Organizing emotions in health care

PURPOSE: To introduce the articles in this special issue, discussing emotion in the in health-care organisations. DESIGN/METHODOLOGY/APPROACH: Discusses such topics as what makes health care different, editorial perspectives, how health care has explored emotion so far, and the impact of emotion on patients and the consequences for staff. FINDINGS: Health care provides a setting that juxtaposes emotion and rationality, the individual and the body corporate, the formal and the deeply personal, the public and the private, all of which must be understood better if changes in expectations and delivery are to remain coherent. ORIGINALITY/VALUE: The papers indicate a shared international desire to understand meaning in emotion that is now spreading across organizational process and into all professional roles within health care.     

Gossip and emotion in nursing and health-care organizations

PURPOSE: The purpose of this paper is to examine the relationship between gossip and emotion in health-care organizations. It draws on findings from empirical research exploring the characteristics and function of gossip which, to date, has been a relatively under-researched organizational phenomenon. DESIGN/METHODOLOGY/APPROACH: A multidisciplinary approach was adopted, drawing on an eclectic range of discipline-based theories, skills, ideas and data. Methods included repertory grid technique, in-depth interviews and structured diary records of work-related gossip. The sample comprised 96 qualified nurses working in a range of practice areas and organizational settings in the UK. FINDINGS: Template analysis was used to integrate findings across three phases of data collection. The findings revealed that gossip is used to express a range of emotions including care and concern about others, anger, annoyance and anxiety, with emotional outcomes that include feeling reassured and supported. It is the individual who gossips, while the organization provides the content, emotional context, triggers and opportunities. RESEARCH LIMITATIONS/IMPLICATIONS: Nurses were chosen as an information-rich source of data, but the findings may simply reflect the professional culture and practice of nursing. Future research should take into account a wider range of health-care organizational roles and perspectives in order to capture the dynamics and detail of the emotions and relationships that initiate and sustain gossip. PRACTICAL IMPLICATIONS: Because gossip makes people feel better it may serve to reinforce the "stress mask of professionalism", hiding issues of conflict, vulnerability and intense emotion. Managers need to consider what the emotions expressed through gossip might represent in terms of underlying issues relating to organizational health, communication and change. ORIGINALITY/VALUE: This paper makes a valuable contribution to the under-researched phenomenon of gossip in organizations and adds to the growing field of research into the role of emotion in health-care organizations and emotion work in nursing.     

Staff expectations on implementing new electronic applications in a changing organization

This study was undertaken to describe staff expectations prior to implementation of new electronic applications in a changing organization. Changes are a part of human existence; changes based on implementation of technology and information and communication technology are taking place in the health care sector globally. The Swedish public health care and social care sector is taking a similar path. A qualitative approach with group interviews of 23 staff divided in 5 groups was performed. Latent content analysis was used to analyze the transcribed interviews. The theme, taking standpoint today in relation to the past, emerged from 3 areas of discussion: "distance holding," "ruled by the organization," and "health care development in the future." New restraints on staff affect the caregiving process. Managers should consider whether a particular change is revolutionary or evolutionary and act in the change process according to the possible psychological impact of the change.     

Mental health of farmers in Southern Queensland: Issues and support

Objective: To inform the development of an initiative designed to support the mental well‐being of farmers in Queensland. Design: Interactive focus groups. Setting: Rural and remote Queensland. Participants: Health professionals, farmers and representatives of organisations and agencies working with farmers. Main outcome measures: Determination of factors contributing to the declining mental health of rural landholders. Content material for inclusion into mental health first aid programs held for field officers. Results: Key areas identified to contribute to the decline in mental health of farmers were: increasing isolation in its varying forms, the ongoing drought, increased government regulations and widening of the schism between urban and rural Australians. The issues that affect farmers are recognised to have a ‘knock‐on’ effect on the people who interact with them. In particular, rural support organisations are concerned for the well‐being of their staff, prompting some to begin to put protocols in place to address their staff need for mental health support. Additional mental health training of field officers that involves awareness, recognition, communication skills, understanding and empathy was recognised by participants to be beneficial. Conclusion: Training of field officers was considered to be of benefit to the support of farmers. An understanding of the various and diverse issues that rural landholders face should be a fundamental component of that training.     

