Hospital workforce engagement, satisfaction, burnout and effects on patient mortality: Findings from the English national health service staff surveys

Previous studies of healthcare organizations' workforces and their performance have focused on burnout and its impact on care. The aim of this research is to expand on this and examine the association of positive organizational states, engagement and recommendation of employer as a place to work, in comparison to burnout on Hospital performance. Methods: This was a panel study of the respondents to the 2012-2019 yearly Staff Surveys of the English National Health Service (NHS) hospital Trusts with hospital performance measured by the adjusted inpatient Summary Hospital-level Mortality Indicator (SHMI). Results: In univariable regression, all three organizational states significantly and negatively correlated with SHMI, with recommendation and engagement showing a nonlinear effect. In multivariable analysis, all three states remained significant predictors of SHMI. Engagement and recommendation showed mutual correlation, with engagement being a more prevalent state than recommendation. Conclusion: Our study indicates that organizations could benefit from monitoring multiple workforce variables to preserve or enhance workforce well-being, while optimizing organizational performance. The surprising finding that higher burnout was associated with improved short-term performance requires further investigation, as does the finding of less frequent staff recommendation of work compared to staff engagement with their work.

Exploring resistance to change in Chinese children's sports schools: An analysis of multiple external and internal perspectives

The development of sports in children is crucial. Unlike European and American sports clubs, China uses children's sports schools as its main form of competitive sports training. However, with the changing economy and mindset in China, this approach is facing challenges and is in urgent need of changes allowing the school and its internal staff to be more sustainable as they can adapt and survive in the overall market. This change means that such schools can no longer simply rely on government assistance but rather must be more in tune with the market economy and gain competitiveness. Zhangjiakou, China, one of the host cities for the 2022 Beijing Winter Olympics, has a good overall sports atmosphere. Its municipal government attaches importance to sports development, including children's sports, with several children's sports schools that are typical of this study. Accordingly, seven Zhangjiakou sports schools were selected for investigation through field research and sampling. Moreover, the sources of resistance to change in Zhangjiakou children's sports schools were analyzed from multiple perspectives, including external politics and economy, internal group and individual perspectives, using data from questionnaires and in-depth interviews.

Alternative work arrangements: Individual, organizational and environmental outcomes

Flexible working models are widely used around the world. Furthermore, several countries are currently transitioning to a 4-day workweek. These working models have significant effects on organizational behavior and the environment. The study investigates the employees' attitudes and behaviors toward flexible working and 4-day workweek and the impact on the environment. The semi-structured interview method was used in the study to determine employee attitudes and behaviors; the carbon footprint calculation method was used to determine the environmental impact of a 4-day workweek. According to the study's findings, it has been discovered that there would be a positive impact on socialization, happiness, stress factor, motivation, personal time, mental health, comfort, work-life balance, time-saving, willingness, positive working environment, personal time, and physical health. Furthermore, a 4-day workweek reduced commuting emissions by 20%, resulting in a 6,07 kg tCO2e reduction per person. As a result, the study attempted to draw attention holistically to the positive effects of the flexible working model and 4-day workweek. The study is intended to serve as a tool for decision-makers and human resource managers.

Factors facilitating the implementation of a clinical decision support system in primary care practices: a fuzzy set qualitative comparative analysis

BACKGROUND

Understanding how to implement innovations in primary care practices is key to improve primary health care. Aiming to contribute to this understanding, we investigate the implementation of a clinical decision support system (CDSS) as part of the innovation fund project AdAM (01NVF16006). Originating from complexity theory, the practice change and development model (PCD) proposes several interdependent factors that enable organizational-level change and thus accounts for the complex settings of primary care practices. Leveraging the PCD, we seek to answer the following research questions: Which combinations of internal and external factors based on the PCD contribute to successful implementation in primary care practices? Given these results, how can implementation in the primary care setting be improved?

METHODS

We analyzed the joint contributions of internal and external factors on implementation success using qualitative comparative analysis (QCA). QCA is a set-theoretic approach that allows to identify configurations of multiple factors that lead to one outcome (here: successful implementation of a CDSS in primary care practices). Using survey data, we conducted our analysis based on a sample of 224 primary care practices.

