bluuebunny/crossref_metadata_2025 huggingface dataset:
A qualitative analysis of officer peer retaliation
Authors: Cancino Jeffrey Michael , Enriquez Roger
Published: July 2006

A survey of the literature shows that researchers have assessed the social processes of retaliation among adversarial crime prone populations. However, notably absent from this research is the study ofpeerretaliation among non‐adversarial and less crime prone populations, such as police officers. The underlying theoretical premise is that peer retaliation, defined here as a mechanism of social control, operates under prevailing police culture conditions.Using focus group interviews collected from one large Southwestern police department, content analysis is used to qualitatively examine the influence of peer retaliation on officer deviance (i.e. reporting incidents of illegal force). The results show that officers' rationalize peer retaliation according to morality and deterrence; while, types of retaliation sanctioned against peers include ostracism and no cover. The implications of these findings are considered.
Policewomen and their problems: the Philippine context
Authors: de Guzman Melchor C. , Frank James
Published: July 2006

The lot of policewomen has been a difficult adaptation to a predominantly male‐dominated organization. Being traditionally dominated by males, the police organization may become a problematic workplace for policewomen. In a patriarchal society, women are placed at a disadvantage because of gender‐related workplace problems that may arise. This study involves an assessment of the gender‐related problems experienced by the policewomen of the Philippine National Police in the central region of the Philippines. Likewise, the study provides analyses of the relationships of these gender‐related problems to the job performance of women officers. Using a survey questionnaire, gender‐related problems of policewomen are identified and related to their performance using both objective and subjective measures. The data indicate that women officers experience gender‐related problems. However, these problems do not seem to relate significantly to their job performances.
A knowledge‐building community for public sector professionals
Authors: Heiskanen Tuula
Published: July 2006

The understanding of expert knowledge as shared, distributed and contextualised has gained ground. The case description in this article focuses on developing expert knowledge in a situation in which both knowledge needs and the definition of expertise fields changed radically in the public sector within a social crisis. The article examines an educational process against the idea of a knowledge‐building community as defined by Bereiter and Scardamalia in 1993. The aim is to highlight the pattern and flow of a progressive discourse. Alongside the idea of a knowledge‐building community, Boland and Tenkasi's 1995 notion of perspective taking and perspective making is utilised. The article discusses the factors that contributed to the success of discussion in the setting in which the target group was characterised by the transcending of organisational boundaries and expertise fields.
Informal learning after organizational change
Authors: Reardon Robert F.
Published: July 2006

This inductive, qualitative study investigates how learning took place among nine experienced engineers in an industrial setting after a major reorganization. A thematic analysis of the transcripts revealed that the learning was informal and that it fell into three distinct categories: learning new workflows, learning about the chemical process, and developing engineering expertise. The participants also describe five limitations to the learning in this context. The dynamic context of this study had a strong influence on the learning that took place.
Developing futures: a knowledge‐based capital for Manchester
Authors: Garcia Blanca C.
Published: July 2006

This piece of work reports on the initial findings of ongoing research conducted at the Victoria University of Manchester UK, aiming at categorizing the city‐region’s different forms of knowledge capital. Using a global knowledge‐based development (KBD) model as an instrument, information about recent urban regeneration and development experiences in its inner city and beyond have been collected, identified and analyzed. Such research is aiming to establish Manchester’s potential to become a knowledge city. In this aim, the current research paper will report first on a review of the theoretical background behind the concepts of the knowledge city (KC) and KBD, which have been the catalysts to a systematic account of facts and figures of urban regeneration developments within Manchester. The review will be followed by the narrative of KDB observations on the continuous flow of creation and renovation initiatives; with observations on outcomes that can be traced out through Manchester’s cumulated and diversified capital repositories and agents. Such flow is presented through the eyes of the different actors involved (authorities, researchers, and partnership organizations), whose voices are present in the diverse capital landmarks of the city. The global knowledge‐based model used has served as a comprehensive framework for consistent, systematic gathering of primary data on capital systems for a deeply contextualized case study. It has facilitated powerful inter‐relational capabilities for researchers’ insights on the city‐region’s potential knowledge capital. It has also provided the platform for systematic identification of socio‐economic issues beyond level one. In the case of Manchester, the model helped interrelating concerns about social inclusion, access, and skills for sustainable development. They were also re‐positioned to their true dimensions as the KBD model has assisted research with the systematic identification of the (knowledge capital) roles that city‐region actors (k‐agents and k‐repositories) are playing, and the solutions they are bringing to those concerns and beyond. Most of all, the KBD model facilitated multiple insights into how global challenges are finding local solutions. And Manchester’s case is undoubtedly filling a gap in the recent literature of knowledge cities. This contribution, amongst many others, is aiming to trigger further debate through a rainbow of contrasting points of view about what KBD has meant for the city‐region of Manchester. It is also hoped that a renewed interest in capital systems research and its social policy implications in and about the city would be triggered as well.
Knowledge repositories in knowledge cities: institutions, conventions and knowledge subnetworks
Authors: Cheng Philip , Ju Choi Chong , Chen Stephen , Ibrahim Eldomiaty Tarek , Millar Carla C.J.M.
Published: July 2006

