Quality assurance and organizational effectiveness in hospitals.

The purpose of this paper is to explore some aspects of a general theoretical model within which research on the organizational impacts of quality assurance programs in hospitals may be examined. Quality assurance is conceptualized as an organizational control mechanism, operating primarily through increased formalization of structures and specification of procedures. Organizational effectiveness is discussed from the perspective of the problem-solving theory of organizations, wherein effective organizations are those which maintain at least average performance in all four system problem areas simultaneously (goal-attainment, integration, adaptation and pattern-maintenance). It is proposed that through the realization of mutual benefits for both professionals and the bureaucracy, quality assurance programs can maximize such effective performance in hospitals.     

Health and work in the construction industry in an urban area of Brazil

This community-based survey in the city of Salvador, capital of Bahia State, Brazil, describes the occupational and health profile of construction workers. All 1,947 male individuals between 10 and 65 years of age identified in a random cluster area single-stage sample were individually interviewed. Narrative data about work injuries were also analyzed. Construction workers were older, more frequently black, poorer, and had less schooling and a higher proportion of informal job contracts than those in other trades. The majority (55.8%) reported wanting a formal job in order to be eligible for paid retirement. Smoking (prevalence ratio = 1.37; 95% CI: 1.08-1.72) and nonfatal work injuries (relative risk = 1.72; 95% CI: 1.49-7.42) were more common among construction workers. Narrative data show lack of information and lack of access to personal protective equipment. Prevention programs and the formalization of job contracts are strongly recommended for construction workers.     

Health complaints and work conditions among lacquerers in the Danish furniture industry

In the present work, morbidity rates were based upon 418 replies to postal inquiries sent to 478 members of the carpenters/cabinet makers trade union in the Arhus area of Denmark. Lacquerers, when compared with former lacquerers and non-lacquerers, have an excess of neurophysiological symptoms and symptoms from the respiratory tract. The statistical association between exposure to lacquers and lung symptoms persists after checking for differences in age, smoking habits, and exposure to dust. Organic solvents are an important component of lacquers. Far too little is yet known of solvents' long-term effects on the human body. Most of our present knowledge concerns the short-term toxic effects on the nervous system. This study further points out a relation between lung symptoms and exposure to organic solvents, and it is suggested that further research into this association must be carried out.     

Impact of work on the quality of life of community-residing young elderly.

Using a random sample of 310 Massachusetts community-residing elderly between the ages of 65 and 74, this study investigates the relationship between employment status and quality of life using a modified version of the Spitzer Uniscale QL index. The odds of reporting the highest quality of life rating, after controlling for socioeconomic and health characteristics, was 3.51:1 for those who worked versus those who did not do so.     

Association of insomnia with quality of life, work productivity, and activity impairment

Purpose  To assess the association of insomnia with health-related quality of life (HRQOL), work productivity, and activity impairment. Methods  Data were obtained from the 2005 US National Health and Wellness Survey. Subjects were assigned to the insomnia group (diagnosed insomnia experienced at least a few times a month) or the noninsomnia group (no insomnia or sleep symptoms). HRQOL was assessed using the short form 8 (SF-8) (mental and physical scores). The work productivity and activity impairment questionnaire (WPAI) assessed absenteeism (work time missed), presenteeism (impairment at work), work productivity loss (overall work impairment), and activity impairment. Linear regression models were used to control for potential confounders. Results  A total of 19,711 adults were evaluated (5,161 insomnia, 14,550 noninsomnia). Subjects in the insomnia group had significantly lower SF-8 physical (−5.40) and mental (−4.39) scores and greater activity impairment scores (+18.04) than subjects in the noninsomnia group (P < 0.01 for all). Employed subjects in the insomnia group had greater absenteeism (+6.27), presenteeism (+13.20), and work productivity loss (+10.33) scores than those in the noninsomnia group (P < 0.01 for all). Conclusions  Insomnia is significantly associated with poorer physical and mental quality of life and work productivity loss and activity impairment.     

Health counseling in adolescent preventive visits: effectiveness, current practices, and quality measurement

Most morbidity and mortality among adolescents results from their participation in health-compromising behaviors. Recent guidelines for clinical adolescent preventive services recommend that primary care clinicians routinely screen for and counsel adolescents about these behaviors, identify and address related social, psychological, and biologic factors. Office-based counseling can influence adult health behaviors, but little is known about the effectiveness of office-based counseling for adolescents. In this review we: (a) evaluate available information about the effectiveness of office-based health counseling to improve outcomes; (b) report what is known about the health counseling adolescents receive from primary care clinicians; and (c) critically review different approaches that have been, or might be, used to measure the content and quality of health counseling provided during adolescent medical visits. With the emphasis on accountability in the current health care environment, evidence supporting the effectiveness of counseling is needed to justify investment in this aspect of clinical adolescent preventive services. Challenges to studying the effectiveness of health counseling include the lack of well-defined theory-based models for adolescent office-based counseling, the complexity of measuring counseling quality, and the many factors that influence adolescent outcomes. Reliable and valid measures of counseling quality are needed both to study and to ensure the quality of counseling received by adolescents. No single measure can be expected to fully capture counseling quality, although patient self-report deserves further development.     

Occupational determinants of work attitudes and organizational attachment.

The "work attitudes-turnover" linkage was compared among four medical-sector occupational groups. In a sample of 707 employees, drawn from eight variously-sized medical-sector sites, intended and actual turnover behavior is predicted. Combining a cross-sectional and longitudinal analysis, and using two logistic regression models, the direct effect of work attitudes on intended and actual turnover was assessed. The "work attitudes-turnover" was shown to be occupationally-dependent.     

Mission and organizational performance in the healthcare industry

Healthcare is a rapidly evolving industry where firms face constantly changing conditions and an ever-increasing demand for services. As competition in this sector continues to grow, managers must assess their organizations and develop methods to improve firm performance and productivity. Successful managers are constantly searching for tools that will motivate their employees to perform at the highest possible level. An increasing amount of literature points to the mission statement as a valuable tool for managers to use to improve organizational performance and increase employee motivation. This article examines the key elements of the organizational mission statement and discusses their significance in relation to firm performance in the healthcare industry. First, the elements of a mission statement will be identified and the relationship of these elements to both organizational success and employee motivation will be discussed. Second, the general mission development process and its most critical features will be considered. Third, specific mission statements from a sample of healthcare organizations will be identified and analyzed using an integrated analytical framework based on the literature. Finally, the significance of the material presented will be considered followed by suggestions for future mission statement development and evaluation.