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Many different kinds of patrons are interested in wage and salary information: business people contemplating job changes, collective bargaining officials, personnel and recruitment officers, students choosing careers or preparing for job interviews, marketing professionals researching industries. However, in many cases wage and salary information is elusive. Some reports with current publication dates cite data that are several years old. Other information reflects national averages when a patron needs regional or state norms. Some sources report beginning salaries, but not typical wages for experienced employees. At times, salary information for managers and executives is easy to find, but not that for blue collar workers in the same industry. Tracking down useful figures can be a frustrating experience for both librarian and patron.

To improve service and increase user satisfaction, some libraries are exploring new models of collaboration among the Interlibrary Loan, Collection Development and Acquisitions departments. One public library and two university libraries present models in which funds were set aside to purchase materials requested by library users through interlibrary loan. The models differ in some details but in all cases interlibrary loan staff select the titles to be purchased and acquisitions staff rush order the requested titles. Titles are then either rush processed in technical services and circulated to the user, or are received un‐processed in interlibrary loan for immediate patron use and are cataloged later. All three models have been in operation for two years or more and have moved from the pilot project stage to permanent implementation. Data are presented on the effectiveness of these models, including turnaround time, average cost per title, user satisfaction, and subsequent circulation of titles.

Fee‐based services in libraries offer research and document delivery services to non‐primary clientele on a cost‐recovery basis. Highlights services at the University of Colorado, Boulder, Rice University and Purdue University. Explores the major financial considerations involved in starting a new fee‐based service, including planning, staffing, pricing and marketing. Relates several special opportunities to which the libraries could not have responded without having had an existing fee‐based service with experienced staff in place. Also examines Internet opportunities.

Finding a balance between the provision of quality individualized care and the ongoing education of junior doctors had been flagged as a concern at a large National Health Service (NHS) teaching hospital in the north of England. In response to this, the organization introduced an intervention designed to improve educational culture by providing support to educators, leaders and clinical staff.

This paper features themed results from eight in-depth interviews with educators, consultants and junior doctors to describe and evaluate the process and impact.

Factors that contributed to a positive educational environment included trainees and educators feeling valued, the presence of supportive leaders and the provision of a safe space for learning. Perceived barriers included time constraints, differing motivation and the generic format of formal education. Participants reflected on how the Wrap Around project helped improve the workplace educational culture and offered suggestions for further improvement including the provision of ongoing feedback to learners about their performance.

Research aimed at recognizing and resolving the perceived tensions between the priorities of education and health-care delivery has been flagged as a gap in the literature. The authors argue that developing and enhancing collaborative leadership and educational culture within an organization can reduce these tensions for those working on the front line. Future work should focus on addressing the perceived distinction between the two within services.

The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care organisations.

Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to Care™ in English hospitals, the paper explores leadership in relation to local implementation. Data were attained from in-depth interviews with senior managers, middle managers and frontline staff (n=79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership.

Four overall themes were identified: different leadership roles at multiple levels of the organisation, experiences of “good and bad” leadership styles, frontline staff having a sense of permission to lead change, leader's actions to spread learning and sustain improvements.

This paper offers useful perspectives in understanding informal, emergent, developmental or shared “new” leadership because it emphasises that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader's boundary spanning activities to spread learning and sustain improvements.

The COVID-19 pandemic continues to challenge healthcare systems worldwide. The authors examined the lived experiences and perceptions of healthcare workers (HCWs) in managerial and senior positions to explore the pandemic's effects on well-being and valued organisational responses.

Using purposive sampling, the authors conducted 39 semi-structured interviews with senior staff including health service administrators, heads of department and senior clinicians at a designated COVID-19 facility in New South Wales, Australia. Interviews were conducted from November 2020 to February 2021 to reflect on experiences during the height of the pandemic in 2020 (mid-March to the end of May 2020).

Workplace experiences affecting HCWs' well-being included being shunned by others, fear of infecting family, fear of the unknown, concerns about personal protective equipment, lack of direction from above and increased workload. Organisational interventions to protect the health and safety of HCWs and their patients included redeployment, improved communication, effective management committees, education and mental health supports.

Organisations can minimise worker-identified factors threatening their well-being during a health crisis by applying broad-ranging initiatives including inclusive and open communication, promoting flexible work practices, providing up-to-date guidelines and policies and fostering camaraderie between workers.

The voices of senior clinical and managerial staff have been largely unheard during the COVID-19 pandemic. The authors addressed this deficit by describing their experiences and insights regarding the pandemic's impact on well-being and the organisation's responses to simultaneously safeguarding its staff and providing quality patient care.