Suggests another dimension of research in, and application of, knowledge management. This theoretical paper adopts a conceptual, multi‐disciplinary approach. First, knowledge can be stored and transmitted via institutions. Second, knowledge “subnetworks” or smaller groupings within larger networks can become key repositories of knowledge. The concept of knowledge “subnetworks” needs to be tested against empirical evidence, which should include a cross‐national comparison of knowledge‐based cities. The paper provides some insights to policy makers in designing or developing global cities. It is one of the few papers that discusses the connection between knowledge management and growth of global cities.
Ba for knowledge cities: a futuristic technology model
Authors: Naveed Baqir Muhammad , Kathawala Yunus
Published: July 2006

Aims to develop a knowledge city model by constructing knowledge homes using futuristic technology building blocks that can help in implementing the concept of virtual Ba to share, manage, and create knowledge. A variety of research organizations and forums are researching new technologies for better connectivity, contactivity, and computational power to manage knowledge. In this paper, a knowledge city model has been developed based upon five important technological components leading to knowledge sharing/creation for knowledgeable citizens. The model also sheds light on how it may cater to the educational, socio‐cultural, business and governmental needs of knowledge cities. Amalgamation of different technologies is indispensable to managing the knowledge of a learning organization. This type of technology integration leads to increasing amounts of data, and intensifies the pressure of information overload upon knowledge workers. The growing network usage also upsets network models, putting remarkable pressure on bandwidth requirements and network management. The technologies used to build a knowledge city address these issues by developing a smart knowledge network. This is not an exhaustive review of various technologies used to construct a knowledge city model, but it is a useful resource for knowledge managers, technology managers, and planners who are interested in exploring promising technologies to manage knowledge. This paper combines the latest technologies to build a knowledge home that is aimed towards implementing Ba in a knowledge city. The paper also introduces the concept of virtual Ba by unifying the traditional Ba and knowledge management technologies.
The future of financial services in Europe
Authors: May Graham
Published: July 2006

Financial services in Europe have undergone dramatic changes in recent years. Much of this is due to developments in information and communication technologies, the arrival of European Monetary Union and the ageing population. These will continue to be important drivers of change as the industry continues to evolve. The future may see the emergence of a few major global players though national sensitivities and preferences may limit mergers. “Surprise‐free”, alternative and wild card scenarios are outlined and a range of issues which appear important for policy makers to consider is raised.
Realism in evidence based medicine: interpreting the randomised controlled trial
Authors: Connelly Jim
Published: July 2006

Realism is emerging as a paradigm for research and explanation in the natural and social sciences. A realist framework is elaborated and applied to the four possible situations that may generate the observations of randomised, controlled trials. It is demonstrated that by using two realist concepts “mechanism” and “context” a number of misinterpretations of such trials from within the dominant empiricist paradigm may be rectified. Evidence based medicine should adopt realism to temper a misleading empiricism, this will involve relegating statistical arguments to their proper subsidiary place and adopting an adequate theory of causation.
Towards a systemic understanding of a hospital waiting list
Authors: Foote J.L. , North N.H. , Houston D.J.
Published: July 2006

Hospital waiting lists are a feature of publicly funded health services that result when demand appears to exceed supply. While much has been written about surgical waiting lists, little is known about the dynamics of radiology waiting lists, which is surprising given that rational treatment, and indeed the medical profession's claim to expertise, rests on establishing a diagnosis. This paper reports the findings of a case study of a problematic ultrasound waiting list. In particular, this paper highlights how the management of the ultrasound waiting list served to subordinate the needs of waiting patients and their general practitioners to the interests and values of radiologists. Radiologist concern to protect specialist expertise from encroachment by outpatient clinicians and sonographers is implicated in the growth of the ultrasound waiting list. It is argued that an adequate understanding of ultrasound waiting lists depends on grasping how radiologists are successful in structuring problems of access in ways that enhance radiologist control over ultrasound imaging. The case study reported helps to shed light on why increasing funding to clear waiting lists proves ineffective.
Managing health risks: junior doctors' views of risk and decision making
Authors: Fuller Richard
Published: July 2006

