Assessment of nurses' work climate at Alexandria Main University Hospital

Work climate is indicative of how well the organization is realizing its full potential. An accurate assessment of work climate can identify the unnecessary obstacles to nurses interfering with their best performance. The present study aims to assess nurses' work climate at Alexandria Main University Hospital. The study sample included all nurses (N=400) who were working in inpatient medical and surgical units at the Alexandria Main University Hospital who were available at the time of data collection. A structured questionnaire was developed to assess nurses' perceptions regarding the dimensions of work climate. Data was collected by individual interview using the structured questionnaire. Results indicated that the highest percentages of nurses in medical and surgical units perceived that their work climate is characterized by good way of performance management, feeling of responsibility, warmth and supportive relationships, quality of communication, morale, organizational clarity and feeling of identity and belongness to the hospital. Nurses perceived that they are lacking work climate conducive to conflict resolution, participation in decision making, opportunity for training and development, fair rewards and recognition, calculated risks, sufficient resources, effective leadership and teamwork. There were no significant difference between nurses perceptions in medical and surgical units regarding all dimensions of work climate. The highest percentage of nurses in all units were satisfied only with the feeling of responsibility, way of performance management, and quality of communication. Conflict and identity were perceived as the most important areas that need improvement in the hospital. Based on the results recommendations were given to enhance work climate through designing compensation and recognition systems, and negotiate their requirements and accomplishment based on established standards and outcomes measures. Also, encouragement of and planning for participative decision making, teamwork, in-service training program and open communication are recommended to be present in the work units.     

Nutrition and the health care agenda: a primary care perspective

The current climate of prioritizing in the NHS brings into focus the debate surrounding efficient and effective management of conditions associated with the modern lifestyle. In any such debate, nutrition should be considered a primary issue as there is now international consensus regarding the optimum diet for the prevention of both coronary heart disease and cancer. Over recent years, government has stated that primary care is in an ideal setting to provide nutrition education to the public. However, we present the case that there currently is a mismatch between the attitude of the public, who appear willing to accept dietary advice from primary care professionals, and the reluctance on behalf of these professionals to fulfil this role. Dissatisfaction with the quality of nutrition education received by those working in primary care is often cited as a barrier to providing dietary advice to patients. With that in mind, we go on to discuss educational strategies that may motivate primary care staff to increase their involvement in providing dietary advice for their patients. The challenge to those involved in the delivery of nutrition training to primary care professionals is to convince them that dietary intervention is worthwhile and that they can make a positive contribution to dietary change within the current organization of primary care. Increasing motivation is an essential outcome of such training, along with providing the skills and knowledge to fulfil this role. The contribution which diet could make is significant and, in this time of questioning priorities, the role of nutrition needs to be put firmly on the health care agenda.     

The impact of organisational settings on physician wellbeing

PURPOSE: The purpose of this research is to show that the Swedish health care system has undergone major changes during the last decades, which have exerted strong influence on the operational freedom of physicians. DESIGN/METHODOLOGY/APPROACH: This study consisted of 169 physicians in management positions, who answered a questionnaire assessing the relationship between their organizational settings and their perceived wellbeing. The organizational setting was defined as contact with top management, decision-making influence, well defined organization and whether the physician is acting as a leader. The perceived wellbeing was defined as social climate, work related exhaustion, work satisfaction, influence, development ability and supportive leadership. FINDINGS: According to the results, organizational support improves work satisfaction and mental energy, and decreases work related exhaustion among physicians. This all leads to decreasing turnover rate among physicians. ORIGINALITY/VALUE: These results point to the importance of maintaining a positive and supportive atmosphere for physicians in their work environment in order to encourage physicians to remain and take on management positions in the health care system. Furthermore enhancing physician influence over decision making processes is important to counteract work-related exhaustion and it might also contribute to a more efficient organization.     

