Implementation of a participatory management model: analysis from a political perspective

Participatory management effects on nurses' organizational support and moral distress

RESEARCH QUESTION/AIM/OBJECTIVES

Providing care for hospitalized children causes moral distress to nurses. Employee participation in discovering and solving the everyday problems of the workplace is one of the ways to hear the voices of nurses. This study aimed to evaluate the effect of participatory management programs on perceived organizational support and moral distress in pediatric nurses.

RESEARCH DESIGN

A quasi-experimental study.

PARTICIPANTS AND RESEARCH CONTEXT

The present study was conducted on 114 pediatric nurses in Iran. Data were collected using the Perceived Organizational Support Scale and the Moral Distress Scale of nurses. The intervention included implementing a participatory management program in three treatment departments that were randomly selected and it lasted 4 months. Participatory management was at the level of problem-solving with a focus on investigating, solving, and correcting issues and problems of work shifts and departments concerning the physical environment, equipment of the department, improvement of work processes, and team cooperation. In the control group, ordinary organizational approaches to problem-solving were used.

ETHICAL CONSIDERATIONS

This study was approved by the Ethics Committee of Mashhad School of Nursing and Midwifery. Informed consent was obtained from the study participants.

FINDINGS/RESULTS

Based on the results, both groups were homogenous before the intervention in terms of moral distress and perceived organizational support. The results showed that the moral distress mean scores in the intervention group decreased from 1.45 (0.52) to 1.03 (0.37) after the intervention. Also, the score of the perceived organizational support was 2.12 (1.2) increased after the intervention to 2.68 (1.10) in the intervention group.

CONCLUSIONS

It was found that the participation of nurses in the problem-solving process to solve daily workplace issues can be effective in increasing their perceived organizational support and reducing their moral distress.

Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis

BACKGROUND

Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.

OBJECTIVES

1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences.

SEARCH METHODS

We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care.

SELECTION CRITERIA

We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services.

DATA COLLECTION AND ANALYSIS

Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles.

MAIN RESULTS

We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability.

AUTHORS' CONCLUSIONS

Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.

Organizational culture, authentic leadership and quality improvement in Canadian healthcare facilities

OBJECTIVE

To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities.

METHOD

Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05).

RESULTS

Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices.

CONCLUSION

This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and authentic leadership practices of healthcare managers. Flexible organizational cultures influence the adoption of authentic leadership, participatory management model and also improves quality.

A qualitative model for evaluating and improving nursing governance in medium- and long-term intermediate care

AIM

To evaluate nursing governance in intermediate care in Catalonia Spain and propose improvements.

BACKGROUND

Drawing on two existing models, the Magnet model and the corporate governance model, we propose that good nursing governance requires nursing leaders to apply the following dimensions: transformational leadership, transformational culture, commitment and sustainability, authority, scientific evidence, transparency and communication, and teamwork.

METHOD

A qualitative, exploratory study conducted in two phases. First, we asked nursing leaders in intermediate care to describe their opinions and experiences in each of the dimensions. Next, we observed governance practices at two intermediate care centres and conducted interviews with their nursing leaders. Content analysis was used.

RESULTS

Our participants' behaviour corresponded closely to the model in the dimensions of transformational culture and commitment and sustainability but failed to meet the model in the dimensions of scientific evidence and transparency and communication.

CONCLUSIONS

Participants had a leadership style focused on transforming their surroundings. According to the model, the leaders in our sample should draw more on scientific evidence and improve their internal communication about outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Establishing committees of nurses to address areas in which governance does not adhere to the model would create sustainable benefits for patients and nurses in intermediate care.

Barriers and facilitators for caregiver involvement in the home care of people with pressure injuries: A qualitative study

Aim

To explore the barriers and facilitators perceived by home caregivers regarding their involvement in the home care of people with pressure injuries.

Background

Although home caregivers are key in the process of caring for people with pressure injuries, little is known about their perceptions regarding their involvement in the same.

Methods

A qualitative study based on grounded theory involving a theoretical sample of 15 home caregivers of people with pressure injuries within the health district of Puertollano, Spain.

Results

This study identified three barriers (feminization of care, necessary life adaptations as a home caregiver, and the organization of health services) and three facilitators (the perceived family duty for caring, willingness to provide care, and satisfaction with the care received on behalf of primary care services) associated with caregiver involvement in the home care of pressure injuries.

Conclusions

The care of a person with pressure injuries is perceived as a duty and requires important adaptations affecting the home caregiver’s personal, social and work life. The emotional closeness and trust that develops between a patient and the primary care staff equals an involvement which, in turn, also has positive results for both the home caregiver and the patient.

Job Satisfaction Challenges Of Nurses In The Intensive Care Unit: A Qualitative Study

Background

Job satisfaction is an important factor in health care settings. This concept is not a single factor; rather, it is the product of factors such as the conditions and relationships that govern the workplace, the organizational system of employment, and social, cultural, and economic factors. Therefore, awareness of its related factors is important for medical staff including nurses in special units and nursing managers. The aim of the present study was to investigate job satisfaction challenges in intensive care unit (ICU) nurses.

Methods

This was a qualitative study using conventional content analysis approach. This study was performed in a general ICU of Amol City, Iran. Thirteen nurses employed in the ICU were recruited until data saturation was reached. Research data were collected through interviews, a focus group and field notes. Findings were analyzed using a conventional method.

Results

According to data analysis, 6 themes including "nursing education", "organizational resources", "management", "multiple occupational stresses", "professional performance" and "professional identity" were developed.

Conclusion

This study provided better and clearer understanding of job satisfaction challenges of nurses working in an ICU. The findings of this research can be helpful in developing management programs for understanding the factors affecting job satisfaction of nurses and job satisfaction promotion.

Architect, Catalyst, Advocate, and Prophet: A Four-Lens View of Companies to Support Ecodesign Integration

Companies are increasingly expected to develop products with better environmental performance throughout their life cycle. Academic literature on ecodesign integration, which investigates firms’ practices of dealing with environmental concerns associated with their products, indicates a need for more focus on formal and informal organizational aspects. From the general management literature, the four-lens view of organizations provides a rich understanding of organizations by embracing their formal (structural lens) and informal (human, political and symbolic lenses) functioning. This article aims to explore the extent to which the four-lens view may support ecodesign integration in companies. This exploratory study builds on fifteen interviews about ecodesign integration at seven manufacturing companies in Denmark and Norway. The main results are threefold: (i) the different lenses of organizations could be found in measures mentioned at the case companies; (ii) measures from the architect’s perspective seemed necessary to provide an official scene for ecodesign and help prioritizing it in organizations; and (iii) the catalyst’s, advocate’s, and prophet’s perspectives seemed necessary to facilitate or complement the architect’s perspective. In the light of these findings, the four-lens view seems relevant to strengthen ecodesign integration, and its potential use as a reflective tool is an avenue for future work.