RESULTS

We identified two configurations of internal and external factors that likewise enable successful implementation. The first configuration enables implementation based on a combination of Strong Inside Motivation, High Capability for Development, and Strong Outside Motivation; the second configuration based on a combination of Strong Inside Motivators, Many Options for Development and the absence of High Capability for Development.

CONCLUSION

In line with the PCD, our results demonstrate the importance of the combination of internal and external factors for implementation outcomes. Moreover, the two identified configurations show that different ways exist to achieve successful implementation in primary care practices.

TRIAL REGISTRATION

AdAM was registered on ClinicalTrials.gov ( NCT03430336 ) on February 6, 2018.

Positive Organizational Psychology Factors as Serial Multiple Mediators of the Relationship between Organization Support and Job Satisfaction Among Peer Support Specialists

BACKGROUND

Research has demonstrated the effectiveness of peer support specialists in helping people with severe mental illness increase community tenure, decrease hospitalization, boost treatment satisfaction, improve social functioning, and increase quality of life.

OBJECTIVE

The purpose of the present study was to evaluate positive organizational psychology constructs as serial multiple mediators of the relationships between perceived organizational support and job satisfaction among peer support specialists.

METHODS

One hundred and twenty-one peer support specialists from the Texas statewide peer certification training programs and the National Association of Peer Supporters participated in the present study. These peer support specialists completed an online survey composed of self-report measures related to perceived organizational support, positive organizational psychology factors, and job satisfaction. A serial multiple mediation (SMMA) analysis was conducted to evaluate autonomous motivation to work, work engagement, and organizational commitment as mediators of the relationship between perceived organizational support and job satisfaction.

RESULTS

The SMMA model accounted for 49% of the variation in job satisfaction scores (R² =. 49, f² = 0.96 [> 0.35], a large effect size). Autonomous motivation to work, work engagement, and organizational commitment were significantly associated with job satisfaction after controlling for the effect of perceived organizational support.

CONCLUSIONS

Perceived organizational support increased autonomous motivation to work, work engagement, organizational commitment, and job satisfaction. Peer support specialists are integral members of the interdisciplinary mental health treatment team. Leaders of community-based mental health and rehabilitation agencies who are committed to hire and retain peer support specialists must provide strong organizational support and develop interventions to increase peer support specialists' autonomous motivation to work, work engagement, and organizational commitment as a job retention and career development strategy.

Harming by Deceit: Epistemic Malevolence and Organizational Wrongdoing

Research on organizational epistemic vice alleges that some organizations are epistemically malevolent, i.e. they habitually harm others by deceiving them. Yet, there is a lack of empirical research on epistemic malevolence. We connect the discussion of epistemic malevolence to the empirical literature on organizational deception. The existing empirical literature does not pay sufficient attention to the impact of an organization's ability to control compromising information on its deception strategy. We address this gap by studying eighty high-penalty corporate misconduct cases between 2000 and 2020 in the United States. We find that organizations use two different strategies to deceive: Organizations 'sow doubt' when they contest information about them or their impacts that others have access to. By contrast, organizations 'exploit trust' when they deceive others by obfuscating, concealing, or falsifying information that they themselves control. While previous research has focused on cases of 'sowing doubt', we find that organizations 'exploit trust' in the majority of cases that we studied. This has important policy implications because the strategy of 'exploiting trust' calls for a different response from regulators and organizations than the strategy of 'sowing doubt'.

Nostalgia in organizations

Scholars have proposed that nostalgia plays various important roles in organizations. At present, there is no comprehensive overview of the role of nostalgia in this context. To help develop such an overview, we review research on personal nostalgia, insofar as it includes outcomes that are organizationally relevant, and research on organizational nostalgia. We propose a model that summarizes the processes through which nostalgia operates in organizations. In this model, we propose that threatening circumstances such as injustice or organizational change evoke organizational (and possibly personal) nostalgia, this evoked nostalgia subsequently counteracts the negative effects of threat on outcomes such as organizational identification and experienced work meaningfulness. We end by discussing implications and future research directions.