Practice in epidemiologic surveillance: between the general and the specific

This study analyses the perspectives of the organization of epidemiological surveillance (ES) in two kinds of organizations. The first is a set of undifferentiated practices; the second is a set of specific practices carried out in the local health system of Ribeir?o Preto, S?o Paulo Federal State. Both organizations are described in general terms and discussed according to the view of local health professionals and professionals of the epidemiological surveillance. This study presupposes that the decentralization should be supported by discussions regarding forms of organization among the groups involved in it. The guiding concepts of this research are nuclei and field of competence and responsibility. Seventeen professionals were the subjects of this study. Eleven participants were nurses and six were managers of the municipal health department of Ribeir?o Preto. Data was obtained from documents and semi-structured interviews, which were analyzed through the method of content analysis, theme modality. The theme "the epidemiological surveillance practice: between the general and the specific" was created according to the following signification nuclei: specific and general knowledge, and collective actions.     

Job stress perceived by hospital medical staff

OBJECTIVE: To identify the psychosocial risk factors related to psychological demands perceived by specialist physicians from six public hospitals in the province of Valencia in Spain. METHODS: A qualitative study was carried out. The population studied comprised the hospitals' specialist medical staff (Oncology, Internal Medicine, Traumatology, Radiology and Intensive Care). A trained interviewer performed 47 individual, face-to-face, semi-structured interviews. To select the participants, the following structural variables were taken into account: gender, age, family responsibilities, medical specialty, professional standing, length of service, and type of contract. Interviews were tape recorded and subsequently transcribed. Finally, the content of the interviews was analyzed. RESULTS: The main psychosocial risk factors mentioned by the participants were workload and lack of staff, mainly due to the characteristics of work organization in the hospital. Another job stressor was daily contact with suffering and death, and feeling responsible for human life. Other significant job stressors were interpersonal relations in the work environment, in the case of patients' relatives, uncertainty about diagnosis and treatment, the possibility of being sued for malpractice, and communicating bad news. CONCLUSIONS: Hospital physicians report a large number of psychosocial risk factors. Some involve the characteristics of the medical profession (contact with suffering and death, responsibility for human life, uncertainty about diagnosis and treatment) and others concern work organization (workload and staffing shortages).     

Qualitative evaluation of a diabetes advisory system, DiasNet

We carried out a qualitative evaluation of the implementation of a computerized diabetes advisory system, DiasNet. Three patients with insulin-dependent diabetes used the system. The methodological frame of reference was the case study. Qualitative interviews were conducted with patients. In addition, 10 qualitative interviews were conducted with health-care professionals and one focus group interview was held. The study lasted for six months. The results showed that patients experienced greater confidence and a more personal rapport with the staff. DiasNet brought about changes in the tasks and duties performed by all professional groups in the diabetes team. From the perspective of the diabetes team, email facilitated a dialogue between the patient and the diabetes team which was independent of time and place.     

Communicating about pupils in mainstream school with special health needs: the NHS perspective

AIM: To add to previous research carried out with young people, parents and teachers, by investigating health staff's perspectives on the difficulties, and possibilities for, achieving good communication with school staff with regard to children in mainstream school with a chronic illness or physical disability. RESEARCH DESIGN AND METHODS: A qualitative research study was carried out in one NHS Trust. Twenty semi-structured interviews were carried out with a purposive sample of health staff to cover the spectrum of professionals who have responsibility for meeting the needs of children with a chronic illness or physical disability in mainstream schools (paediatricians, school doctors, school nurses, specialist nurses, health visitors, GPs, speech and language therapists, paediatric occupational therapists, paediatric physiotherapists, clinical psychologists and psychiatrists). RESULTS: The extent to which health professionals communicated with school staff, and the way in which they went about it, varied widely. Communication was facilitated by joint meetings, shared documentation, and local policy development. Sources of difficulty in communication between health and education staff were: the parent as a conduit of information; the practical difficulties of arranging meetings; and lack of knowledge about other professionals' roles. The ethos of the school with regard to health matters, and the flow of information within health services, also had an impact on the communication process. Participants' recommendations focused on two key issues: clarification of the roles of health and education staff with regard to this group of pupils; and how information should flow from health to school staff. DISCUSSION: Many of the findings parallel the previous research with teachers, indicating agreement between professionals from different agencies about aspects of the communication process which are problematic and require attention. The findings suggest that improving communication requires both joint work between health and education staff, and improvements to practice within each agency.     