Towards an evidence based health care management

Inspired by the development of Evidence Based Medicine, this article introduces a new approach for health care management called Evidence Based Management. This approach promises to improve the practice of health care management, at the same time as it may stimulate research on the organization and management of health care. Evidence Based Management means that health care managers should learn to search for and critically appraise evidence from management research as a basis for their practice. This will require some new managerial skills that should be included in the education and training of health care managers. It will also require a new orientation for research on health care management. There will be a demand for more applied research, and also for research with a more positivist orientation. Copyright © 1998 John Wiley & Sons, Ltd.     

Physician executives in managed care: characteristics and job involvement across two career stages.

This paper examines characteristics, job involvement, and career stage differences among 294 physician executives working in managed care settings. The following research questions guide the study: What types of physicians are currently in managerial roles in these settings? What role (if any) does medical career stage play in physician executives' professional and job-related attitudes? What factors are related to physician executives' involvement in their management roles? Several observations are made from the findings. First, contemporary physician executives see management as an exciting alternative career that involves multiple work loyalties, weaker beliefs in traditional professional values, and the sacrifice of significant amounts of clinical for management work. Second, these trends are more pronounced for physician executives at earlier points in their medical careers, although their work loyalties to profession and employing organization are weaker than older physician executives' loyalties. Younger individuals' involvement in management work, more than older individuals' involvement, appears to depend upon the surrounding work climate within the organization. Finally, the amount of time spent by physician executives as clinicians is inversely related to how psychologically attached they are to management, regardless of career stage.     

Work time losses of medical personnel at a rural medical center

Proceeding from the study of the work of medical personnel at the rural physician's station, a set of recommendations has been developed. They involve improvement of management of medical facilities at the rural physician's station, planning and information supply, outpatient and inpatient care, labour organization and vocational training of the staff, raising efficacy of preventive work. Application of the above recommendations help us decrease significantly inadequate work time losses and increase the share of the main types of work of the medical personnel. Thus, it is shown that work efficiency of medical staff can be raised and health care delivery to the rural population improved.     

Economic organization of medicine and the Committee on the Costs of Medical Care.

Recent strategies in managed care and managed competition illustrate how health care reforms may reproduce the patterns of economic organization of their times. Such a reform approach is not a new development in the United States. The work of the 1927-1932 Committee on the Costs of Medical Care exemplifies an earlier effort that applied forms of economic organization to medical care. The committee tried to restructure medicine along lines consistent with its economic environment while attributing its models variously to science, profession, and business. Like current approaches, the committee''s reports defined costs as the major problem and business models of organization as the major solution. The reports recommended expanded financial management and group medicine, which would include growth in self-supporting middle-class services such as fee clinics and middle-rate hospital units. Identifying these elements as corporate practice of medicine, the American Medical Association-based minority dissented from the final report in favor of conserving individual entrepreneurial practice. This continuum in forms of economic organization has limited structural reform strategies in medicine for the remainder of the century.     

Designing a first-line manager development program using organization-appropriate strategies.

First-line managers (head nurses) are increasingly accountable for all aspects of nursing care delivery and resource management on a unit. However, traditional methods of training head nurses may not adequately prepare them to meet their increasing responsibilities. A structured first-line manager development program can help correct this deficiency. However, the successful implementation of such a program requires an understanding of organizational culture as well as substantive knowledge about management. This article describes how a hospital-based first-line manager development program was designed and implemented by using strategies appropriate to the values, norms, and resources within the organization.     

Riding the waves of change in health system material management: team building in times of uncertainty.

Within the health care industry, reorganization brings new challenges and opportunities for improving work-related processes. This article examines one Midwestern health system's response to the systemic change that may occur after restructuring. The consolidation of diverse and separate material management departments within one integrated material management division prompted a concerted team development and training effort. In this model, management and non-management staff worked collaboratively to achieve a unified work group that will continue to evolve and grow with the needs of the organization.     