From delta to omicron: The role of individual factors and social context in self-reported compliance with pandemic regulations and recommendations

As SARS-CoV-2 spreads especially when larger groups gather (e.g., at the workplace), it is crucial to understand compliance with regulations and recommendations in such settings. Using data from adults in Germany (N = 29,355) assessed between October 2021 and February 2022, we investigated factors associated with self-reported compliance in both private and working life and how these relate to each other. The results indicate that private compliance was stronger among older individuals and females; among those who worried more about the pandemic situation and assumed that infection was more severe; among those who trusted the government more; and among those who did not perceive public health measures as exaggerated. Private compliance was also associated with personality traits; in particular, individuals who followed regulations and recommendations were likely to be more introverted, conscientious, open, and agreeable. Compliance at work related to both private compliance and colleagues' behaviors. Individuals whose private compliance was high also complied at work. However, when private compliance was low, compliance at work aligned with colleagues' behaviors; that is, compliance at work was high when colleagues complied and low when they did not. The observed effects were stable over time. In summary, they suggest that compliance with regulations and recommendations depends on individual risk perception, trust in government, perception of required or recommended measures, and social norms. To promote protective behaviors in contexts where larger groups gather (including workplaces), making positive social norms more salient (e.g., by supporting role models) may prove especially useful.

Resetting Prices: Estimating the Effect of Tuition Reset Policies on Institutional Finances and Enrollment

Private nonprofit colleges are increasingly using tuition resets, or a decrease in sticker price by at least 5%, to attract new students and counter declining demand. While discounting tuition with institutional aid is a common practice to get accepted students to matriculate and to increase affordability, a tuition reset is a more transparent approach that moves colleges away from a high aid/high tuition model. The authors find minimal evidence that these policies increase student enrollment in the long run, but that there may be short-term impacts. As expected, institutional aid decreases and varies directly with the size of the sticker price reduction. The average net price students pay decreases, but this effect may be driven by changes in the estimated non-tuition elements of the total cost of attendance. Finally, net tuition revenue appears unrelated to tuition resets. These findings call into question the efficacy of this practice.

The Relationship between the Conflict Management Strategies and Ethical Leadership Behaviours of Nurse Managers Perceived by Nurses

AIM

The aim of this study was to determine nurse managers' level of ethical leadership perceived by nurses, and to examine its relationship with conflict management strategies.

BACKGROUND

Ethical leadership is about how managers use their power in their decisions and actions, and its source is based on moral and ethical authority. Therefore, it is important to understand the impact of ethical behaviors of nurse managers in the work environment on determining conflict management strategies.

METHOD

The data of this descriptive, correlational and cross-sectional study were collected face-to-face from 285 nurses between April-June 2019. The data collection instruments included the introductory information form, the Ethical Leadership Scale and The Rahim Organizational Conflict Inventory-II.

RESULTS

Ethical leadership scores perceived by nurses in nurse managers were found 3.78, and the highest score was obtained from the behavioral ethics subscale (3.81±.91). In conflict management strategies perceived by nurses, it was determined that they got highest scores from collaborating style (3.76±.90), and lowest scores from competing style (2.90±.94). There was no significant relationship only between ethical leadership and its subscales and competing (r: -.038/-.041, p>0,05). In other subscales, there were positive, moderate and highly significant relationships (r: .466-.747, p<.001). The rate of explanatoriness of communicative ethics subscale in conflict management strategies ranged from 22.3% to 58.0%.

CONCLUSIONS

The study shows that communicative ethics subscale significantly affects the conflict management strategies of nurse managers. Therefore, it is important for nurse managers to communicate bilaterally and be a role model for nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Ethical leaders value trust and respect in their interactions with employees and reflect what appropriate behavior to the situation is. Nurses who perceive that their managers demonstrate ethical leadership behaviors will also evaluate their role in conflict resolution. On the other hand, the power-based, aggressive, non-compromising domination approach that the person imposes on others is not associated with the ethical leadership perception towards their managers by nurses and is a strategy that should not be preferred. Therefore, nurse managers who use appropriate conflict management strategies saw as a role model by nurses.

Small + Safe + Well: lessons learned from a Total Worker Health® randomized intervention to promote organizational change in small business

BACKGROUND

Leadership commitment to worker safety and health is one of the most important factors when organizations develop and implement a Total Worker Health® approach. We aimed to assess the effectiveness of a Total Worker Health ("TWH") leadership development program that targeted owners and other senior-level leadership positions on changing organizational and worker outcomes from baseline to one-year later.

