Oisín Conaty, Leah Gaughan, Colum Downey, Noreen Carolan, Megan Joanne Brophy, Ruth Kavanagh, Deborah A.A. McNamara, Edmond Smyth, Karen Burns and Fidelma Fitzpatrick
The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework.
Abstract
Purpose
The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework.
Design/methodology/approach
Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles. Data were fed back weekly using a point prevalence design (PPD). Interventions included SAP guideline changes, reminders and tools to support key messages.
Findings
SAP in 168 orthopaedic surgeries from 15 June 2016 to 31 January 2017 was studied. Prescribing appropriateness improved from 20 to 78 per cent. Junior doctor changeover necessitated additional education and reminders.
Practical implications
Due to constant staff changeover; continuous data collection, communication, education and reminders are essential to ensure continuous compliance with clinical guidance. Patients with hip fractures are difficult to weigh, requiring weight estimation for weight-based antimicrobial dosing. Unintended consequences of interventions included the necessity to change pre-operative workflow to accommodate reconstitution time of additional antimicrobials and inadvertent continuation of new antimicrobials post-operatively.
Originality/value
Rather than perform the traditional retrospective focused audit, we established a prospective, continuous, interventional quality improvement (QI) project focusing on internal processes within the control of the project team with rapid cyclical changes and interventions. The weekly PPD was pragmatic and enabled the QI project to be sustained with no additional resources.
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Daniel Meehan, Ameera Balhareth, Madhumitha Gnanamoorthy, John Burke and Deborah A. McNamara
The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources…
Abstract
Purpose
The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital.
Design/methodology/approach
A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes.
Findings
In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases.
Practical implications
Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals.
Originality/value
While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.
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Deborah A. McNamara, Paul Rafferty and Fidelma Fitzpatrick
Interdisciplinary healthcare education and collaboration facilitates healthcare quality improvement (QI). Education challenges include cost, logistics and defining the optimum…
Abstract
Purpose
Interdisciplinary healthcare education and collaboration facilitates healthcare quality improvement (QI). Education challenges include cost, logistics and defining the optimum staff-engaging method. The purpose of this paper is to determine the optimum QI educational model and measure its impact using plan-do-study-act (PDSA) cycles.
Design/methodology/approach
The authors established an on-site interdisciplinary QI learning collaborative: weekly 30-minute learning sessions close to the working environment; a learning materials Twitter repository; and junior doctor-led QI work streams aligned with surgical directorate quality goals supported by a mentorship network. Delivery style (lectures, workshops and QI project reporting) and learning session content was planned weekly using PDSA cycles and modified using participant feedback (score 0-10). All surgical directorate QI work streams were measured before and at nine months.
Findings
From May 2014 to February 2015, there were 32 learning sessions with 266 scores (median 12 weekly, range 5-21). Workshop delivery scored the highest (mean score 9.0), followed by live project reports (mean score 8.8). The surgical QI work streams increased threefold from four to 12, including six junior doctor-led projects.
Practical implications
By proactively acting upon feedback, the authors centralised QI measurement and tailored learning sessions to staff needs. Building sustainability involves continually refining learning curriculum and QI work streams, and expanding the mentorship network.
Originality/value
The collaborative was established at no additional cost. Twitter is used to promote meetings, facilitate conversations and act as a learning repository. The mentorship framework builds QI and coaching expertise.
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Patrick Ho Lam Lai, Deborah Hogan, Tay McNamara, Marcie Pitt-Catsouphes, Kathleen Christensen and Samuel L. Bradley
The unprecedented exigencies of COVID-19 and the subsequent spotlight on systemic racial, social and economic disparities have brought workplace equity to the forefront of…
Abstract
Purpose
The unprecedented exigencies of COVID-19 and the subsequent spotlight on systemic racial, social and economic disparities have brought workplace equity to the forefront of organizational dialogue. These discontinuities set the stage for discussions about possible limitations of traditional diversity, equity and inclusion (DEI) approaches that may have overlooked disparities in specific organizational systems. In response, we conducted an exploratory study to examine a new framework that focuses attention on the equity of employment systems that contextualize employees’ experiences of equity at the workplace.