The Changing Nature of Management in Child Care Centres in Queensland: A Review of Directors' Perspectives

The aim of this paper is to produce an understanding of directors' work; perceptions of their role as managers in the centre; their experiences; and the nature of management within the context of the child care field in a complex social, legislative and economic climate. In the current context of the delivery of child care services in a market-driven climate, the language of business and organisational theory has entered the lexicon of the early childhood field. The findings indicate that the director of a child care centre needs to have knowledge, skills and experience in business management to enhance their competencies for management of centres in today's competitive environment.     

Quality circles: the nurse executive as mentor

Changes within and around the health care environment are forcing health care executives to reexamine their managerial and leadership styles to confront the resulting turbulence. The nurse executive is charged with the profound responsibility of directing the delivery of nursing care throughout the organization. Care delivered today must be of high quality. Declining financial resources as well as personnel shortages cause the executive to be an effective innovator in meeting the increasing demands. Quality circles offer the nurse executive an avenue of recourse. Circles have been effectively implemented in the health care setting, as has been consistently documented over time. By way of a participative management approach, quality circles may lead to increased employee morale and productivity, cost savings, and decreased employee turnover rates, as well as realization of socialization and self-actualization needs. A most effective approach to their introduction would be implementation at the first-line manager level. This promotes an acceptance of the concept at the management level as well as a training course for managers to implement the process at the unit level. The nurse executive facilitates the process at the first-line manager level. This facilitation will cause a positive outcome to diffuse throughout the entire organization. Quality circles offer the nurse executive the opportunity to challenge the existing environmental turmoil and effect a positive and lasting change.     

Hospital management in the context of health sector reform: a planning model in Ethiopia

Through health sector reform in developing countries, Ministries of Health have sought to enhance health care through greater community governance and improved management effectiveness in their public hospitals. In this paper, we present a partnership-mentoring model for enhancing management capacity that has been piloted in Ethiopia and may be useful in other developing countries. The model included needs assessment and baseline evaluation using a hospital management indicator checklist, deployment of 24 Fellows (US and international hospital administrators) for 1 year to work as mentors with hospital management teams in 14 Ethiopian hospitals, continuing didactic and practical training in quality improvement methods for hospital management teams, and 24 management improvement projects to be completed during the year with plans for replication more broadly as appropriate. Surveys of Fellows and Ethiopian managers within the first quarter of onsite activity found high levels of trust in one another's abilities and intent to implement changes. The partnership-mentoring model promotes sustainability and may provide other countries with approaches for improving the quality of hospital care through improved hospital management. Copyright (c) 2007 John Wiley & Sons, Ltd.     

Total quality management in a health care organization: how are employees affected?

Since the late 1980s, health care managers have exhibited a rapidly growing interest in large-scale total quality management (TQM) programs. This quasi-experimental study examines the effects of one such TQM program on employee job satisfaction, perceptions of organizational climate, and general opinions concerning the work situation. Two years after the TQM program had been introduced, responses of participants and nonparticipants were compared. Participants in the program exhibited a higher level of job satisfaction and more favorable opinions regarding both the organization and their work.     

Best Practices of Total Quality Management Implementation in Health Care Settings

Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations.     

Best practices of total quality management implementation in health care settings

Due to the growing prominence of total quality management (TQM) in health care, the present study was conducted to identify the set of TQM practices for its successful implementation in healthcare institutions through a systematic review of literature. A research strategy was performed on the selected papers published between 1995 and 2009. An appropriate database was chosen and 15 peer-reviewed research papers were identified through a screening process and were finally reviewed for this study. Eight supporting TQM practices, such as top-management commitment, teamwork and participation, process management, customer focus and satisfaction, resource management, organization behavior and culture, continuous improvement, and training and education were identified as best practices for TQM implementation in any health care setting. The article concludes with a set of recommendations for the future researchers to discuss, develop, and work upon in order to achieve better precision and generalizations.     