METHODS

The Small + Safe + Well study included small businesses from a variety of industries in the state of Colorado, USA that were participating in Health Links™. We designed a randomized waitlisted control comparison design (RCT) to evaluate the added benefit of a TWH leadership development program. An employer assessment tool was used to assess TWH policies and programs, and an employee health and safety survey was used to assess safety leadership and health leadership practices, safety climate and health climate, safety behaviors and health behaviors, and well-being. We used a linear mixed model framework with random effects for business and employee to assess the impact of intervention on the outcomes of interest.

RESULTS

Thirty-six businesses (37% retention) and 250 employees (9% retention) met the RCT study inclusion criteria and were included in the analysis. Businesses improved their TWH policies and programs score from baseline to one-year later, regardless of leadership intervention group assignment. Neither intervention group demonstrated improvements in employee-reported outcomes.

CONCLUSIONS

This study sought to address a gap in the literature regarding small business senior leadership development for TWH. Our study demonstrates many of the challenges of conducting studies focused on organizational change in workplaces, specifically in small businesses. When designing TWH intervention studies, researchers should consider how to best engage small business leaders in interventions and implementations early on, as well as methods that are well matched to measuring primary and secondary outcomes longitudinally. Future research is needed to test the feasibility and sustainability of TWH interventions in small business.

TRIAL REGISTRATION

The trial was retrospectively registered with ClinicalTrials.gov ( ID U19OH011227 ).

Psychosocial antecedents of knowledge sharing in healthcare research centers: a mixed-methods approach

PURPOSE

Literature addressing psychosocial factors' relation with knowledge sharing in healthcare organizations is still scarce, being of extreme shortage in specific environments, such as healthcare research centers. This paper investigates the impact of psychosocial factors as antecedents of knowledge sharing between healthcare research peers in such environments.

DESIGN/METHODOLOGY/APPROACH

By expanding on the theory of reasoned action (TRA), the authors follow a mixed-methods design to study the relation between perceptions of psychosocial factors and knowledge sharing in healthcare researchers. A quantitative approach uses a structural equation modeling (SEM) to test the links in an original model. A fuzzy-set qualitative comparative analysis (fsQCA) identifies alternative configurations that lead knowledge sharing intention and its absence as well as the knowledge sharing behavior and its absence considering additional sample characteristics.

FINDINGS

Findings show evidence of the proposed psychosocial antecedents' effect on knowledge sharing. Additional configurations of causal conditions that lead to the presence or absence of the intention and knowledge sharing behavior are discussed, with emphasis on both psychosocial antecedent configuration and sample characteristics.

ORIGINALITY/VALUE

This study identifies the influence of both psychosocial and team characteristic aspects leading to knowledge sharing behavior between healthcare researchers. The importance of a rich social network lying on trust is vital for a sharing environment inside research environments. Given the complex nature of behavioral intentionality, additional findings allow an articulation between individual characteristics, substantiating the proposition of complex configurations between antecedents that hints for team configuration strategies and managerial practices in healthcare research teams.

How self-determination of scholars outclasses shrinking public research lab budgets, supporting scientific production: a case study and R&D management implications

The main purpose of this study is to analyze how reorganization of public research organizations and shrinking public research lab budgets affect the evolution of research activity and scientific productivity. This study focuses on a case study of National Research Council of Italy (CNR), one of largest European public research organizations, to identify evolution of research activities and dynamics of scientific production from 2000 to 2019. The statistical analysis suggests that, in line with the origin of the CNR, scientific research focuses mainly on research fields of natural sciences, such as chemical, life and physical sciences, with an increasing role of scientific research in energy, engineering and mathematics. The study also shows a high intensity of collaboration of the CNR within international research networks. A key finding of this study is to show, for the first time, that although uncertain reforms and reductions of public funds, scientific productivity is growing. This novel result can be explained with self-determination of scholars as a vital determinant supporting scientific production that outclasses shrinking public research lab budgets and organizational deficiencies. The management and research policy implications of this study can be generalized to support an efficient organizational and managerial behavior, and higher scientific productivity of public research institutes in contexts of reduced public funding and market turbulence.

