The purpose of this study is to improve compliance with clinical risk procedures across a United Kingdom based mental health trust.
Abstract
Purpose
The purpose of this study is to improve compliance with clinical risk procedures across a United Kingdom based mental health trust.
Design/methodology/approach
A cross‐sectional audit was carried out in April 2010. In total, 70 Risk Assessment Proformas (RAPS) were measured against an agreed “gold‐standard”. The standards were a combination of Department of Health recommendations as well as the current Hertfordshire Partnership NHS Foundation Trust (HPFT) policy on clinical risk assessment.
Findings
Only 53 (out of a possible 70) RAPS were completed. The acute and community psychiatric service stream samples on the whole provided more information within their RAPS than other parts of the service. There were overall low levels of documentation regarding service user and carer involvement.
Practical implications
To strengthen the clinical management of risk (and thus reduce harm) in mental health settings a systematic approach to risk assessment should be present. This involves clinicians working in partnership with both service users and carers. Based on the results, more needs to be done to actively involve carers and the service user in formulating the risk management plan. Not only will this promote positive risk management within the organization it will also enable individual “recovery”.
Originality/value
By auditing the organizational processes that underpin the management of risk, deficiencies in clinical care can be identified. Mental Health Trusts can promote positive risk management within their organization by engaging service users and their carers in managing risk.
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Alexis Bowers and Elham Aldouri
Despite contemporary mental health services shifting to a community‐based model of care, acute inpatient care is still necessary for many patients experiencing an acute…
Abstract
Purpose
Despite contemporary mental health services shifting to a community‐based model of care, acute inpatient care is still necessary for many patients experiencing an acute psychological crisis. As inpatient services cost the National Health Service nearly £600 million a year, initiatives to reduce time spent in hospital, whilst maintaining safety and quality, are being actively promoted on a national level. Mental health patients in Hertfordshire spend on average two weeks in hospital during their acute crisis. The aim of this study is to reduce bed occupancy rates by implementing a novel approach to inpatient management.
Design/methodology/approach
A pragmatic controlled clinical trial design was used to address the aim of this study.
Findings
The results demonstrate that, compared to a functionalized inpatient ward (one with a designated inpatient consultant psychiatrist conducting a weekly ward round), it is possible to reduce bed occupancy rates without increasing demand on other wards. Furthermore, 28‐day readmission rates and total admissions over seven days were reduced.
Research limitations/implications
Limitations relating to the study design and potential generalisability to similar services are discussed. Further studies to triangulate the data are suggested.
Practical implications
This novel approach to inpatient management provides exciting data that suggest patients can be moved along the acute pathway more efficiently. Recommendations for further studies are made in light of the findings.
Originality/value
This paper will appeal to acute care clinicians, service managers, and commissioners of mental health services. It provides an evidence base for making efficiencies within the acute service whilst maintaining quality of care for patients.
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This chapter explores queer theory as a “thought of a method” in educational ethnography by sharing stories of two third grade boys and situating them in a discussion of…
Abstract
This chapter explores queer theory as a “thought of a method” in educational ethnography by sharing stories of two third grade boys and situating them in a discussion of Britzman’s ideas about reading and Butler’s notion of fantasy. The stories are presented as a possible queer educational ethnography, in which the ethnographer writes the fantastic narrative of the boys as they read creatively to reveal and unsettle gender and reading as sites of constraint to which other constraints adhere. The boys’ reading itself is a queer reading of these constraints and as such makes alterity visible and possible. The study and the methodological framework suggest that educational ethnographers and other adults who work in schools should become attuned to the markers of constraint and alterity, so as to recognize, shelter, and maintain the alterity that children make possible. The chapter asserts children must be allowed to read for alterity, and shows how fantastic narratives that emerge from such readings are limited by the hushing of individuals who disallow alterity in classrooms. Ultimately, this chapter is relevant to ethnographers of education in that it suggests that queer theory not only is necessary to narrate and thus shelter the ways that gender can and should be unsettled in classrooms, but also allows us to narrate and shelter other queer urgencies related to fear, violence, and vulnerability that children experience or share in classrooms. Implications for the current climate of school reform based on standardization of curriculum are also discussed.
