Management and Employee Agreement on Reports of Organizational Policies and Practices Important in Return to Work Following Carpal Tunnel Surgery

This studys purpose was to assess the agreement between management and employee ratings of organizational policies and practices (OPP) involved in the return to work process following carpal tunnel surgery. As a part of the prospective community-based Maine Carpal Tunnel II Study, 65 manager and employee pairs completed a questionnaire tapping four OPP dimensions: people oriented culture, safety climate, ergonomic practices, and disability management. It was hypothesized that managers and employees would agree on their assessment of the four OPPs and a composite organizational support index. Agreement was assessed using Lins concordance correlation coefficient. Employee and manager ratings were similar for the organizational support index (rho_c = 0.14, p = 0.08), and people oriented culture (rho_c = 0.25, p = 0.01) but not the other three OPPs. In larger companies (> 450 employees), ratings were also similar for safety climate (rho_c = 0.24, p = 0.09), disability management (rho_c = 0.22, p = 0.07) and ergonomic practices (rho_c = 0.35, p = 0.02). In unionized companies there was agreement for safety climate (rho = 0.44, p = 0.02), disability management (rho_c = 0.41, p = 0.01) and ergonomic practices (rho_c = 0.40, p = 0.06). These preliminary results suggest employees can report on certain OPPs and that an employee questionnaire can be used to assess organizational support. Given recent evidence that employee ratings of OPPs are predictive of injury/illness incidence, work disability and return-to-work outcomes, further research is needed to confirm these findings.     

Health services for women in outpatient substance abuse treatment

OBJECTIVE: To evaluate how a sample of outpatient substance abuse treatment units respond to organizational and environmental influences by adopting and implementing treatment services for women. DATA SOURCES: The National Drug Abuse Treatment System Survey from 1995 and 2000, a national survey of outpatient substance abuse treatment units. STUDY DESIGN: Health services for women are the dependent variables. The predictors include organizational and environmental factors that represent resource dependence and institutional pressures for the treatment unit. Logistic regression and Heckman selection models were used to test hypotheses. DATA COLLECTION: Program directors and clinical supervisors at each treatment unit were interviewed by telephone in 1995 and 2000. PRINCIPAL FINDINGS: Units that depended on specific funding for women's programs and that depended on government funds were more likely to adopt, but not necessarily implement, women's services. Methadone units and units that train more staff to work with women were more likely to adopt as well as implement women's services. Private not-for-profit units were more likely to adopt some services, while for-profit units were less so. However, in general, neither for-profit nor not-for-profit units significantly implemented services. There was evidence that the odds of adopting services were greater in 2000 than 1995 for two services, but were otherwise stable. CONCLUSIONS: There is considerable variation in the adoption and implementation of women's services. In addition, not all adopted services were significantly implemented, which could reflect limited organizational resources and/or conflicting expectations. This also suggests that referral mechanisms to these services, and therefore access, may not be adequate. Government funds and specific funds for women's programs are important resources for the provision of these services. Women's services appear more available in methadone units, suggesting that regulation has been influential and that the recent methadone accreditation system should be evaluated. Staff training may be one strategy to encourage implementation of these services. For the most part, the adoption of services for women did not change between 1995 and 2000.     

Test of the health promotion model as a causal model of commitment to a plan for exercise among Korean adults with chronic disease

The purpose of this study was to test seven constructs (prior experience of exercise, perceived health status, exercise benefits, exercise barriers, exercise self-efficacy, social support for exercise, and options for exercise) from the health promotion model (HPM) as a causal model of commitment to a plan for exercise in a sample of 400 Korean adults with chronic disease. Using structural equation modeling (SEM), we found that all fit indices indicated a good fit. The final model accounted for 54% of the variance in commitment to a plan for exercise. Prior experience with exercise and exercise benefits were the factors most highly related. Health professionals can assess prior experience and emphasize personally relevant benefits of exercise in designing intervention programs to help Korean adults with chronic disease become more physically active.     

Mirror,mirror on the wall,who is the most improved of all?

This article examines the rhetoric and reality of clinical governance in the United Kingdom using the analogy of the New Year pantomime. The authors argue that processes to improve the quality of health care services provision have been in place for many years. Although the terms and language used to describe these processes have, over time, changed, the task remains the same. Clinical governance is the latest in a long list of such changes. The tensions involved in working towards achieving centrally driven targets and performance standards whilst at the same time addressing the huge modernization agenda are explored through managerial and clinical experiences. Whilst the clinical governance approach has undoubtedly achieved improvements, the sustainability of these is questioned. Organisational responses to the current system are explored and a glimpse into the future is given, as the present structures and processes change in 2004. The authors argue that practitioners and managers, who may have survived the current arrangements, might have considerably more difficulty in doing so in the future.     

