Jeanette Kirk, Ove Andersen and Janne Petersen
Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools…
Abstract
Purpose
Older patients are at high risk of hospital readmission, which has led to an increasing number of screening and intervention programs. Knowledge on implementing screening tools for preventing readmissions in emergency department (ED), where the primary focus is often the present-day flow of patients, is scant. The purpose of this paper is to explore whether a new screening tool for predicting readmissions and functional decline in medical patients>65 years of age could be implemented and its influence on cross-continuum collaborations between the primary and secondary sectors.
Design/methodology/approach
The study took place in an ED in Denmark, in collaboration with the surrounding municipalities. An evaluation workshop with nurses and leaders from the ED and the surrounding municipalities took place with the aim of investigating the organizational changes that occurred in daily practice after the implementation of the screening tool. The workshop was designed and analyzed using cultural historical activity theory (CHAT).
Findings
The results showed that it was possible to develop collaboration between the two sectors during the test period. However, the screening tool created different transformations for the municipality employees and in the ED. The contradictions indicated that the screening tool did not mediate a general and sustained transformation in the cross-continuum collaboration.
Research limitations/implications
Screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context and sectors. CHAT offers a perspective to understand the collective object when working with organizational transformations and implementation.
Practical implications
The study have shown that screening tools are not objective, neutral or “acontexual” artifacts and must always be adapted to the local context. This is called adaption process. This adaption requires time and resources that should be taken into consideration from the beginning of introduction of new screens.
Originality/value
This paper contributes with knowledge about CHAT which offers a way to understand the leading collective object when working with organizational transformations and implementation. CHAT focuses not only on the structural changes but also on the cultural aspects of organizational changes, which is important if we want to reach a sustained change and implement the new screening tool in different sectors.
Details
Keywords
Jeanette Wassar Kirk, Nina Thorny Stefansdottir, Ove Andersen, Mette Bendtz Lindstroem, Byron Powell, Per Nilsen, Tine Tjørnhøj-Thomsen and Marie Broholm-Jørgensen
To explore the mechanisms of the implementation strategy, “oilcloth sessions” and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new…
Abstract
Purpose
To explore the mechanisms of the implementation strategy, “oilcloth sessions” and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new emergency department.
Design/methodology/approach
A qualitative design was used whereby data were collected using field notes from an ethnographic study of the oilcloth sessions and follow-up semi-structured interviews with staff, managers and key employees who participated in the oilcloth sessions. The data analysis was inspired by the realist evaluation approach of generative causality proposed by Pawson and Tilley.
Findings
The primary ripple effect was that the oilcloth sessions were used for different purposes than the proposed program theory, including being used as: (1) a stage, (2) a battlefield, (3) a space for imagination and (4) a strategic management tool influencing the implementation outcomes. The results bring essential knowledge that may help to explain why and how a well-defined implementation strategy has unplanned outcomes.
Originality/value
Unintended outcomes of implementation strategies are an underexplored issue. This study may help implementation researchers rethink the activities required to reduce unintended negative outcomes or explore potential unplanned outcomes and, in this way, hinder or enhance outcomes, effectiveness and sustainability. Future studies within implementation research should incorporate attention to unintended outcomes to fully understand the impact of implementation strategies.
Details
Keywords
Jeanette Kirk, Thomas Bandholm, Ove Andersen, Rasmus Skov Husted, Tine Tjørnhøj-Thomsen, Per Nilsen and Mette Merete Pedersen
The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in…
Abstract
Purpose
The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.
Design/methodology/approach
The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.
Findings
Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.
Research limitations/implications
The population of patients and relatives participating in the workshops was small, which likely affected the co-design process.
Practical implications
Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.
Originality/value
Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.
Details
Keywords
Ozgur Ekmekci and Andrea Casey
Very little is known about how contingent workers' identification with an organization evolves over time. This study seeks to contribute to the literature by investigating how the…
Abstract
Purpose
Very little is known about how contingent workers' identification with an organization evolves over time. This study seeks to contribute to the literature by investigating how the emergence and strength of organizational identification is affected by four variables: duration of primacy; duration of recency; frequency of interaction with other members of the organization; and frequency of information received about the organization.
Design/methodology/approach
Using a cognitive model of organizational identification grounded in memory, agent‐based modeling and NetLogo language were employed to form a model in which two groups of 567 contingent workers joined 1,134 different organizations and worked for 365 days. Correlation and multiple linear regression were used to analyze the data.
Findings
Evolution of organizational identification for a contingent worker depends on how much the individual interacts with other members of the organization and how much information about the organization that particular individual receives over time.
Research limitations/implications
The generalizability of the simulation study's findings may be expanded if similar studies are carried out incorporating factors that mark differences in individuals, groups, organizations, sectors, industries, cultures, and geographies.
Originality/value
The existing literature on how contingent employees identify with an organization does not adequately provide a process‐based view of the phenomenon. This study extends and complements literature on contingent workers by emphasizing the social construction of time in and from memory throughout the process of organizational identification.
Details
Keywords
Alison H. Parker, Jen A. Smith, Tania Verdemato, Jeanette Cooke, James Webster and Richard C. Carter
Effective menstrual management is essential for the mental and physical well being of women. However, many women in low-income countries lack access to the materials and…
Abstract
Purpose
Effective menstrual management is essential for the mental and physical well being of women. However, many women in low-income countries lack access to the materials and facilities required. They are thus restricted in their activities whilst menstruating thus compromising their education, income and domestic responsibilities. The paper aims to discuss these issues.
Design/methodology/approach
This study describes the menstrual management challenges faced by women in an emergency situation in Uganda. Totally, 50 interviews and focus group discussions were conducted with women from villages, internally displaced person (IDP) camps and schools so that the menstrual management of the host population could be compared with the IDPs.
Findings
This study showed that in IDP camps there was a significant lack of materials including soap, underpants and absorbing cloth, and facilities like latrines and bathing shelters. As a consequence women in IDP camps suffer with poor health and diminished dignity. There is also a lack of education about menstruation and reproductive health and practices are strongly influenced by cultural taboos.
Originality/value
This is the first time that the menstrual management of women in IDP or refugee camps has been studied.
Details
Keywords
The following is an annotated list of materials dealing with information literacy including instruction in the use of information resources and research and computer skills…
Abstract
The following is an annotated list of materials dealing with information literacy including instruction in the use of information resources and research and computer skills related to retrieving, using, and evaluating information. This review, the twenty‐first to be published in Reference Services Review, includes items in English published in 1994. A few are not annotated because the compiler could not obtain copies of them for this review.