Design/methodology/approach
This paper introduces a framework that focuses on the equity of ten key employment systems (job structures, compensation and benefits, recruitment and hiring, orientation and onboarding, supervision and mentoring, training and career development, employee performance assessment and feedback, employee resources and supports, promotion and separation). Combining the indices that measured the equity of these ten employment systems, we created an Overall Equity of Employment Systems Index and examined antecedent variables and outcomes related to the index. Data were gathered from HR leaders of 1,062 workplaces in the US.
Findings
Utilizing multivariate analyses, this research found that lower scores on the Organizational Pressures Index were consistently linked to higher levels of equity across all of the employment systems. Furthermore, higher percentages of women and employees of color were positively associated with increased equity in most of the employment systems and in the Overall Equity of Employment System Index. There was a significant positive relationship between the Overall Equity of Employment Systems Index and organizational resilience, while a negative relationship was observed with employee stress.
Practical implications
This study extends the existing DEI literature by offering a new framework that employers can use to: (1) assess the equity of specific employment systems and (2) strengthen the equity components of the employment systems.
Originality/value
The framework used for this exploratory study offers an alternative approach to the study of systemic equity in the workplace.
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Deborah Richards, Salma Banu Nazeer Khan, Paul Formosa and Sarah Bankins
To protect information and communication technology (ICT) infrastructure and resources against poor cyber hygiene behaviours, organisations commonly require internal users to…
Abstract
Purpose
To protect information and communication technology (ICT) infrastructure and resources against poor cyber hygiene behaviours, organisations commonly require internal users to confirm they will abide by an ICT Code of Conduct. Before commencing enrolment, university students sign ICT policies, however, individuals can ignore or act contrary to these policies. This study aims to evaluate whether students can apply ICT Codes of Conduct and explores viable approaches for ensuring that students understand how to act ethically and in accordance with such codes.
Design/methodology/approach
The authors designed a between-subjects experiment involving 260 students’ responses to five scenario-pairs that involve breach/non-breach of a university’s ICT policy following a priming intervention to heighten awareness of ICT policy or relevant ethical principles, with a control group receiving no priming.
Findings
This study found a significant difference in students’ responses to the breach versus non-breach cases, indicating their ability to apply the ICT Code of Conduct. Qualitative comments revealed the priming materials influenced their reasoning.
Research limitations/implications
The authors’ priming interventions were inadequate for improving breach recognition compared to the control group. More nuanced and targeted priming interventions are suggested for future studies.
Practical implications
Appropriate application of ICT Code of Conduct can be measured by collecting student/employee responses to breach/non-breach scenario pairs based on the Code and embedded with ethical principles.
Social implications
Shared awareness and protection of ICT resources.
Originality/value
Compliance with ICT Codes of Conduct by students is under-investigated. This study shows that code-based scenarios can measure understanding and suggest that targeted priming might offer a non-resource intensive training approach.
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Deborah Agostino and Yulia Sidorova
The purpose of this paper is to investigate how centres of calculation, now emerging in connection with social media, impact on the process of acting on distant customers…
Abstract
Purpose
The purpose of this paper is to investigate how centres of calculation, now emerging in connection with social media, impact on the process of acting on distant customers. Specifically, the authors are interested in exploring how the distance between the organization and its customer is affected and how knowledge is accumulated within this centre.
Design/methodology/approach
A case study in an Italian telecommunication company was conducted over a time horizon of two years, analysing data sources in the form of interviews, documents and reports, corporate website, social media platforms and participants’ observations. With the adoption of social media, the company configured a new centre of calculation, called monitoring room, in the attempt to accumulate knowledge about its customers. The authors unpacked the activity of the centre of calculation discussing its ability to perform action upon a distant periphery and the process of knowledge accumulation inside the centre itself.
Findings
The results highlight the implication of social media for “action at a distance”. On the one hand, social media blurs the distinction between the centre and a periphery giving rise to a de-centring, and stimulating a joint control activity between the customer and the organization. On the other hand, social media was found vulnerable in providing a unique knowledge about customers: accumulation cycles that exploit social media data can be replicated by users with skills in data analytics and the knowledge they provide might conflict with knowledge provided by traditional data.