The Behavior of Organization in Economic Crisis: Integration, Interpretation, and Research Development

We investigated the significance of an economic crisis for organizations' ethical behavior, employees' unethical behavior, and association. To capture the effect of the "2008' World economic crisis," we compared the behaviors of organizations and employees' unethical behavior during a crisis with their behavior in more favorable circumstances before and after the crisis. We used structural equation modeling to analyze answers collected from 2024 employees in Slovenian organizations between 2006 and 2016. The results showed significant growth of organizational engagement in ethical behavior, despite the crisis in the middle of the observed period. The employees' unethical behavior was significantly less acceptable in crisis compared to before the crisis, while after the crisis, its acceptability increased again, despite not significant. The aggregate sample revealed a significantly negative influence of employee's unethical behavior on organizations' ethical behavior that was not significantly different across the considered periods. The research suggests the need to manage the organization's ethical behavior in times of economic downturn, like in the present COVID 19. Additionally, managers need to devote more attention to prevent employees' unethical behavior and its influence on organizations' ethical behavior.

Developing an animal-assisted support program for healthcare employees

Background

Employee burnout and its associated consequences is a significant problem in the healthcare workforce. Workplace animal therapy programs offer a potential strategy for improving employee well-being; however, research on animal therapy programs for healthcare workers is lacking. This study aimed to evaluate the feasibility, acceptability and preliminary impact of an animal-assisted support program to improve healthcare employee well-being.

Methods

In this mixed-methods pilot intervention study, we implemented an animal-assisted support program in a multidisciplinary healthcare clinic at a large VA hospital. The program included 20 sessions over 3 months, each approximately 1-h long. Real-time mood data were collected from participants immediately before and after each session. Participation rates were tracked in real time and self-reported at follow-up. Data on burnout and employee perceptions of the program were collected upon completion via a survey and semi-structured interviews. Differences in mood and burnout pre/post program participation were assessed with t-tests.

Results

Participation was high; about 51% of clinic employees (n = 39) participated in any given session, averaging participation in 9/20 sessions. Mood (on a scale of 1 = worst to 5 = best mood) significantly improved from immediately before employees interacted with therapy dogs (M = 2.9) to immediately after (M = 4.5) (p = 0.000). Employees reported significantly lower levels of patient-related burnout (e.g., how much exhaustion at work relates to interaction with patients) after (M = 18.0 vs. before, M = 40.0) participating (p = 0.002). Qualitative findings suggested that employees were highly satisfied with the program, noticed an improved clinic atmosphere, and experienced a reduction in stress and boost in mood.

Conclusions

Establishing an animal-assisted support program for employees in a busy healthcare clinic is feasible and acceptable. Our pilot data suggest that animal-assisted programs could be a means to boost mood and decrease facets of burnout among healthcare employees.

A Multisite Case Study of Caregiver Advise, Record, Enable Act Implementation

BACKGROUND AND OBJECTIVES

The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act's three components into routine care delivery.

RESEARCH DESIGN AND METHODS

We conducted a multisite, ethnographic case study at three different hospitals' medical-surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework.

RESULTS

Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements.

DISCUSSION AND IMPLICATIONS

General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.

Ambulatory Surgery Center Medical Director: Visionary Leader

The ambulatory surgery center medical director is a physician leader who recognizes the need to develop a culture that encourages communication and empowerment of employees and professional staff, leading to engagement that optimize care through patient selection, safety and satisfaction requires vision and guidance from the medical director and is central to success of the ASC. Innovative thinking further improves patient care and long-term success by leveraging advances in technology and sustainable practices.

Thrill and adventure seeking in risky driving at work: The moderating role of safety climate

Introduction Within many industrialized countries, the leading cause of worker fatalities and serious injuries can be attributed to road trauma. In non-occupational research, high levels of sensation seeking personality, and specifically thrill and adventure seeking, have been associated with risky driving behaviors. In work driving literature, high organizational safety climate has been associated with reduced risky driving in work drivers. However, the extent that factors such as safety climate and thrill seeking interact in regard to work driving safety remains unclear, and the current research examined this interaction. Methods A total of 1,011 work drivers from four organizations participated in the research. Surveys were distributed online and hardcopies were sent via mail. The survey included measures of thrill and adventure seeking, safety climate and work-related driving behaviors, as well as questions relating to participant demographics and information about their work driving. Results The results demonstrated that safety climate significantly moderated the effect of thrill and adventure seeking trait on driving errors, driving violations, and driving while fatigued. Conclusion These results suggest that the development of a strong safety climate has the potential to improve work driving safety outcomes by reducing the impact of particular personality traits such as thrill seeking within an organizational context. Practical application To improve work driving safety, organizations and management need to develop strategies to encourage and foster positive work driving safety climate, particularly within work settings that may attract thrill and adventure seeking employees.

