organisation structure and can be divided into corporate, unit and shopfloor level. Managerial action in this arena is examined in terms of interaction between three sets of factors i.e. company business objectives, strategies and policies; managerial values of power and control; and the responses of unions. Similarities and differences between management action in the home and host plants of the two multi-national companies are also examined. The major findings of the research are as follows. There is significant difference between the participation arena of the parent and the subsidiary company. The latter is marked by absence of higher level participation forums and lack of opportunity for employees to discuss, let alone influence, key decisions. This results from parent company control over key activities of the subsidiary. The similarities in management action in the participation arenas of the two companies in both countries can be attributed to the operation of the three sets of factors mentioned above. Nevertheless, the particular circumstances of each company are a greater influence on managerial action than the national context. Finally, future areas of research in this field are explored.

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.

"Girls Who Do Boys Like They’re Girls": gender and call centre’s junior management

This paper focuses on the structuring of work and organization by exploring the hierarchical and gendered nature of the division of labour within a contemporary service-based organization. Central to our account is the role of the ‘team leader’, which we argue, as a junior management position, occupies a key role in understanding and accounting for the gendered hierarchical terrain of the organization. In exploring the role of team leaders, a position that empirically, tends overwhelming to be held by female members of staff, we draw attention to the perception of the gendered nature of the role by subordinate members of the organization, team-leaders themselves, and more senior members of staff. The specific constitution and character of the team leader position is brought into sharp relief through comparison with the subordinate role of ‘problem manager’, a position which was overwhelming held by men. Our ethnographic approach attempts to draw attention to that which is both ‘said’ and ‘done’ within the organizational context and the account of junior managers that emerges is highly gendered. The paper seeks to map this account onto the existing and on-going debate within Gender and Organizational research, which explores, documents and challenges Masculinities at work.

Semantic annotation for knowledge management:requirements and a survey of the state of the art

While much of a company's knowledge can be found in text repositories, current content management systems have limited capabilities for structuring and interpreting documents. In the emerging Semantic Web, search, interpretation and aggregation can be addressed by ontology-based semantic mark-up. In this paper, we examine semantic annotation, identify a number of requirements, and review the current generation of semantic annotation systems. This analysis shows that, while there is still some way to go before semantic annotation tools will be able to address fully all the knowledge management needs, research in the area is active and making good progress.

Knowledge management for more sustainable water systems

The management and sharing of complex data, information and knowledge is a fundamental and growing concern in the Water and other Industries for a variety of reasons. For example, risks and uncertainties associated with climate, and other changes require knowledge to prepare for a range of future scenarios and potential extreme events. Formal ways in which knowledge can be established and managed can help deliver efficiencies on acquisition, structuring and filtering to provide only the essential aspects of the knowledge really needed. Ontologies are a key technology for this knowledge management. The construction of ontologies is a considerable overhead on any knowledge management programme. Hence current computer science research is investigating generating ontologies automatically from documents using text mining and natural language techniques. As an example of this, results from application of the Text2Onto tool to stakeholder documents for a project on sustainable water cycle management in new developments are presented. It is concluded that by adopting ontological representations sooner, rather than later in an analytical process, decision makers will be able to make better use of highly knowledgeable systems containing automated services to ensure that sustainability considerations are included.

Institutional contradiction and management control innovation:a field study of total quality management practices in a privatised telecommunications company

The purpose of this paper is to theorise the changes surrounding the introduction of a management control innovation, total quality management (TQM) techniques, within Telecom Fiji Limited. Using institutional theory and drawing on empirical evidence from multiple sources including interviews, discussions and documents, the paper explicates the institutionalization of these TQM practices. The focus of the paper is the micro-processes and practice changes around TQM implementation, rather than the influence of the macro-level structures that are often linked with institutional theory. The change agents used Quality Action Teams and the National Quality Council to introduce new TQM routines. The present study extends the scope of institutional analysis by explaining how institutional contradictions impact to create and make space for institutional entrepreneurs, who in turn, modify existing routines or introduce new routines in fluid organizational environments which also exhibit evidence of resistance.

Knowledge management for more sustainable water systems

The management and sharing of complex data, information and knowledge is a fundamental and growing concern in the Water and other Industries for a variety of reasons. For example, risks and uncertainties associated with climate, and other changes require knowledge to prepare for a range of future scenarios and potential extreme events. Formal ways in which knowledge can be established and managed can help deliver efficiencies on acquisition, structuring and filtering to provide only the essential aspects of the knowledge really needed. Ontologies are a key technology for this knowledge management. The construction of ontologies is a considerable overhead on any knowledge management programme. Hence current computer science research is investigating generating ontologies automatically from documents using text mining and natural language techniques. As an example of this, results from application of the Text2Onto tool to stakeholder documents for a project on sustainable water cycle management in new developments are presented. It is concluded that by adopting ontological representations sooner, rather than later in an analytical process, decision makers will be able to make better use of highly knowledgeable systems containing automated services to ensure that sustainability considerations are included. © 2010 The authors.