Managing risk and making decisions presents an increasing challenge to doctors as they are encouraged to adopt a partnership approach with patients to dealing with risk, within a “risk society” constructed around individuality, uncertainty, blame and responsibility. In‐depth interviews, stimulated by clinical vignettes, were used to explore the key position of doctors within this risk society. Analysis, sensitised through contemporary texts, revealed unexpected findings that portrayed doctors as reflexive jugglers of risk. Discourses in this study revealed indecision and uncertainty, balanced against needs to preserve professional roles and engage patients in addressing risk, whilst preventing widespread harm and conflict. In concluding, the alternative approaches to risk with older people will suggest a more trusting and positive process that presents a real opportunity for truly sharing risk and decisions that benefit both doctor and patient.
Story teller or story analyst?
Authors: Tovey Philip , Manson Nicola
Published: July 2006

Despite recent developments in the sociology of complementary and alternative medicine (CAM), a critical analysis of the apparent affinity between CAM and nursing has, to date, remained essentially undeveloped. An empirical project is currently being conducted as an initial step to address the absence of such important critical research. A total of 30 written life history narratives were obtained from nurses working with and using CAM to explore such matters as professional boundaries and nurses' authentication strategies and conceptualisation and operationalisation of CAM. This paper addresses questions and conflicts that arose as the analytical tools were considered for these narrative accounts. Specifically, the paper explores whether the storied narrative sits easily with a critically oriented sociology of CAM; the differences between the role of “storyteller” or “story analyst”; and ask whether there is potential for developing a critical sociology of CAM nursing that retains the essence of personal stories.
An empirically‐based model for clinician‐managers' behavioural routines
Authors: Braithwaite Jeffrey
Published: July 2006

Numerous past articles, many of which consist of idealised prescriptions for success or the occasional case study or practitioner's contribution, have commented on the role of hospital clinician‐managers. Prior work is circumscribed, however, in that it tends to be normative and a priori (how clinician‐managers in principle should manage) rather than descriptive and a posteriori (how clinician‐managers in situ do manage). In addition, it is apparent that an empirically‐grounded, testable model is lacking for the way clinician‐managers work. This paper sets out to balance past normative‐prescriptive accounts with a descriptive‐analytic one, and presents an empirically‐based conceptual model of the behavioural routines of hospital clinician‐managers. The model, based on multiple studies of clinician‐managers' activities, conjectures five major modes of operating and four primary and five secondary pursuits. The paper advances accounts of how clinician‐management work is conducted and the time frames for it, and hypothesises about clinician‐managers' relationships, and how power and control is experienced and exercised. It also briefly discusses some of the implications of both the research program and the findings. However, following Popper, researchers ought to invite attempts to improve rigor through a systematic critique of their findings. Critical analysis of this work under falsification processes is consequently welcomed.
Implementation of hospital restructuring and nursing staff perceptions of hospital functioning
Authors: Burke Ronald J.
Published: July 2006

Hospital restructuring and downsizing has taken place in most developed countries during the past ten years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff, as well as features of the restructuring process that contribute to more effective transitions. This research reports results of a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital effectiveness. Data were collected in November 1996 and again in November 1999 from nursing staff using questionnaires. Would the way hospital restructuring was implemented and managed in 1996 be related to nursing staff perceptions of hospital functioning in 1999? The findings showed positive but moderate relationships between more favorable restructuring processes and perceptions of hospital functioning.
Interview with Beverly Alimo‐Metcalfe
Authors: Powell Sarah
Published: July 2006

Professor Beverly Alimo‐Metcalfe speaks to Spotlight editor Sarah Powell about the transformational imperatives of leadership.
Leadership for the systemization of health care: the unaddressed issue in health care reform
Authors: Degeling Pieter , Carr Adrian
Published: July 2006

The case literature strongly suggests that both in England and in Australia health care reforms have had very little impact in terms of “improved performance”. It is in the context of a perceived failure in the implementation of the reforms that an interest has arisen in leadership at the level of individual clinical units (e.g. an orthopaedics unit or birth unit), as the possible “fix” for bridging the promise‐performance gap. Drawing upon extensive case studies that highlight the problem and context for appropriate forms of leadership, this paper argues that the appropriate discourse, in terms of leadership in health reform, needs to focus upon the issue of authorization. In making this argument, addresses the current conceptions of leadership that have been advanced in the discourse before offering some case study material that is suggestive of why attention should be focused on the issue of authorization. Illustrates how and why the processes of leading, central to implementing reform, cannot be construed as socially disembodied processes. Rather, leading and following are partial and partisan processes whose potential is circumscribed by participants' position‐takings and what is authorized in the institutional settings in which they are located. Argues that the “following” that clinical unit managers could command was shaped by the sub‐cultures and “regulatory ideals” with which staff of each profession are involved. In the interests of reform, policy players in health should not be focusing attention solely upon the performative qualities and potential leadership abilities of middle level management, but also on their own performance. They should consider how their actions affect what is authorized institutionally and which sets the scope and limits of the leadership‐followership dialectic in clinical settings.
Power and leadership
Authors: Braynion Paula
Published: July 2006