Factors influencing the long-term sustainment of quality improvements made in addiction treatment facilities: a qualitative study

BACKGROUND

A greater understanding of the factors that influence long-term sustainment of quality improvement (QI) initiatives is needed to promote organizational ability to sustain QI practices over time, help improve future interventions, and increase the value of QI investments.

METHODS

We approached 83 of 201 executive sponsors or change leaders at addiction treatment organizations that participated in the 2007-2009 NIATx200 QI intervention. We completed semi-structured interviews with 33 individuals between November 2015 and April 2016. NIATx200 goals were to decrease wait time, increase admissions and improve retention in treatment. Interviews sought to understand factors that either facilitated or impeded long-term sustainment of organizational QI practices made during the intervention. We used thematic analysis to organize the data and group patterns of responses. We assessed available quantitative outcome data and intervention engagement data to corroborate qualitative results.

RESULTS

We used narrative analysis to group four important themes related to long-term sustainment of QI practices: (1) finding alignment between business- and client-centered practices; (2) staff engagement early in QI process added legitimacy which facilitated sustainment; (3) commitment to integrating data into monitoring practices and the identification of a data champion; and (4) adequate organizational human resources devoted to sustainment. We found four corollary factors among agencies which did not sustain practices: (1) lack of evidence of impact on business practices led to discontinuation; (2) disengaged staff and lack of organizational capacity during implementation period led to lack of sustainment; (3) no data integration into overall business practices and no identified data champion; and (4) high staff turnover. In addition, we found that many agencies' current use of NIATx methods and tools suggested a legacy effect that might improve quality elsewhere, even absent overall sustainment of original study outcome goals. Available quantitative data on wait-time reduction demonstrated general concordance between agency perceptions of, and evidence for, sustainment 2 years following the end of the intervention. Additional quantitative data suggested that greater engagement during the intervention period showed some association with sustainment.

CONCLUSIONS

Factors identified in QI frameworks as important for short-term sustainment-organizational capacity (e.g. staffing and leadership) and intervention characteristics (e.g. flexibility and fit)-are also important to long-term sustainment.

Re-thinking barriers to organizational change in public hospitals

Public hospitals are well known to be difficult to reform. This paper provides a comprehensive six-part analytic framework that can help policymakers and managers better shape their organizational and institutional behavior. The paper first describes three separate structural characteristics which, together, inhibit effective problem description and policy design for public hospitals. These three structural constraints are i) the dysfunctional characteristics found in most organizations, ii) the particular dysfunctions of professional health sector organizations, and iii) the additional dysfunctional dimensions of politically managed organizations. While the problems in each of these three dimensions of public hospital organization are well-known, and the first two dimensions clearly affect private as well as publicly run hospitals, insufficient attention has been paid to the combined impact of all three factors in making public hospitals particularly difficult to manage and steer. Further, these three structural dimensions interact in an institutional environment defined by three restrictive context limitations, again two of which also affect private hospitals but all three of which compound the management dilemmas in public hospitals. The first contextual limitation is the inherent complexity of delivering high quality, safe, and affordable modern inpatient care in a hospital setting. The second contextual limitation is a set of specific market failures in public hospitals, which limit the scope of the standard financial incentives and reform measures. The third and last contextual limitation is the unique problem of generalized and localized anxiety, which accompanies the delivery of medical services, and which suffuses decision-making on the part of patients, medical staff, hospital management, and political actors alike. This combination of six institutional characteristics - three structural dimensions and three contextual dimensions - can help explain why public hospitals are different in character from other parts of the public sector, and the scale of the challenge they present to political decision-makers.

Incentives to change: effects of performance-based financing on health workers in Zambia

BACKGROUND

Performance-based financing (PBF) has been implemented in a number of countries with the aim of transforming health systems and improving maternal and child health. This paper examines the effect of PBF on health workers' job satisfaction, motivation, and attrition in Zambia. It uses a randomized intervention/control design to evaluate before-after changes for three groups: intervention (PBF) group, control 1 (C1; enhanced financing) group, and control 2 (C2; pure control) group.