Professional participation in organizational decision making: Physicians in HMOs

Although it has been suggested that participation by physicians in administrative and policy decisions is linked to outcomes in health care organizations, there is little research on this subject. Using Shortell's framework this paper considers relationships between perceived participation and three intermediate organizational outcomes: physician work satisfaction, perceived staff consensus about day-to-day activities, and attitudes toward patients. Also considered are situational, professional, and personal characteristics which may be related to participation. Data were collected from four staff model health maintenance organizations (HMOs) in 1978 and 1979 through physician questionnaires, administrator interviews, and documents. Physicians who reported greater participation were more satisfied with work, perceived greater staff consensus, and had more favorable attitudes toward patients. Greater participation was associated with full-time employment status and more years in the HMO (but not with the physicians' professional or personal characteristics). Implications of these findings are discussed, and it is proposed that the findings suggest mechanisms by which participation in organizational decision making may affect ultimate outcomes of the organization.     

Introducing the electronic patient record (EPR) in a hospital setting: boundary work and shifting constructions of professional identities

Today's healthcare sector is being transformed by several ongoing processes, among them the introduction of new technologies, new financial models and new ways of organising work. The introduction of the electronic patient record (EPR) is representative and part of these extensive changes. Based on interviews with health personnel and office staff in a regional hospital in Norway, and with health administrators and information technology service-centre staff in the region, the article examines how the introduction of the EPR, as experienced by the participants, affects the work practices and boundaries between various professional groups in the healthcare system and discusses the implications this has for the understanding of medical practice. The article shows how the EPR has become part of the professionals' boundary work; expressing shifting constructions of professional identities.     

Factors that influence the acceptability of collecting in-home finger stick blood samples in an urban, low-income population

OBJECTIVES: To examine the acceptability of non-medical, community-based interviewers obtaining blood samples during in-home interviews from low-income study participants. METHODS: Two separate focus groups were conducted, one with ten non-medical community-based interviewers and the other with eight research participants from a low-income population. (Both the interviewers and the research participants had previously taken part in a research project over the course of five years.) RESULTS: Participants and interviewers were comfortable with finger stick blood samples performed in the home. The interviewers felt that adequate training was critical. Participants identified key issues: blood would not be used for other purposes and that the interviewers would be trained to handle blood safely. Both groups felt that it was crucial to communicate the study purpose and results. Recommendations from the focus groups were implemented and the acceptance rate for blood sampling was 99.5% (205/206). CONCLUSION: Proper training of interviewers, organization of supplies, and communication with participants can be combined to maximize acceptance of in-home, finger stick blood sample collection by community-based interviewers among a low-income population.     

Why do elderly people seek professional home care? Methodologies compared

In order to investigate which characteristics, besides physical limitations, of elderly people living at home contribute to the utilization of professional home care, a study was conducted in which 450 elderly people aged 55 and over, 123 with and 327 without professional home care, were interviewed.To obtain a selection for the interviews, a postal questionnaire, containing questions on functional status and care utilization, sent out to a random sample of the elderly people (55+) living at home (n=2451), preceded the actual interviews. The oral interviews yielded the same information, plus an inventory of aspects of the mental status, the social network, the socio-economic status and the housing condition. Analysis was performed in three ways: bivariate analysis, logistic regression analysis and discriminant analysis. The bivariate analysis revealed that users of professional care were older, more often female and more often not married. Their social network was less extensive, as they received less informal care and lived alone more often. Besides they had more mental and financial problems.From the regression analysis it appeared that, in addition to the functional status, the amount of informal care and the household composition contributed to the utilization of professional home care. For the other characteristics inventoried, no independent association with the utilization of professional care could be established. With hindsight, it appeared that in this study long interviews hardly had additional value over postal questionnaires, in which the contribution of functional status and informal care to professional care was already discovered.Carla Frederiks is senior staff member of the department of epidemiology and health care research of the University of Limburg. Margreet te Wierik and Erik van Rossum are junior staff members of the department of epidemiology and health care research of the same university. Adriaan Ph. Visser was associate professor in the research project Services for the elderly of the same university, nowadays director of the International Health Foundation, Brussels, Belgium. Alexander Volovics is senior staff member of the department of statistics and informatics of the same university. Ferd Sturmans is professor of the department of epidemiology and health care research of the same university.     