The author's role as a nurse consultant in a Mental Health Trust in the north of England is particularly interesting because of the peculiar position of the nurse consultant. One of the main components of the role is leadership, yet they are not operational managers so cannot draw on traditional positional power as a way of influencing people. This led the author to explore the concept of power and its implications for leadership. The paper is the result of this exploration: it reviews theories of power and how these can be applied to an understanding of leadership.
Telehealth adoption in hospitals:an organisational perspective
Authors: Gagnon Marie‐Pierre , Lamothe Lise , Fortin Jean‐Paul , Cloutier Alain , Godin Gaston , Gagné Camille , Reinharz Daniel
Published: July 2006

Purpose

The purpose of this study is to explore the influence of hospitals’ organisational characteristics on telehealth adoption by health‐care centres involved in the extended telehealth network of Quebec (French acronym RQTE)

Design/methodology/approach

The article is based on a review of the literature and a questionnaire, which was administered via telephone interviews to the 32 hospitals involved in the Extended Telehealth Network of Quebec. Contingency analyses were performed to determine which organisational factors have influenced telehealth adoption. Subsequently, a multiple case study was conducted among nine hospitals representative of different categories of telehealth adopters. In‐depth interviews with various actors involved in telehealth activities have permitted a deepening of one's understanding of the impact of clinical and administrative contexts on telehealth adoption.

Findings

The results from both the questionnaire and interviews support the observation made by Whitten and Adams in 2003 that telehealth programs are not isolated, but located within larger health organisations. Moreover, health‐care organisations are also positioned in a larger geographical, economical and socio‐political environment. Therefore, it is important to investigate the context in which telehealth projects are taking place prior to experimentation.

Originality/value

This study has highlighted the relevance of considering the characteristics and the dynamics of health‐care organisations at each stage of telehealth implementation in order to take their specific needs into account.
Mapping care pathways for the elderly
Authors: Katsaliaki Korina , Brailsford Sally , Browning David , Knight Peter
Published: July 2006

Purpose – Aims to describe a project carried out within Hampshire Social Services investigating potential care pathways for older people after discharge from hospital and to show the potential of the simulation methodology in such situations. Design/methodology/approach – A discrete‐event simulation was used to determine the system capacities and to estimate the likely associated reimbursement costs. Findings – A prototype simulation model was developed showing the potential value of this approach. Research limitations/implications – Restrictions in data access shifted the focus from quantitative service mapping to a more descriptive approach. Practical implications – Currently, many older patients experience delayed discharge from acute beds because of capacity limitations in Social Services’ traditional post‐acute care services. At the same time, new regulations require Local Authorities to reimburse NHS Acute Trusts if hospital discharge is delayed solely due to inadequate provision of social care assessments and services. In order to overcome the so‐called “bed‐blocking” problem, a new range of services termed “Intermediate Care” has been introduced to offer alternative options for older patients. These services are examined in terms of capacity and appropriateness. Originality/value – This paper fulfils an identified need to record and evaluate the new post‐acute packages introduced by the Social Services and NHS and proposes simulation as one of the most suitable methodologies for such objectives.
Organisational change through clinical governance: the West Midlands three years on
Authors: Wallace Louise M. , Boxall Matthew , Spurgeon Peter
Published: July 2006

Clinical governance is an organisational approach to improving the quality of clinical services. A survey was conducted of 33/40 NHS trusts 2.5 to three years after a baseline survey of the 46 trusts was conducted in the West Midlands region. Reported outcomes were achieved more often than expected at baseline. Patient outcomes and documented changes in clinical behaviour were both expected and reported in over three quarters at both periods. A more open culture was expected in 65 per cent at baseline and achieved in 84 per cent at time 2. Strategies for change continued to rely on both periods in optional, educative, audit and protocol procedures. The new approaches of critical incident review and consultant appraisal were welcomed. External review and league tables had adverse impacts where results were poor, but minimal impact if results were positive. Conclusions are drawn about more effective means of catalysing change.
An audit of the management of emergency surgical admissions in Wales: are we keeping pace with the trend?
Authors: Barthelmes L. , Kakkilaya H. , Jenkinson L.R.
Published: July 2006