Harnessing the power of medical malpractice data to improve patient care

Intelligence gleaned from medical malpractice cases helps health care institutions analyze their litigation practices, trend financial outcomes, and even identify clinical services needing attention. But when examined more deeply, medical malpractice data can also be a powerful patient safety tool by revealing clinical patterns that contribute to medical errors and by enabling leadership to more accurately plan investments in patient safety and risk management. This case study describes how one organization, UMass Memorial Health Care in Worcester, Massachusetts, harnesses its deeply coded medical malpractice data and benchmarks its performance against national peers to catalyze clinical improvements. This strategy has proven successful in yielding positive change in such areas as emergency department ultrasound coverage, obstetrics communication, and airway management training. UMass Memorial's ability to embed claims data use into its culture and to share learning across clinical services offers lessons for health care organizations of any size.     

Promotor(a)s, the organizations in which they work, and an emerging paradox: how organizational structure and scope impact promotor(a)s' work

OBJECTIVE: To analyze how organizational structures and scope (geographic and programmatic) generate dissonance between the organization and its workers, creating a paradox with policy implications for access to health care in hard-to-reach populations. The workers are lay community health workers called promotor(a)s. The organizations are community based organizations in which the promotor(a)s work, either as volunteers, part-time or as full-time wage staff. METHOD: Ethnographic study of 12 organizations and their promotor(a)s. Data gathering included interviews with organization directors, promotor(a)s, service providers working with the organizations, and community residents served by the organizations and workers. In addition, promotor(a)s were observed in the course of their work. Sampling was a non-probability, snowball procedure for identifying the organizations and the workers within them. RESULTS: A paradox is emerging between (a) promotor(a)s who perceive their work to be locally focused and tightly integrated with the communities they serve and live in, and (b) the employing organizations that are expanding in geographical and programmatic scope because the work promotor(a)s do is in increasing demand by agencies and funding sources external to the communities served. The paradox potentially threatens to undermine and transform the work and working environment of the promotor(a)s. The challenge is to find a balance that will sustain a workable and working relationship among the organization, the workers, and the communities served. CONCLUSION: Care is needed in setting out policies that translate the paradox into greater congruence among organization, workers and communities. Policy needs discussed focus on (a) worker training, (b) worker employment and deployment, and (c) funding source recognition of the paradox.     

Nurses' professionalism in Canada: a labor process analysis.

This article draws on a body of research conducted by the author over the past ten years on the social organization of nursing work. It explores questions surrounding nurses' contemporary labor process control and its meaning for nurses' professionalization and proletarianization. Both are dynamic processes, changing as public administration of the Canadian health care system changes and as nurses are successful in winning more complete self-regulation. Nurses are currently being articulated more and more securely to dominant ideas of public sector management through textually mediated technologies. Nurses find new upwardly mobile careers and challenging, responsible, and more respected work. However, as the generation of objective information for professional accountability, cost-accounting, and managerial decision-making becomes unified in computerized patient information systems, producing and using such information becomes a central and determining core of everyday nursing work. It organizes nurses into a "managed" practice of patient care, contradictory for them in many ways. Outstanding among these contradictions is a new professionalized standpoint of cost-efficiency that subordinates nurses' traditional interests and grounding of their work in the standpoint of care.     

Teaching organization theory for healthcare management: three applied learning methods

Organization theory (OT) provides a way of seeing, describing, analyzing, understanding, and improving organizations based on patterns of organizational design and behavior (Daft 2004). It gives managers models, principles, and methods with which to diagnose and fix organization structure, design, and process problems. Health care organizations (HCOs) face serious problems such as fatal medical errors, harmful treatment delays, misuse of scarce nurses, costly inefficiency, and service failures. Some of health care managers' most critical work involves designing and structuring their organizations so their missions, visions, and goals can be achieved-and in some cases so their organizations can survive. Thus, it is imperative that graduate healthcare management programs develop effective approaches for teaching OT to students who will manage HCOs. Guided by principles of education, three applied teaching/learning activities/assignments were created to teach OT in a graduate healthcare management program. These educationalmethods develop students' competency with OT applied to HCOs. The teaching techniques in this article may be useful to faculty teaching graduate courses in organization theory and related subjects such as leadership, quality, and operation management.