Guillermo A. Sandoval, Adalsteinn D. Brown, Walter P. Wodchis and Geoffrey M. Anderson
The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines…
Abstract
Purpose
The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines and in-patient mortality and length of stay.
Design/methodology/approach
This study used panel data (2007–2010) from 124 hospital corporations operating in Ontario, Canada. Imaging use focused on medical patients accounting for 25 percent of hospital discharges. Main outcomes were in-hospital mortality rates and average length of stay. A model for each outcome-technology combination was built, and controlled for hospital structural characteristics, market factors and patient characteristics.
Findings
In 2010, 36 and 59 percent of hospitals had adopted MRI machines and CT scanners, respectively. Approximately 23.5 percent of patients received CT scans and 3.5 percent received MRI scans during the study period. Adoption of these technologies was associated with reductions of up to 1.1 percent in mortality rates and up to 4.5 percent in length of stay. The imaging use–mortality relationship was non-linear and varied by technology penetration within hospitals. For CT, imaging use reduced mortality until use reached 19 percent in hospitals with one scanner and 28 percent in hospitals with 2+ scanners. For MRI, imaging use was largely associated with decreased mortality. The use of CT scanners also increased length of stay linearly regardless of technology penetration (4.6 percent for every 10 percent increase in use). Adoption and use of MRI was not associated with length of stay.
Research limitations/implications
These results suggest that there may be some unnecessary use of imaging, particularly in small hospitals where imaging is contracted out. In larger hospitals, the results highlight the need to further investigate the use of imaging beyond certain thresholds. Independent of the rate of imaging use, the results also indicate that the presence of CT and MRI devices within a hospital benefits quality and efficiency.
Originality/value
To the authors’ knowledge, this study is the first to investigate the combined effect of adoption and use of medical imaging on outcomes specific to CT scanners and MRI machines in the context of hospital in-patient care.
Details
Keywords
Suggests that, in traditional approaches to competence analysis,the emotional components of work are seldom considered. Yet many serviceoccupations, such as airline flight…
Abstract
Suggests that, in traditional approaches to competence analysis, the emotional components of work are seldom considered. Yet many service occupations, such as airline flight attendants, require considerable skill in dealing with other people′s feelings while effectively managing one′s own. The term “emotional competence” is used to describe this aspect of job performance. Reports a study of 52 flight attendants which was designed to ascertain their own feelings about their work and whether more needed to be done in training to prepare new workers for the emotional components of the job. Found that personal interactions with other people, passengers and crew, elicited both the most positive and the most negative responses; yet, overall, the respondents reported considerable job satisfaction. Many flight attendants made a distinction between the job tasks and the lifestyle nature of the job itself. Training for the emotional components of competence may require only slight additions to existing practices yet, as more work draws on skills in this area, this aspect of performance will become increasingly important.
Details
Keywords
The focus of training needs analysis is typically job performance. Ifpeople lack the knowledge or skills necessary to perform successfullythe various tasks which comprise their…
Abstract
The focus of training needs analysis is typically job performance. If people lack the knowledge or skills necessary to perform successfully the various tasks which comprise their jobs we have identified a training need. If another factor is hindering performance, such as faulty equipment or low morale, we have identified another type of need. We concentrate on job performance because it is observable and because it synchronizes with the behaviourist model of learning which figures so prominently in most thinking about training. It could well be argued that this deficiency approach is no longer adequate in our present environment in which the very nature of jobs and competences is subject to constant change. Argues for a more proactive, strategically based approach and suggests key issues which will need to be addressed at each stage of the process.
Details
Keywords
Geoff McCombe, Anne Marie Henihan, Jan Klimas, Davina Swan, Dorothy Leahy, Rolande Anderson, Gerard Bury, Colum Dunne, Eamon Keenan, David Meagher, Clodagh O’Gorman, Tom O’Toole, Jean Saunders, Bobby P. Smyth, John S. Lambert, Eileen Kaner and Walter Cullen
Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to…
Abstract
Purpose
Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness.
Design/methodology/approach
Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively sampled from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically.
Findings
Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced.
Research limitations/impelications
Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority.
Originality/value
To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.
Details
Keywords
Kathy Kornas, Meghan O'Neill, Catherine Y. Liang, Lori Diemert, Tsoleen Ayanian, Melissa Chang and Laura Rosella
The purpose of this study is to understand health care providers' experiences with delivering a novel Integrated Care (IC) Program that co-ordinates hospital-based clinical…
Abstract
Purpose
The purpose of this study is to understand health care providers' experiences with delivering a novel Integrated Care (IC) Program that co-ordinates hospital-based clinical services and home care for thoracic surgery patients, including perceptions on the provision of person-centred care and quality of work life.
Design/methodology/approach
The authors conducted a process evaluation using qualitative methods to understand provider experiences in the Integrated Care (IC) Program and to identify areas for programme improvement. Study data were collected using a focus group with thoracic surgeons, open-ended survey with home care providers, and semi-structured interviews with lead thoracic surgeons and IC leads, who are nurses serving as the primary point of contact for one consistent care team. Data were analysed using thematic analysis.
Findings
The IC Program was successful in supporting a partnership between health care providers and patients and caregivers to deliver a comprehensive and person-centred care experience. Informational continuity between providers was facilitated by IC leads and improved over time with greater professional integration and adaptation to the new care delivery processes. Differential impacts were found on quality of work life for providers in the IC Program.