As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time.

Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n=133) and 2011 (n=130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis.

At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p=0.02) and the Ward-II (p=0.04), but not at Ward-I (p=0.11).

Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change.

Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members’ relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging.

This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean.

There is increasing evidence in the literature that patient outcome is strongly linked to the quality of nursing care. In practice, the process of measuring the quality of nursing care is complex and multifaceted as it is dependent not only on the skills and practices of the individual nurse, but also on the professional and organisational structure that is practised within. The expert panel concept was developed to address clinical standards and practice at The Royal Melbourne Hospital. The Nursing Expert Panel's purpose was to evaluate nursing practice, identify practice deficits, highlight areas of clinical innovation and excellence, and make recommendations where appropriate to improve patient outcome. The aim of this paper is to investigate this.

A pilot programme to evaluate eight clinical areas was developed and implemented. The key areas of evaluation included clinical care as well as the managerial and professional practices that support patient care. The Expert Panel, consisting of predominantly nursing staff, was recruited from within the organisation. During the evaluation, the panel collected qualitative and quantitative data using a variety of data collection tools. Data were then analysed and recommendations developed.

Five common themes of practice deficit were identified during the pilot period and the development of strategies for practice improvement is in progress.

Following successful implementation of the pilot phase, the Nursing Expert Panel process is now being implemented across the organisation. With ongoing evaluation and improvement of the Expert Panel Process, this quality initiative will become the foundation of nursing standards and practice evaluation at this organisation.

Effective voice behavior in healthcare workers is critical for patient safety, quality improvement and workforce well-being. A review of the literature on voice behavior in healthcare highlights that little is known about the voice behaviors of new graduates in allied health and that current theory, from medical and nursing research, does not adequately apply to this sector. New knowledge about voice behavior for this sector of the workforce will support education and healthcare institutions in building and sustaining a healthy voice behavior culture.

This paper reports on phase two of a two-phase study looking at the voice behavior experiences of new allied health graduates over one year. Using a realist perspective and narrative analysis, we uncover and illustrate what works, with whom and under what conditions.

Four synthesized narratives outline the contexts and mechanisms that result in different voice behavior outcomes – speaking up effectively, speaking up with unmet expectations, not speaking up and a reduction in speaking up over time. Experiences of positive interprofessional collaboration and reflective supervision supported effective voice behavior.

This study used a case study approach, focusing on healthcare providers within a large New Zealand city and a cohort of 10 participants. Some researchers argue that small numbers limit the generalization of findings to different populations. Realists argue that, given the way in which knowledge is developed using realist methodologies, the resultant theory is portable. Interviews were conducted online during the COVID-19 pandemic. This may have impacted the connection between the interviewer and interviewee, causing the interviewees to not express their true thoughts. However, the interviewer did take time to connect with the interviewees and build trust over the three interviews over one year. Participants did not capture the diversity in the allied health workforce – most identified as female and none identified as Māori/Indigenous. And finally, participants could inhibit or exaggerate information due to the influence of social desirability. This does not appear to be a significant limitation in this study, given the many examples shared by the participants highlighted their challenges.

This study provides an in-depth exploration of how new graduates in allied health experience speaking up. Our findings enrich the knowledge of speaking up by using synthesized narratives to provide insights into what factors can enable a healthy speaking up culture within the new graduate allied health workforce. This is new knowledge that will be of interest at the individual, team and organizational levels of healthcare. The findings will support curriculum design and new graduate support frameworks for the education and health sectors. Highlighted in this study are the importance of the following factors in supporting speaking up for allied health new graduates: the employment of reflective supervision, purposeful facilitation of team belonging and interprofessional collaboration and tailored speaking up training for allied health new graduates and leaders in healthcare.

By taking a realist perspective and using narrative analysis, we gain an understanding of the voice behavior experiences of new graduates in allied health and the contextual factors and mechanisms that activate effective voice behavior in sub-acute and rehabilitation settings. These findings differ from nursing and medicine and highlight the benefits of reflective supervision and interprofessional collaborative practice.

Bruno Latour, one of the architects of actor-network theory, has now enfolded this approach within a larger project, An Inquiry into Modes of Existence – AIME. Framed as an empirical inquiry into the ontological and epistemological conditions of modernity, Latour argues for a radical shift in how “objective truth,” “scientific fact,” and “meaning” are established within the world. In this chapter, I draw on several elements of AIME to illustrate how Latour’s ontology, building on, augmenting and responding to criticisms of actor-network theory, can be used to explore higher education, focussing on one episode derived from a larger ethnography of medical education.