Chiara Pomare, Kate Churruca, Janet C. Long, Louise A. Ellis and Jeffrey Braithwaite
Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different stakeholders…
Abstract
Purpose
Hospitals are constantly redeveloping to improve functioning and modernise the delivery of safe and high-quality care. In Australia, it is expected that different stakeholders have the opportunity to contribute to the design and planning of hospital redevelopment projects. The purpose of this study is to examine the potential for misalignment between policy (“work as imagined”) and staff experiences of a hospital redevelopment (“work as done”).
Design/methodology/approach
A case study of a large Australian hospital in a capital city undergoing redevelopment. Forty-six semi-structured interviews were conducted with hospital staff. Staff experiences were identified in corroboration with additional data: key-informant discussions with members of the hospital executive; document analysis (e.g. hospital and government documents) and survey responses about experiences of the hospital redevelopment.
Findings
A disjuncture was identified between policy and the experiences of hospital staff. Over one in every three (36.0%) staff felt uninformed about the redevelopment and 79.4% were not involved in decisions throughout the process of design and redevelopment, which contradicted the procedure laid out in policy for hospital development.
Originality/value
Despite the seemingly “good news story” of allocating billions of dollars to redeveloping and modernising health services in Australia, the experiences of staff on the front lines suggest a lack of consultation. Rectifying these concerns may be integral to avoid fragmentation during the challenging circumstances of hospital redevelopment.
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Victoria Walton, Anne Hogden, Janet C. Long, Julie Johnson and David Greenfield
This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.
Abstract
Purpose
This paper aims to explore if health professionals share understanding of teamwork that supports collaborative ward rounds.
Design/methodology/approach
A purpose-designed survey was conducted in two acute medical and two rehabilitation wards from a metropolitan teaching hospital. Medical officers, nurses and allied health professionals participated. To understand characteristics that support collaborative ward rounds, questions developed from literature and industry experience asked: what are the enablers and challenges to teamwork; and what are clinicians’ experiences of positive teamwork? Descriptive and thematic analyses were applied to the dimensions of effective teamwork as a framework for deductive coding.
Findings
Seventy-seven clinicians participated (93% response rate). Findings aligned with dimensions of teamwork framework. There was no meaningful difference between clinicians or specialty. Enablers to teamwork were: effective communication, shared understanding of patient goals, and colleague’s roles. Challenges were ineffective communication, individual personalities, lack of understanding about roles and responsibilities, and organisational structure. Additional challenges included: time; uncoordinated treatment planning; and leadership. Positive teamwork was influenced by leadership and team dynamics.
Practical implications
Ward rounds benefit from a foundation of collaborative teamwork. Different dimensions of teamwork present during ward rounds support clinicians’ shared understanding of roles, expectations and communication.
Originality/value
Rounds such as structured rounding, aim to improve teamwork. Inverting this concept to first develop effective collaboration will support team adaptability and resilience. This enables teams to transition between the multiple rounding processes undertaken in a single ward. The emphasis becomes high-quality teamwork rather than a single rounding process.
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Stephanie Best, Janet C. Long, Clara Gaff, Jeffrey Braithwaite and Natalie Taylor
Clinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has…
Abstract
Purpose
Clinical genomics is a complex, innovative medical speciality requiring clinical and organizational engagement to fulfil the clinical reward promised to date. Focus thus far has been on gene discovery and clinicians’ perspectives. The purpose of this study was to use implementation science theory to identify organizational barriers and enablers to implementation of clinical genomics along an organizations’ implementation journey from Preadoption through to Adoption and Implementation.
Design/methodology/approach
We used a deductive qualitative approach study design drawing on implementation science theory - (1) Translation Science to Population Impact Framework, to inform semi structured interviews with organizational decision-makers collaborating with Australian and Melbourne Genomics, alongside and (2) Theoretical Domains Framework (TDF), to guide data analysis.
Findings
We identified evolving organizational barriers across the implementation journey from Preadoption to Implementation. Initially the organizational focus is on understanding the value of clinical genomics (TDF code: belief about consequences) and setting the scene (TDF code: goals) before organizational (TDF codes: knowledge and belief about consequences) and clinician (TDF codes: belief about capability and intentions) willingness to adopt is apparent. Once at the stage of Implementation, leadership and clarity in organizational priorities (TDF codes: intentions, professional identity and emotion) that include clinical genomics are essential prerequisites to implementing clinical genomics in practice. Intuitive enablers were identified (e.g. ‘providing multiple opportunities for people to come on board) and mapped hypothetically to barriers.
Originality/value
Attention to date has centred on the barriers facing clinicians when introducing clinical genomics into practice. This paper uses a combination of implementation science theories to begin to unravel the organizational perspectives of implementing this complex health intervention.