Originality/value
This study describes provider experiences with delivering integrated and person-centred care across the hospital to home continuum, which can inform future integrated care initiatives.
Details
Keywords
Sheng Ye, Joanne Sneddon, Anat Bardi, Liat Levontin, Geoffrey Soutar and Julie Lee
This paper aims to draw on values theory, associative network theory and schema congruity theory to examine how consumers attribute human-like values to product categories and…
Abstract
Purpose
This paper aims to draw on values theory, associative network theory and schema congruity theory to examine how consumers attribute human-like values to product categories and products, and how these attributions affect product evaluations.
Design/methodology/approach
Study 1 randomly assigned 925 respondents to one of three product categories (cars, mobile phones and vacations). They were asked about their values and to attribute values to an assigned product category. Study 2 randomly assigned 919 respondents to one of the four value-expressive car conditions. They were asked to attribute values to the car, and then about their attitudes and purchase intentions.
Findings
Respondents attributed human-like values to product categories and products that were distinct and reflected the motivational compatibilities and conflicts inherent in the circular structure of human values. Moreover, multifaceted value congruity effects were found to positively influence attitudes and intentions to purchase a car, including congruity with product category values-schema, consumers’ personal values-schema and the structure of human values.
Originality/value
The authors demonstrate how a cognitive memory-based view can be used to better understand the complexities of the attribution of human-like values to products and product categories. Moving beyond the attribution of brand personality, this study shows the importance of not only understanding the attributions of values to a product but also considering how these attributions interact with the more abstract product category values to influence evaluations.
Details
Keywords
Cori Ann McKenzie and Geoff Bender
This paper encourages teachers and scholars of English Language Arts to engage deliberately with literary ambiguity.
Abstract
Purpose
This paper encourages teachers and scholars of English Language Arts to engage deliberately with literary ambiguity.
Design/methodology/approach
Through close attention to ambiguous moments in commonly taught texts, the essay argues that explicit attention to ambiguity can support four enduring goals in the field: fostering social justice, developing students’ personal growth, cultivating dispositions and skills for democracy and engendering disciplinary literacy skills.
Findings
The readings suggest the following: first, wrestling with ambiguities in Harper Lee’s To Kill a Mockingbird may foster critical orientations needed in the fight for social justice; second, ambiguities in Gene Luen Yang’s American Born Chinese may support students’ personal development; third, questions generated by Walter Dean Myers’ Monster invite readers to practice skills needed for democracy; finally, exploring divergent interpretations of Laurie Halse Anderson’s Speak may develop students’ disciplinary literacy skills.
Originality/value
In an era marked by standardization and accountability, it may be difficult for teachers and scholars to linger with literary ambiguity. By underscoring the instrumental potential of literary ambiguity, the essay illustrates why and how teachers might reject this status quo and embrace the indeterminacy of literary ambiguity.
Details
Keywords
Esme Franken, Geoff Plimmer and Sanna Malinen
Support from managers that enables employee growth promotes adaptation to changing and complex job challenges. Guided by social exchange theory, this study aims to establish…
Abstract
Purpose
Support from managers that enables employee growth promotes adaptation to changing and complex job challenges. Guided by social exchange theory, this study aims to establish growth-oriented management (GOM) as a key management capability to support employee growth. It also identifies employee resilience as a mechanism for growth in employees and examines its role in mediating the relationships between GOM and key employee outcomes: well-being and work engagement.
Design/methodology/approach
This study draws on survey data (n = 751) from white-collar employees in Australia. Structural equation modeling (SEM) was used to estimate the fit of the hypothesized model to the data. Confirmatory factor analysis was also performed to examine convergent and discriminant validity of the study variables.
Findings
Findings show GOM influenced well-being and work engagement, both directly and indirectly through employee resilience. This reveals more broadly that the unique combination of behaviors that comprise GOM plays a pivotal role in supporting growth-oriented outcomes in employees.
Originality/value
This is the first empirical study on the impact of GOM on well-being and engagement, as well as on the mediating mechanism of employee resilience in these relationships. GOM is an innovative contribution to scholarship on employee and organizational development, reflecting the changing nature of management, and responding to the increasingly diverse development needs of employees.
Details
Keywords
Jan Klimas, Kevin Lally, Lisa Murphy, Louise Crowley, Rolande Anderson, David Meagher, Geoff McCombe, Bobby P. Smyth, Gerard Bury and Walter Cullen
The purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and manage…
Abstract
Purpose
The purpose of this paper is to describe the development and process evaluation of an educational intervention, designed to help general practitioners (GPs) identify and manage problem alcohol use among problem drug users.
Design/methodology/approach
The educational session was developed as part of a complex intervention which was informed by the Medical Research Council framework for complex interventions. A Cochrane review and a modified Delphi-facilitated consensus process formed the theoretical phase of the development. The modelling phase involved qualitative interviews with professionals and patients. The training's learning outcomes included alcohol screening and delivery of brief psychosocial interventions and this was facilitated by demonstration of clinical guidelines, presentation, video, group discussion and/or role play.
Findings
Participants (n=17) from three general practices and local medical school participated in four workshops. They perceived the training as most helpful in improving their ability to perform alcohol screening. Most useful components of the session were the presentation, handout and group discussion with participants appreciating the opportunity to share their ideas with peers.
Originality/value
Training primary healthcare professionals in alcohol screening and brief psychosocial interventions among problem drug users appears feasible. Along with the educational workshops, the implementation strategies should utilise multi-level interventions to support these activities among GPs.