METHODS

Mixed methods are employed. The quantitative portion comprises of a baseline and an endline survey. The survey and sampling scheme were designed to allow for a rigorous impact evaluation of PBF or C1 on several key performance indicators. The qualitative portion seeks to explain the pathways underlying the observed differences through interviews conducted at the beginning and at the three-year mark of the PBF program.

RESULTS

Econometric analysis shows that PBF led to increased job satisfaction and decreased attrition on a subset of measures, with little effect on motivation. The C1 group also experienced some positive effects on job satisfaction. The null results of the quantitative assessment of motivation cohere with those of the qualitative assessment, which revealed that workers remain motivated by their dedication to the profession and to provide health care to the community rather than by financial incentives. The qualitative evidence also provides two explanations for higher overall job satisfaction in the C1 than in the PBF group: better working conditions and more effective supervision from the District Medical Office. The PBF group had higher satisfaction with compensation than both control groups because they have higher compensation and financial autonomy, which was intended to be part of the PBF intervention. While PBF could not address all the reasons for attrition, it did lower turnover because those health centers were staffed with qualified personnel and the personnel had role clarity.

CONCLUSIONS

In Zambia, the implementation of PBF schemes brought about a significant increase in job satisfaction and a decrease in attrition, but had no significant effect on motivation. Enhanced health financing also increased stated job satisfaction.

The relationship between chiropractor required and current level of business knowledge

Background

Chiropractors frequently practice within health care systems requiring the business acumen of an entrepreneur. However, some chiropractors do not know the relationship between the level of business knowledge required for practice success and their current level of business knowledge. The purpose of this quantitative study was to examine the relationship between chiropractors’ perceived level of business knowledge required and their perceived level of current business knowledge.

Methods

Two hundred and seventy-four participants completed an online survey (Health Care Training and Education Needs Survey) which included eight key business items. Participants rated the level of perceived business knowledge required (Part I) and their current perceived level of knowledge (Part II) for the same eight items. Data was collected from November 27, 2013 to December 18, 2013. Data were analyzed using Spearman’s ranked correlation to determine the statistically significant relationships for the perceived level of knowledge required and the perceived current level of knowledge for each of the paired eight items from Parts I and II of the survey. Wilcoxon Signed Ranks Tests were performed to determine the statistical difference between the paired items.

Results

The results of Spearman’s correlation testing indicated a statistically significant (p < 0.01) positive correlation for the perceived level of knowledge required and perceived current level of knowledge for six variables: (a) organizational behavior, (b) strategic management, (c) marketing, (d) legal and ethical, (e) managerial decisions, and (f) operations. Wilcoxon Signed Ranks testing indicated a significant difference for three paired items: strategic management; marketing and; legal and ethical. The results suggest that relationships exist for the majority of business items (6 of 8) however a statistically difference was demonstrated in only three of the paired business items.

Conclusion

The implications of this study for social change include the potential to improve chiropractors’ business knowledge and skills, enable practice success, enhance health services delivery and positively influence the profession as a viable career.

A comparison of how behavioral health organizations utilize training to prepare for health care reform

BACKGROUND

Under the Affordable Care Act, States have obtained Medicaid waivers to overhaul their behavioral health service systems to improve quality and reduce costs. Critical to implementation of broad service delivery reforms has been the preparation of organizations responsible for service delivery. This study focused on one large-scale initiative to overhaul its service system with the goal of improving service quality and reducing costs. The study examined the participation of behavioral health organizations in technical assistance efforts and the extent to which organizational factors related to their participation.

METHODS

This study matched two datasets to examine the organizational characteristics and training participation for 196 behavioral health organizations. Organizational characteristics were drawn from the Substance Abuse and Mental Health Services Administration National Mental Health Services Survey (N-MHSS). Training variables were drawn from the Clinical Technical Assistance Center's master training database. Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that participated in training, the organizational characteristics (size, population served, service quality, infrastructure) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received.