Learning by Doing in the Context of Modern Information and Media Literacy of Students in “Library and Information Management” in ULSIT Using the Digital Collection “Bulgarian Revival”

The purpose of this article is to evaluate the effectiveness of learning by doing as a practical tool for managing the training of students in "Library Management" at the ULSIT, Sofia, Bulgaria, by using the creation of project 'Data Base “Bulgarian Revival Towns” (CD), financed by Bulgarian Ministry of Education, Youth and Science (1/D002/144/13.10.2011) headed by Prof. DSc Ivanka Yankova, which aims to create new information resource for the towns which will serve the needs of scientific researches. By participating in generating the an array in the database through searching, selection and digitization of documents from these period, at the same time students get an opportunity to expand their skills to work effectively in a team, finding the interdisciplinary, a causal connection between the studied items, objects and subjects and foremost – practical experience in the field of digitization, information behavior, strategies for information search, etc. This method achieves good results for the accumulation of sustainable knowledge and it generates motivation to work in the field of library and information professions.

Digital Right Management (DRM) and Library Copyright Policy

The purpose of this paper is to introduce Digital Rights Management (DRM) and its implications for content producers, consumers, and libraries. Simply stated, DRM is a technology that allows copyright owners to regulate and manage their content when it is disseminated in a digital format, and it is the reason why some patrons cannot access some of the downloadable digital content provided by libraries. In the first part of this paper, we provide a short introduction to DRM by outlining the entities, the various technologies used as well as usage restrictions that come with DRM. In the second part of the paper are discussed the alternatives for the libraries, using DRM as a tool for library copyright policy and the main documents, which present the position of library organizations towards information legislation.

Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

Customer relationship management: A content analysis of issues and best practices

This dissertation is a study of customer relationship management theory and practice. Customer Relationship Management (CRM) is a business strategy whereby companies build strong relationships with existing and prospective customers with the goal of increasing organizational profitability. It is also a learning process involving managing change in processes, people, and technology. CRM implementation and its ramifications are also not completely understood as evidenced by the high number of failures in CRM implementation in organizations and the resulting disappointments. ^ The goal of this dissertation is to study emerging issues and trends in CRM, including the effect of computer software and the accompanying new management processes on organizations, and the dynamics of the alignment of marketing, sales and services, and all other functions responsible for delivering customers a satisfying experience. ^ In order to understand CRM better a content analysis of more than a hundred articles and documents from academic and industry sources was undertaken using a new methodological twist to the traditional method. An Internet domain name (http://crm.fiu.edu) was created for the purpose of this research by uploading an initial one hundred plus abstracts of articles and documents onto it to form a knowledge database. Once the database was formed a search engine was developed to enable the search of abstracts using relevant CRM keywords to reveal emergent dominant CRM topics. The ultimate aim of this website is to serve as an information hub for CRM research, as well as a search engine where interested parties can enter CRM-relevant keywords or phrases to access abstracts, as well as submit abstracts to enrich the knowledge hub. ^ Research questions were investigated and answered by content analyzing the interpretation and discussion of dominant CRM topics and then amalgamating the findings. This was supported by comparisons within and across individual, paired, and sets-of-three occurrences of CRM keywords in the article abstracts. ^ Results show that there is a lack of holistic thinking and discussion of CRM in both academics and industry which is required to understand how the people, process, and technology in CRM impact each other to affect successful implementation. Industry has to get their heads around CRM and holistically understand how these important dimensions affect each other. Only then will organizational learning occur, and overtime result in superior processes leading to strong profitable customer relationships and a hard to imitate competitive advantage. ^

Process of privatization: Benefits of *reform in management of public housing

The study of the private management of public housing is an important topic to be critically analyzed as the government search for ways to increase efficiency in providing housing for the poor. Public Housing Authorities must address the cost for repairing or replacing the deteriorating housing stock, the increase in the need for affordable housing, and the lack of supply. There is growing pressure on efficient use of public funds that has heightened the need for profound structural reform. An important strategy for carrying out such reform is through privatization. Although privatization does not work in every case, the majority position in the traditional privatization literature is that reliance on private organizations normally, but not always, results in cost savings. ^ The primary purpose of this dissertation is to determine whether a consensus exist among decision-makers on the efficiency of privatizing the management of public housing. A secondary purpose is to review the techniques (best practices) used by the private sector that results in cost-efficiencies in the management of public housing. The study employs the use of a triangulated research design utilizing cross-sectional survey methodology that included use of a survey instrument to solicit responses from the private managers. The study consists of qualitative methods using interviews from key informants of private-sector management firms and public housing agencies, case studies, focus groups, archival records and housing authorities documents. ^ Results indicated that important decision-makers perceive that private managers made a positive contribution to cost-efficiencies in the management of public housing. The performance of private contractors served as a yardstick for comparison of efficiency of services that are produced in-house. The study concluded that private managers made the benefits of their management techniques well known creating a sense of competition between public and private managers. Competition from private contractors spurred municipal worker and management productivity improvements creating better management results for the public housing authorities. The study results are in concert with a review of recent research and studies that also concluded private managers have some distinct advantages to controlling costs in the management of public housing. ^