Over the last 20 years surgery has undergone significant change in the UK and emergency admissions are now beginning to exceed elective cases. There has also been consultant expansion allowing a consultant‐led emergency service. The Confidential Enquiry for Peri‐operative Deaths (CEPOD) also recommended that an emergency theatre is available 24‐hours a day. This study was undertaken to identify the current consultant management of acute surgical admissions, to investigate the impact of consultant expansion on the management of acute surgical admissions and to assess the development of CEPOD theatres throughout Wales. A telephone survey was conducted in February 2001 and repeated in February 2002. The provision of a CEPOD theatre has markedly improved throughout Wales in the last year. A consultant‐led emergency service is still only provided by 29 per cent of hospitals and this was achieved mostly by consultant expansion. In most hospitals the working pattern has been unable to change to reflect the increase in emergency work.
An integrated pathway of care (IPOC) in obstetric anaesthesia
Authors: Shannon P.E. , Collins J.
Published: July 2006

States that the traditional model of obstetricians seeing all pregnant women and directing their care is changing due to a recognised need for anaesthetists to provide, good, high‐quality information on pregnant women and the development of midwifery‐led care. Presents the “pathway” of care which has undergone a 12‐month study period involving 3,500 pregnant women. Concludes that the results from the study reveal important gaps in the service, but that the pathway of care has produced benefits for all professional groups involved.
Clinical governance: a fresh look at its definition
Authors: Vanu Som Chandra
Published: July 2006

Clinical governance was introduced in 1997 as a comprehensive framework to improve the healthcare quality in the National Health Service. Since then, the proliferation of various definitions and models of clinical governance illustrates that different perceptions are emerging on clinical governance. However, none of these definitions captures the essence of clinical governance in terms of its organisation‐wide implications for continuous quality improvement. Although there is discrete mention of structure, process and outcomes in the literature on clinical governance, it is hard to find any clear explanation on how clinical governance influences organisational elements. This paper therefore analyses clinical governance in terms of the inputs, processes, structure and the outcomes of healthcare organisations. The fact that the introduction of any new governance framework will have much wider implications for the management of healthcare organisations is illustrated through a refined definition of clinical governance presented in this paper.
Attitudes to the identification and reporting of significant events in general practice
Authors: McKay John , Bowie Paul , Murray Lilian , Lough Murray
Published: July 2006

The new National Patient Safety Agency (NPSA) aims to facilitate the mandatory reporting of relevant significant events. A questionnaire survey of 617 general practitioners was undertaken and 466 responses were received (76 per cent). A minority (18 per cent) agreed the reporting of adverse incidents should be mandatory, while a majority (73 per cent) agreed that they would be selective in their reporting in a mandatory system. Most (75 per cent) favoured a local anonymised system of reporting. A difficulty in determining when an event is “significant” was acknowledged by 41 per cent of respondents and 30 per cent agreed significant events were often not acted on. Less experienced respondents were more likely to have difficulty in determining when an event is significant (p = 0.01). The success of the NPSA system may be obstructed by the mandatory requirement to participate and in the difficulty for some in determining when an event is “significant”.
Medication safety in 2004: the NHS agenda
Authors: Cowan Jane
Published: July 2006

The Department of Health published a new document on medication safety in January 2004. This article reviews the content of the document from risk and safety perspectives. It considers difficulties in effective implementation of the relevant principles discussed in the document. It discusses the overriding concerns of training and resources, which are a significant barrier to reducing medication errors.
Challenges to improving patient safety in the NHS
Authors: Kaur Hothi Daljit
Published: July 2006

Evidence‐based practice is dominating the NHS. However, when the need to reform risk management reached crisis point, the UK Government and Department of Health responded by investing in a new national body (the National Patient Safety Agency) and strategies based around mainly non‐medical research. This report demonstrates the unsuitability of these extrapolated ideas within the setting of the health service and highlights the inefficient use of resources in a system that is barely coping with existing demands.
Improving quality care through a nursing review team
Authors: Dugdall H. , Lamb C. , Carlisle A.
Published: July 2006

This project was organised in response to nursing teams experiencing sustained pressure, reflected by increased staff sickness, escalating complaints and emerging themes in clinical incident reports. A framework was developed to provide a structure that would enable a team of senior nurses to review nursing practice in any clinical speciality within the acute Trust. The aim was to highlight and report on areas of good practice, identifying and making recommendations in areas for improvement. The review process involved gathering information that helped to form a triangle of evidence. Interviews were conducted with the multi‐disciplinary team in order to provide evidence. There has been evidence of improved morale at ward level that can be attributed to changes in practice and improved resource allocation. There is clear evidence of changes at service level enabling a more seamless system of care delivery. The framework and methodology developed for this review process can be adopted to make an initial assessment of nursing care within the clinical area.
Making clinical governance happen at team level: the Dorset experience
Authors: Mynors‐Wallis L. , Cope D. , Suliman S.
Published: July 2006