Patient Advice and Liaison Services: strengthening the voices of individual service users in health-care organizations

OBJECTIVE: To explore the roles of Patient Advice and Liaison Services (PALS) in their interactions with service users. CONTEXT: Every National Health Service health-care provider in England now has a PALS, which provides service users with information and help in resolving concerns and dissatisfactions with health care. DESIGN: Longitudinal qualitative study, 2002-4. This paper draws on data from 27 semi-structured interviews. SETTING AND PARTICIPANTS: PALS personnel working in six case study PALS in London. FINDINGS: PALS personnel adopt seven roles in order to support their clients in sorting out problems with health care: information provider; listener; messenger (passing on information from service users to staff); go-between (passing information forward and back); supporter (helping service users to present their own views); mediator (when two or more parties are in dispute); resource mobilizer (when the support of senior staff or other agencies is necessary to resolve a problem). CONCLUSIONS: Though these are not new functions, PALS is a universal service which is better placed than front-line health-care staff to offer such support, and increases choice for service users looking for sources of information and advice.     

连云港市医疗卫生机构健康教育现状分析

目的掌握和了解连云港市医疗卫生机构健康教育工作开展情况,进一步推进健康教育工作。方法采用听取汇报、查阅资料、现场察看、随机访谈、个别访谈等方法对全市直属10家医疗卫生机构进行调查。结果连云港市医疗卫生机构健康教育取得了一定的工作成效,健教网络薄弱、专业人员短缺、与当地健康教育专业机构缺乏沟通合作等问题影响健康教育工作的深入开展。结论在加强医疗卫生机构健康教育网络建设的同时,以创建健康促进示范化医院为载体、结合创建国家卫生城市活动,推动全市医疗卫生机构的健康教育工作。     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

The organisational response to patient complaints: a case study in Taiwan

PURPOSE: To explore and evaluate how hospital staff respond to patient complaints. DESIGN/METHODOLOGY/APPROACH: A teaching hospital with 1,500 beds in Taiwan was purposefully chosen as a case study of hospital response to patients' complaints. Data was obtained through interviews with quality surveying managers (n = 53), government managers (n = 4), staff of non-government organizations (n = 3) and a senior social worker, as well as analysis of documents (September 2001-April 2002). FINDINGS: Using the managerial-operational-technical framework developed by the researchers, the study demonstrated problematic aspects of handling complaints at the case hospital. It was revealed that: complaint handlers were not sufficiently empowered, information sharing was limited within the organization, communication among professional staff and with management was inadequate, the physical safety of workers had been threatened, and improvements could not be sustained. Moreover, it became apparent that the case study hospital generally responded to patient complaints in a reactive and defensive manner. ORIGINALITY/VALUE: It is evident that the hospital did not use patient complaints as a source of learning that could have promoted higher standards of care. The case study reveals some of the constraints and identifies requirements for appropriate use of information and feedback from patients. The study raises some issues requiring further research to ensure more appropriate use of patient complaints to improve quality of care.     

Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland

OBJECTIVE: To examine the views of rural practitioners concerning issues and challenges in mental health service delivery and possible solutions. DESIGN: A qualitative study using individual semi-structured interviews. SETTING: Eight general practices from eight rural Queensland towns, three rural mental health services and two non-government organisations, with interviews being conducted before recent changes in government-subsidised access to allied health practitioners. PARTICIPANTS: A sample of 37 GPs, 19 Queensland Health mental health staff and 18 participants from community organisations. MAIN OUTCOME MEASURES: Analysis of qualitative themes from questions about the key mental health issues facing the town, how they might be addressed and what challenges would be faced in addressing them. RESULTS: There was substantial consensus that there are significant problems with inter-service communication and liaison, and that improved collaboration and shared care will form a critical part of any effective solution. Differences between groups reflected differing organisational contexts and priorities, and limitations to the understanding each had of the challenges that other groups were facing. CONCLUSIONS: Improvements to mental health staffing and to access to allied health might increase the ability of GPs to meet the needs of less complex patients, but specific strategies to promote better integrated services are required to address the needs of rural and regional patients with complex mental health problems. The current study provides a baseline against which effects of recent initiatives to improve mental health care can be assessed.     

Clinical governance development needs in health service staff

This paper reports on a study to ascertain the development needs in terms of clinical governance of 220 health service staff across all the key professions from primary and secondary care, including chief executives and clinical governance leads. Interviews suggested that the development of clinical governance was progressing through the structures created by the leads, and that there was considerable goodwill shown towards it in most of the interviews conducted. Of the participants 69 per cent had heard of clinical governance, though detailed knowledge was rare. The author suggests that development overall needs to be carried out using a multi-disciplinary and multi-agency approach where possible, perhaps using pathways of care. It needs also to take account of the expressed fears from medical staff of discussing their care in a multi-disciplinary setting, and of the two potential conflicting themes that are apparent to chief executives of change towards no-blame cultures, while encouraging account-ability and the recognition of risk.