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Jeffrey Braithwaite, Kristiana Ludlow, Kate Churruca, Wendy James, Jessica Herkes, Elise McPherson, Louise A. Ellis and Janet C. Long
Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected…
Abstract
Purpose
Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.
Design/methodology/approach
In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.
Findings
Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.
Practical implications
These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.
Originality/value
Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.
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This study is a radical interactionist analysis of family conflict. Drawing on both a negotiated order perspective and Athen's theory of complex dominative encounters, this study…
Abstract
This study is a radical interactionist analysis of family conflict. Drawing on both a negotiated order perspective and Athen's theory of complex dominative encounters, this study analyzes the role that domination plays in conflicts among intimates. As the family engages in repeated conflicts over roles, the family also engages in negotiations over the family order, what role each party should play, interpretations of past events, and plans for the future. These conflicts take place against a backdrop of patriarchy that asymmetrically distributes power in the family to determine the family order. The data from this study come from a content analysis of mothers with substance use problems as depicted in the reality television show Intervention. The conflicts in these families reveal that these families develop a grinding family order in which families engaged in repeated conflict but also continued to operate as and identify as a family. These conflicts are shaped by and reinforce patriarchal expectations that mothers are central to family operation. The intervention at the end of each episode offered an opportunity for the family to engage in a concerted campaign to try to force the mother into treatment and reestablish the family order.
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Charles Oppenheim and Joanna Wills
Considers one possible strategy for ensuring JANET’s continued growth and development, namely to introduce advertising on JANET web pages. Despite this strict policy of no…
Abstract
Considers one possible strategy for ensuring JANET’s continued growth and development, namely to introduce advertising on JANET web pages. Despite this strict policy of no commercial activity on JANET, a few passive advertisements are in fact permitted. Research into the feasibility of advertising was conducted by interviewing and by questionnaire. Key players involved in this topic and a number of JANET users were questioned. The best solution to the problem would be to allow Higher education institutions (HEIs) the choice of paying for an advert‐free JANET or receiving a free JANET with adverts.However, there would probably be more resistance on the part of HEIs to paying for JANET than keeping the service free of charge but containing advertisements.Therefore, it is recommended that advertising be placed on JANET for a trial period. During this period, reactions from users an the HEIs should be gathered.
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JANET(the Joint Academic Network) is a wide‐area network linking together computers and users in British universities, polytechnics, establishments of the research councils, and…
Abstract
JANET(the Joint Academic Network) is a wide‐area network linking together computers and users in British universities, polytechnics, establishments of the research councils, and the British Library. It provides for interactive working, file transfer, electronic mail and job transfer. Online access is possible to many catalogues of university and polytechnic libraries, the British Library's BLAISE‐LINE and ARTel services, and various bibliographic and numeric databases held on university computers. Users registered for electronic mail can use Janet to send this kind of mail to other sites in Britain, or overseas through the EARN, BITNET, and NORTHNET combined network. There are two‐way gateways between Janet and British Telecom network PDN, allowing access to commercial online hosts in Great Britain or overseas. These gateways can provide a faster and cheaper alternative to dial‐up use of PDN.
The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and…
Abstract
The Bureau of Economics in the Federal Trade Commission has a three-part role in the Agency and the strength of its functions changed over time depending on the preferences and ideology of the FTC’s leaders, developments in the field of economics, and the tenor of the times. The over-riding current role is to provide well considered, unbiased economic advice regarding antitrust and consumer protection law enforcement cases to the legal staff and the Commission. The second role, which long ago was primary, is to provide reports on investigations of various industries to the public and public officials. This role was more recently called research or “policy R&D”. A third role is to advocate for competition and markets both domestically and internationally. As a practical matter, the provision of economic advice to the FTC and to the legal staff has required that the economists wear “two hats,” helping the legal staff investigate cases and provide evidence to support law enforcement cases while also providing advice to the legal bureaus and to the Commission on which cases to pursue (thus providing “a second set of eyes” to evaluate cases). There is sometimes a tension in those functions because building a case is not the same as evaluating a case. Economists and the Bureau of Economics have provided such services to the FTC for over 100 years proving that a sub-organization can survive while playing roles that sometimes conflict. Such a life is not, however, always easy or fun.
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In the last four years, since Volume I of this Bibliography first appeared, there has been an explosion of literature in all the main functional areas of business. This wealth of…
Abstract
In the last four years, since Volume I of this Bibliography first appeared, there has been an explosion of literature in all the main functional areas of business. This wealth of material poses problems for the researcher in management studies — and, of course, for the librarian: uncovering what has been written in any one area is not an easy task. This volume aims to help the librarian and the researcher overcome some of the immediate problems of identification of material. It is an annotated bibliography of management, drawing on the wide variety of literature produced by MCB University Press. Over the last four years, MCB University Press has produced an extensive range of books and serial publications covering most of the established and many of the developing areas of management. This volume, in conjunction with Volume I, provides a guide to all the material published so far.