Clinical governance is at the heart of the drive to improve the quality of patient care in the National Health Service. National targets, the National Service Frameworks and NICE Guidance are providing a top‐down mechanism to deliver this improved care. Improved patient care will not happen, however, without the active and enthusiastic participation of clinicians and clinical teams. This article sets out the mechanism that Dorset Healthcare NHS Trust, a specialist mental health and learning disability trust, has established to foster and develop the involvement of clinical teams in clinical governance. The article describes the development of team‐based clinical governance portfolios and sets out how they have been used to focus clinical teams on clinical governance activities.
What do NHS staff think and know about clinical governance?
Authors: Murray James , Fell‐Rayner Hazel , Fine Howard , Karia Nisha , Sweetingham Rachel
Published: July 2006

Clinical governance has been an important issue in the British National Health Service for several years. This study looks to see how this has filtered down to front‐line staff, in terms of their knowledge about clinical governance, their attitude to it, and their implementation of it. A total of 539 participants across three NHS trusts in the South of England completed the Staff Clinical Governance Survey. The results showed generally positive attitudes and varying levels of knowledge and implementation. The use of this questionnaire enables services to audit their implementation of clinical governance, and highlights specific training needs for staff and their managers.
Hospitalist programs in academic medical centers
Authors: Smith Wally R. , Wyttenbach Mindy E. , Austin Warren , Rangappa Shantaram
Published: July 2006

The use of hospitalists in the care of in‐patients is a relatively new phenomenon in the USA – hospitalists are delivering medical care to patients in private practice, public hospitals, and academic medical centers. Several obstacles hinder understanding of the characteristics of academic medical center‐based hospitalists. These include differences in definitions and nomenclature, differences in job descriptions, roles and administration across hospitalist programs, and in qualifications and credentialing of hospitalists versus other physicians. These differences derive from the heterogeneity of AMCs by bed size, level of local and regional competition, and cultural, utilization and referral patterns. The field needs an agreed definition of the term “hospitalist”. Assuming a good definition, one could take advantage of already good descriptive data on AMCs to quantify hospitalists within AMCs and to study how hospitalist programs vary by AMC characteristics.
Can single‐stop carpal tunnel syndrome assessment clinics reduce waiting time to surgery?
Authors: Bassi R.S. , Haidar S.G. , Gupta A.K. , Sinha A.K. , Deshmukh S.C.
Published: July 2006

At the one‐stop carpal tunnel syndrome clinic, patients undergo neurophysiological studies followed by clinical assessment by the orthopaedic consultant on the same day. Patients with paraesthesia or numbness in the median nerve distribution for greater than three months duration without a history of a previous soft tissue neck injury were selected for assessment in the one‐stop carpal tunnel syndrome clinic based on a proforma completed by their general practitioners. Data of patients attending the one‐stop carpal tunnel syndrome clinic over a ten‐month period were compared with that over the same period from a conventional hand clinic. A total of 77 patients attended the one‐stop carpal tunnel syndrome clinic over a ten‐month period. The mean time from referral to surgery was 23 weeks in this group compared to 44 weeks for a conventional clinic. On average, the one‐stop carpal tunnel syndrome clinic reduced the time from referral to surgery by 21 weeks. The one‐stop carpal tunnel syndrome clinic is convenient and cost effective for patients and hospitals.
Developing a multi‐professionally agreed list of adverse events for clinical incident reporting in trauma and orthopaedics
Authors: Giles Sally , Cook Gary , Jones Michael , Todd Brian , Mason Margaret , Walshe Kieran
Published: July 2006

The aim of this study was to develop a multi‐professionally agreed list of adverse events, which may act as a prompt for clinical incident reporting in trauma and orthopaedics and to determine what healthcare professionals understand by the term adverse event. A modified Delphi process with healthcare professionals working in trauma and orthopaedics (242) in three NHS trusts was performed. The process involved initial brainstorming sessions, a two‐round Likert‐style postal questionnaire and final focus group discussion. The initial brainstorming sessions generated a list of 224 adverse events to be included in the first round of the postal questionnaire. They included 83 causes of adverse events, 36 health and safety related adverse events and 105 clinical adverse events. Following the second round questionnaire and focus group discussion, a final list of 20 adverse events was produced. There were variations between professional groups in terms of validity scoring of individual adverse events. Overall, medical staff gave a lower rating to the adverse events than the other two professional groups. There were also variations between professional groups in terms of response rates. The modified Delphi process proved to be a successful tool for generating a multi‐professionally agreed list of adverse events and for understanding what healthcare professionals understand by the term adverse event.
Multidisciplinary hospital antibiotic stewardship: a West London model
Authors: Cooke Fiona J. , Dean Franklin Bryony , Lawson Wendy , Jacklin Ann , Holmes Alison
Published: July 2006