RESULTS

Overall 142 (72. 4%) of the sample participated in training. Organizations who pursued training were more likely to be large in size (p = .02), serve children in addition to adults (p < .01), provide child evidence-based practices (p = .01), and use computerized scheduling (p = .01). Of those trained, 95% participated in webinars, 64% participated in learning collaboratives and 35% participated in in-person trainings. More organizations participated in business trainings than clinical (63.8 vs. 59.2%). Organizations serving children had higher odds of participating in both clinical training (OR = 5.91, p < .01) and business training (OR = 4.24, p < .01) than those that did not serve children.

CONCLUSIONS

The majority of organizations participated in trainings indicating desire for technical assistance to prepare for health care reform. Larger organizations and organizations serving children were more likely to participate potentially indicating increased interest in preparation. Over half participated in business trainings highlighting interest in learning to improve efficiency. Further understanding is needed to support organizational readiness for health care reform initiatives among behavioral health organizations.

Utilities of gossip across organizational levels : Multilevel selection, free-riders, and teams

Gossip is a subject that has been studied by researchers from an array of disciplines with various foci and methods. We measured the content of language use by members of a competitive sports team across 18 months, integrating qualitative ethnographic methods with quantitative sampling and analysis. We hypothesized that the use of gossip will vary significantly depending on whether it is used for self-serving or group-serving purposes. Our results support a model of gossip derived from multilevel selection theory that expects gossip to serve group-beneficial rules when rewards are partitioned at the group level on a scale that permits mutual monitoring. We integrate our case study with earlier studies of gossip conducted by anthropologists, psychologists, and management researchers.

The association of intensivists with failure-to-rescue rates in outlier hospitals: results of a national survey of intensive care unit organizational characteristics

PURPOSE

Critical care is often an integral part of rescue for patients with surgical complications. We sought to understand critical care characteristics predictive of failure-to-rescue (FTR) performance at the hospital level.

METHODS

Using 2009 to 2011 FTR data from Hospital Compare, we identified 144 outlier hospitals with significantly better/worse performance than the national average. We surveyed intensive care unit (ICU) directors and nurse managers regarding physical structures, patient composition, staffing, care protocols, and rapid response teams (RRTs). Hospitals were compared using descriptive statistics and logistic regression.

RESULTS

Of 67 hospitals completing the survey, 56.1% were low performing, and 43.9% were high performing. Responders were more likely to be teaching hospitals (40.9% vs 25.0%; P=.05) but were similar to nonresponders in terms of size, region, ownership, and FTR performance. Poor performers were more likely to serve higher proportions of Medicaid patients (68.4% vs 20.7%; P<.0001) and be level 1 trauma centers (55.9% vs 25.9%; P=.02). After controlling for these 2 characteristics, an intensivist on the RRT (adjusted odds ratio, 4.27; confidence interval, 1.45-23.02; P=.005) and an internist on staff in the ICU (adjusted odds ratio, 2.13; P=.04) were predictors of high performance.

CONCLUSIONS

Intensivists on the RRT and internists in the ICU may represent discrete organizational strategies for improving patient rescue. Hospitals with high Medicaid burden fare poorly on the FTR metric.

Organizational behavior of employees of Tehran University of Medical Sciences

Organizational behaviors are commonly acknowledged as fundamentals of organizational life that strongly influence both formal and informal organizational processes, interpersonal relationships, work environments, and pay and promotion policies. The current study aims to investigate political behavior tendencies among employees of Tehran University of Medical Sciences (TUMS). This cross-sectional, descriptive and analytical study was conducted on 810 TUMS employees at the headquarters of the Tehran University of Medical Sciences, Iran during 2010-2011. The research tool for data collection was a researcher-tailored questionnaire on political behaviors. The validity of the questionnaire was confirmed by seven management professors, and its reliability was tested by a pilot study using test-retest method which yielded a Cronbach's alpha coefficient of 0.71. The respondents were asked to fill the questionnaire and express their perceptions and tendencies to engage in organizational behaviors. The collected data was read to and analyzed by IBM SPSS environment and correlation analytical methods. Overall, 729 respondents filled and returned the questionnaire yielding a response rate of 90%. Most of the respondents indicated that they had no tendency to engage in political behavior. Moreover, we found that there was a significant correlation between sex, higher education degrees, tenure and the employees' tendency to engage in political behavior. The participants were not overtly political because of their personal belief, ethical values, and personal characters. Non-political and overtly political employees are both prejudicial for all organizations. Therefore, it seems that the medium rate of good political behavior is vital and prevalent in Iranian organizations.