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Thomas Keil, Pasi Kuusela and Nils Stieglitz
How do organizations respond to negative feedback regarding their innovation activities? In this chapter, the authors reconcile contradictory predictions stemming from behavioral…
Abstract
How do organizations respond to negative feedback regarding their innovation activities? In this chapter, the authors reconcile contradictory predictions stemming from behavioral learning and from the escalation of commitment (EoC) perspectives regarding persistence under negative performance feedback. The authors core argument suggests that the seemingly contradictory psychological processes indicated by these two perspectives occur simultaneously in decision makers but that the design of organizational roles and reward systems affects their prevalence in decision-making tasks. Specifically, the authors argue that for decision makers responsible for an individual project, responses given to negative performance feedback regarding a project are dominated by self-justification and loss-avoidance mechanisms predicted by the EoC literature, while for decision makers responsible for a portfolio of projects, responses to negative performance regarding a project are dominated by an under-sampling of poorly performing alternatives that behavioral learning theory predicts. In addition to assigning decision-making authority to different organizational roles, organizational designers shape the strength of these mechanisms through the design of reward systems and specifically by setting more or less ambiguous goals, aspiration levels, time horizons of incentives provided, and levels of failure tolerance.
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Organizations may fail to innovate because receivers exhibit bias against adopting creative ideas. This paper explores many motivational, cognitive, and affective factors that can…
Abstract
Organizations may fail to innovate because receivers exhibit bias against adopting creative ideas. This paper explores many motivational, cognitive, and affective factors that can cause receivers to hinder the creativity–innovation process. In particular, receivers may engage in motivated reasoning and skepticism against creative ideas, face barriers to recognizing creative value, and experience negative affect when receiving creative ideas. Each creative adoption decision point during the creativity–innovation process is an opportunity for bias to derail progress. This helps explain why innovation can be so difficult. Understanding the biases that hinder the creativity–innovation process allows individuals and organizations to take action to mitigate them.
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Timothy R. Hannigan, Yunjung Pak and P. Devereaux Jennings
Entrepreneurship evolves in and around fields, particularly around the creation of opportunities. A central problem remains that entrepreneurial opportunities are both distributed…
Abstract
Entrepreneurship evolves in and around fields, particularly around the creation of opportunities. A central problem remains that entrepreneurial opportunities are both distributed among and co-created by embedded actors. We propose framing this in cultural terms as a “multiverse problem,” whereby entrepreneurial possibilities are understood within the bounds of a field, but also through traversing adjacent topographies. We argue that a focus on entrepreneurial moments captures important dynamics that bring together adjacent possibles, leading to drastically different pathways. The usefulness of this argument is illustrated in this paper through the articulation of a cultural cartographic approach to mapping and realizing entrepreneurial possibilities. We develop four principles of cultural cartography, apply them to several examples, and demonstrate implications to cultural entrepreneurship and adjacent theoretical traditions.
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Decentralization has been a continual focus of attention of both scholars and practitioners for more than half a century. Even though there is a general agreement on what…
Abstract
Decentralization has been a continual focus of attention of both scholars and practitioners for more than half a century. Even though there is a general agreement on what decentralization is, there is no consensus about how it should be measured. This article builds on the existing body of literature that specifies three major dimensions of decentralization: political, administrative, and economic. The article offers a measurement model that unifies these dimensions in a meaningful manner that allows for comparison across countries. The proposed model is then empirically tested using confirmatory factor analysis of a data set of 37 countries over the period 2000-2009. This factor analysis reveals that there are, in fact, only two dimensions of the decentralization process. The newly developed modelʼs index illustrates that the conceptually challenging processes of decentralization can be accurately measured and analyzed. The index can be used for hypothesis testing of the causality role of decentralization.