Antibiotic resistance presents a major public health challenge at local, national and international levels. At a local level, the challenge is to tackle the antibiotic stewardship agenda, within the clinical governance framework, across all professional groups and specialities. This paper presents the response to this challenge in a large multi‐site NHS trust. The approach focuses around a multi‐disciplinary antibiotic steering group, in which a dedicated infectious diseases pharmacist plays a key role. Proposes seven key elements for a successful antibiotic stewardship programme and discuss examples of local action. These elements are: strong leadership; dedicated individuals with responsibility for leading on antibiotic use; integration into pre‐existing trust structures; harnessing existing resources to deliver change; obtaining local data on prescribing patterns and resistance; communication; and education and training. All pillars of clinical governance are supported by the multi‐disciplinary approach described.
The teaching and use of a mnemonic to improve the management of shoulder dystocia
Authors: Heazell Alexander E.P. , Bhatti Nighat R.
Published: July 2006

Aims to assess the benefits of using a mnemonic to structure the care given during episodes of shoulder dystocia, an obstetric emergency that has important sequelae for the mother and infant. A retrospective case‐notes‐based study was carried out to describe practice prior to the introduction of the mnemonic. A prospective study was undertaken to evaluate the use of a mnemonic in practice, and whether this had an effect on foetal morbidity. Prior to the introduction of the mnemonic and structured documentation, care was delivered in an unstructured and in a non‐evidence‐based manner in 35 per cent of patients; documentation was incomplete in 68 per cent of cases. There was a 5 per cent incidence of injury to the infant. Following the introduction of a mnemonic, the use of evidence‐based manoeuvres increased to 100 per cent, and care was delivered in a structured manner and there were no recorded injuries to infants. The management of shoulder dystocia has been made safer and more controlled by using a mnemonic to describe an evidence‐based pathway. It has facilitated a multi‐disciplinary team‐based approach to the management of this obstetric emergency.
Implementing organizational learning initiatives
Authors: Yeo Roland
Published: July 2006

Purpose

The paper explores several key issues in organizational learning and their contributions to practice and policy. It determines the different stages of learning, crucial factors and performance outcomes associated with organizational learning.

Design/methodology/approach

Four Singapore organizations were studied, from which a total of 24 organizational learning practitioners representing both the private and public sectors were interviewed.

Findings

Qualitative data were presented in the form of excerpts from the respondents in support of the key research objectives as well as quantitatively through the number of mentions, a technique which is uncommon yet useful for an exploratory study.

Research limitations/implications

The research was limited by the single geographical context, which might not adequately represent the Asian perspective. However, the paper provides room for continuation as the author introduces two other parts (for subsequent issues) that further detail implications for practice and policy based on the same study.

Practical implications

Data revealed that: the complexity between the different levels of learning can be simplified by understanding the goals set at each level; and the relationship between learning and performance goes beyond tangible expectations.

Originality/value

Of considerable value to practitioners is the discovery of several crucial factors influencing organizational learning and a list of possible learning outcomes ranked in order of importance; the ranking system being a unique technique helping practitioners in their decision‐making more effectively.
A guide to executive coaching
Authors: du Toit Angélique
Published: July 2006

Purpose

This paper introduces managers to the benefits of Executive Coaching as experienced by both the individual as well as the organization. It also recognises the difficulties purchasers of coaching may experience in selecting the appropriate coach for the individual or the organization.

Design/methodology/approach

It introduces a brief guide, detailing what to look out for when selecting a coach. Findings

Findings

As coaching is a relatively new profession, there are very few common standards and guidelines available in monitoring the quality of the training of the coaches and the maintenance of quality in delivery.

Originality/value

The paper introduces the benefits of coaching which will in turn support the selection process.
Airline flight deck management techniques applied to business
Authors: Berry David
Published: July 2006

Purpose

Introduces Command Leadership and Resource Management (CLRM) and explains the application of this new and unusual method of transferring aviation related leadership skills to the commercial business environment.

Design/methodology/approach

CLRM is based on the theory of Kurt Lewin who stated that “People are a function of behavior and environment: change one and the other will change”. The observation and assessment of individuals’ reactions to environmental changes, the team's chemistry (action and reaction) and level of magnetism that keeps the team and the project on course through the application of airline flight deck management techniques.

Findings

Forces participants to observe and self assess their mental attributes and to physically test, stretch and employ latent leadership skills in a non artificial, non classroom based environment by facing issues and dynamics which occur daily in the workplace.