Clinical governance and the learning organization

AIM: This paper compares and contrasts clinical governance and organizational learning. BACKGROUND: Clinical governance represents one of the most significant policy developments in recent years. It places on all health care delivery organizations a statutory duty to develop the systems, standards and processes necessary to improve health care quality and manage risk. At the same time, many health care organizations are seeking new ways in which learning can be retained and deployed more widely within the organization (organizational learning). KEY ISSUES: Both approaches emphasize cultural changes as essential underpinnings to quality improvement. However, the two approaches also differ fundamentally in their logic of action. Clinical governance is essentially 'top down', being built around formal standards, established procedures, and regular monitoring and reporting. In contrast, organizational learning emphasizes 'bottom up' changes in values, beliefs and motivations in such a way that learning and change are prioritized. The challenge for managers and practitioners lies in seeking a creative tension between these two contrasting styles of organizational change.     

Introducing the Learning Practice--I. The characteristics of Learning Organizations in Primary Care

RATIONALE, AIMS AND OBJECTIVES: This paper is the first of three related papers exploring the ways in which the principles of Learning Organizations (LOs) could be applied in Primary Care settings at the point of service delivery. Here we introduce the notion of the Learning Practice (LP) and outline the characteristics and nature of an LP, exploring cultural and structural factors in detail. METHODS: Drawing upon both theoretical concepts and empirical research into LOs in health care settings, the format, focus and feasibility of an LP is explored. RESULTS AND CONCLUSIONS: Characteristics of LPs include flatter team-based structures that prioritize learning and empowered change, involve staff and are open to suggestions and innovation. Potential benefits include: timely changes in service provision that are realistic, acceptable, sustainable, and owned at practitioner level; smoother interprofessional working; and fast flowing informal communication backed up by records of key decisions to facilitate permanent learning. Critical comment on potential pitfalls and practical difficulties highlights features of the present system that hinder development: tightly defined roles; political behaviours and individual-oriented support systems; plus the ongoing difficulties involved in tolerating errors (whilst people learn). This paper contributes to the wider quality improvement debate in the area in three main ways. First, by locating Government's desires to create health systems capable of learning within the theoretical and empirical evidence on LOs. Second, it suggests what an LP could be like and how its culture and structures might benefit both staff and patients in addition to meeting externally driven reforms and health priorities. Third, it extends the application of LO concepts to the health care sector locating the principles in bottom-up change.     

Predictors of nurses' intent to stay at work in a university health center

The purpose of the present study was to evaluate nurses' intent to stay at work and to determine the associations between intent to stay and various predictors. A sample of 108 nurses at a single tertiary care hospital filled in a questionnaire on intent to stay, satisfaction at work, satisfaction with administration, organizational commitment and work group cohesion. The results showed that the majority of nurses are planning to stay in their current job. Satisfaction at work and satisfaction with administration are the best predictors of intent to stay and explained 25.5% of intent to stay variance. It is possible that developing strategies based on the predictors of intent to stay at work could improve that intent. Healthcare organizations could consider this with the objective of increasing nurses' intent to stay at work and, consequently, retention.     

Maintenance of T cell specification and differentiation requires recurrent notch receptor-ligand interactions

Notch signaling has been shown to play a pivotal role in inducing T lineage commitment. However, T cell progenitors are known to retain other lineage potential long after the first point at which Notch signaling is required. Thus, additional requirements for Notch signals and the timing of these events relative to intrathymic differentiation remain unknown. Here, we address this issue by culturing subsets of CD4 CD8 double negative (DN) thymocytes on control stromal cells or stromal cells expressing Delta-like 1 (Dll1). All DN subsets were found to require Notch signals to differentiate into CD4+ CD8+ T cells. Using clonal analyses, we show that CD44+ CD25+ (DN2) cells, which appeared committed to the T cell lineage when cultured on Dll1-expressing stromal cells, nonetheless gave rise to natural killer cells with a progenitor frequency similar to that of CD44+ CD25- (DN1) thymocytes when Notch signaling was absent. These data, together with the observation that Dll1 is expressed on stromal cells throughout the thymic cortex, indicates that Notch receptor-ligand interactions are necessary for induction and maintenance of T cell lineage specification at both the DN1 and DN2 stages of T cell development, suggesting that the Notch-induced repression of the B cell fate is temporally separate from Notch-induced commitment to the T lineage.