Originality/value
The authors contribute to an emergent stream of literature that is investigating accounting implications derived from social media, by underlying the controversial effects connected with centres of calculation enacted by social media data. The authors suggest that, while social media data provide the organization with huge amount of information real time, at the same time, it contributes to de-centring allowing customers and external actors to act upon the organization, rather than improving knowledge inside the centre.
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Nina Helgevold and Chris Wilkins
Recent decades have seen a growing consensus that as the demands on teachers becomes increasingly complex, improving the effectiveness of both initial teacher education (ITE) and…
Abstract
Recent decades have seen a growing consensus that as the demands on teachers becomes increasingly complex, improving the effectiveness of both initial teacher education (ITE) and career-long professional development is key to school improvement. ITE in particular has been for too long polarised at policy level, between ‘theory-led’ and ‘practice-led’ approaches. This chapter discusses how this polarisation is simplistic and unhelpful and highlights the benefits of the more constructive orientation towards a synergistic relationship between theory and practice that can occur, particularly when schools and universities collaborate closely in bringing new teachers into the profession. This chapter sets the scene for subsequent chapters in this book by signalling the potential for the collaborative inquiry-based lesson study model into ITE to enhance partnerships between schools and universities and contribute to a smooth transition from ITE into lifelong professional learning.
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Anthony J. de Francesco and Deborah Levy
The purpose of this paper is to investigate the key drivers affecting property investment decisions within a context of sustainability and how these drivers are likely to change…
Abstract
Purpose
The purpose of this paper is to investigate the key drivers affecting property investment decisions within a context of sustainability and how these drivers are likely to change the investment product landscape and the management of existing property investment portfolios.
Design/methodology/approach
Examples from the Australian property market are discussed in order to demonstrate how sustainability principles may form part of the wider agenda of corporate property investment strategy and social responsibility.
Findings
A full understanding of the impact of sustainability on the property investment landscape can only be found by adopting an holistic approach, including the behavioural effects of economic, social, ecological, policy and regulative environments.
Originality/value
This paper provides important new insights as to the effect that sustainability may have on future investment decisions and the future investment product landscape.
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Laura Madden, Deborah Kidder, Kimberly Eddleston, Barrie Litzky and Franz Kellermanns
The purpose of this paper is to examine the differential effects of workplace stress and the use of social support by contingent vs standard employees.
Abstract
Purpose
The purpose of this paper is to examine the differential effects of workplace stress and the use of social support by contingent vs standard employees.
Design/methodology/approach
Conservation of resources (COR) theory is used to frame research questions. Using content analysis of 40 interviews from individuals in the hospitality industry, differences between the levels of stress reported by contingent and standard employees as well as differences in their use of social support networks to offset stress is examined.
Findings
Contingent employees report experiencing more stress than do standard employees in the same profession. Furthermore, contingent employees seek out more social support than do standard employees. There was no difference between the two groups with respect to the desire for social support from three sources: vertical, horizontal, and customer groups.
Originality/value
This study extends the literature on contingent workers, the literature on how different types of employees deal with stress, as well as adding to the COR literature by showing that contingent employees experience and assuage their stress differently than do standard employees.
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In the 1970s, the United States Congress enacted two statutes that have had dramatic and far‐reaching effects on the education of handicapped children by public schools. These two…
Abstract
In the 1970s, the United States Congress enacted two statutes that have had dramatic and far‐reaching effects on the education of handicapped children by public schools. These two laws, Section 504 of the Rehabilitation Act of 1973 and the Education For All Handicapped Children Act of 1975 (known as Public Law 94–142), have required local public school agencies to provide new eductional programs for thousands of handicapped children not previously served by the public schools. Counselors, principals, and teachers were quickly informed of the law's requirements and willingly began the task of main‐streaming and assimilating these children into various curricula. Their physical needs were attended to rapidly; their societal and emotional needs, unfortunately, lagged behind. Within the past seven years, there has been an increase in books, articles, and films specifically addressed to counseling the handicapped. Unlike past literature which focused only on the vocational aspect of rehabilitation counseling, current writing emphasizes personal counseling meant to assist a disabled child to participate fully in the problems and joys of daily living.