Practical implications

The application of team related activities such as employee interactions and communicational tasks invoke and improve leadership skills at all levels of management to drive corporate aspirations to successful conclusions.

Originality/value

To the author's best knowledge and belief, the transfer of a mandatory form of aviation management training to the business world using a self contained environment to demonstrate this learning technique has not been previously practiced.
The protection of landscape as a resource
Authors: Bulcão Lara , Ribeiro Luís , Arsénio Pedro , Abreu Maria Manuela
Published: July 2006

The evolution of the concept of landscape to incorporate components like cultural and socio‐economic factors, in addition to the natural and aesthetic features, influenced the perception of landscape as a resource. On the other hand, the relationships between territorial features as well as the understanding of their temporal dynamics determine the significance of these features for the quality of a landscape and, consequently, for its conservation. This implies that all components – natural and physical, but also cultural and visual – upon which landscape quality is assessed, ought to be considered and studied globally. Natural resources and cultural heritage, however, are usually considered independently when developing protected areas management plans. Here, we present a methodology developed for the Monte da Guia management plan, which allows the interrelated analysis of landscape factors such as geology, geomorphology, pedology, flora and vegetation cover as well as the cultural and visual characters. Using the concepts of biophysical sensitivity and visual quality, we evaluated the relevance of these various factors for the determination of the state of equilibrium/degradation of a landscape, and hence for its conservation value. This methodology may contribute to the development of improved zoning maps and management guidelines determining land use and management strategies for the conservation of individual resources that, together, determine landscape quality.
Computational fluid dynamics
Authors: Pitarma R.A. , Ramos J.E. , Ferreira M.E. , Carvalho M.G.
Published: July 2006

The improvement in the quality of life together with thermal comfort, air quality, health, workplace security and energy conservation measures justify the integral education of environmental (outdoor and/or indoor) phenomena. Environmental education, through the appropriate tool, can play an important and vital role in this domain. Computational fluid dynamics (CFD) is the analysis of systems involving fluid flow, heat transfer and associated phenomena such as distribution of pollutants by means of computer‐based simulation. This technique, allowing the simulation and the visualization of environmental problems, represents a powerful tool to motivate, guide and educate on the environment. The main objective of this paper is to introduce this new advanced active tool in environmental education, directed to indoor‐environment quality, that permits the prediction and visualization of air movement, air temperature and air contaminant (such as tobacco smoke) distribution in rooms. With suitable mathematical models and boundary conditions, a computational code has been developed to predict and visualize these phenomena. In order to demonstrate its applicability, the simulation of air contamination distribution in an office room with a smoker was performed.
A qualitative study of facilities and their environmental performance
Authors: Tarcan Ertugrul , Sait Varol Ergin , Ates Metin
Published: July 2006

Improving indoor environmental conditions and, thus, health standards will have a direct impact on the performance of the employees and, thus, organisations and on the wealth of the community. The indoor air quality, lighting, ergonomics, acoustics and health complaints scales are widely used to determine building performance levels. The research model was tested using responses from 362 employees in 25 diverse hospitals. The results indicate that building comfort level assessments play a critical role in influencing the health complaints and building general sufficiency level judgements of the employees. These judgements differ from each other for the hospital groups classified according to the ownership criteria. This study will support a better evaluation of development policies of workplace environmental conditions by managers.
Decision support for optimal emission reduction
Authors: Holnicki Piotr , Kaluszko Andrzej
Published: July 2006

In this paper, a problem related to the optimal allocation of financial means for reduction of air pollutants concentration in a given region is considered. The implementation is sulfur oxides oriented. The problem is formally stated as the cost‐constrained minimization of the environmental damage function by the optimal choice of desulfurization technologies, within the predefined set of controlled (power and heating) plants. Optimization methods have been implemented and tested on the real data for the selected region. The case study relates to the set of major power plants in the region of Silesia (Poland) and the basic desulfurization technologies, which are to be allocated.
Some trends related to air pollution in Damascus
Authors: Meslmani Yousef
Published: July 2006

Short‐term monitoring of air pollutants for 15 selected sites in Damascus city has been investigated. The following air pollutants were measured: total suspended particulate (TSP), sulphur dioxide (SO2), nitrogen monoxide (NO), nitrogen dioxide (NO2) and carbon monoxide (CO). The overall average concentrations of the previous five pollutants were determined. The calculated concentrations were about 246μg/m3 for TSP, 39μg/m3 for SO2, 49μg/m3 for NO2 and 2.8mg/m3 for CO. In this reported study, the TSP and the particulate with less than 10‐micrometer size (PM10) were the most effective pollutants in the air of Damascus city.