bluuebunny/crossref_metadata_2025 huggingface dataset:
Management consulting practice on intellectual capital
Authors: Marr Bernard
Published: January 2007

Purpose

With intellectual capital and intangible assets high on the agenda of executives around the world, and little practical evidence of good practice in measuring and managing these assets, there is a great need for help. This editorial to a special issue on the topic introduces the problem and highlights key issues. The special issue provides an overview of how management consulting companies acting in this space suggest tackling the problem. The purpose is therefore to bring together the approaches of different management consulting firms and to make their differences explicit.

Design/methodology/approach

All major general management consulting firms as well as specialist consulting firms focusing in the area of intellectual capital and intangible assets were directly invited to submit a paper for this special issue. The call for papers was also made publicly available in the journal and through e‐mail campaigns by Emerald. All submissions underwent a double‐blind refereed selection process.

Findings

Even though many submissions were received for this special issue, most of the authors were not able to demonstrate a sufficient understanding of the constructs nor were they able to justify the tools and methodologies developed. Reviewers were made aware of the practical background of many of the authors and it was ensured that sufficient and constructive feedback was provided. Even with various rounds of reviews many papers had to be rejected as they resembled marketing brochures rather then logical discussions. This unfortunately shows that there still is a massive skills gap in the industry and companies should be careful before they engage with any management consulting firm to help them measuring or managing their intangibles.

Practical implications

The focus of potential papers was not academic rigor (as opposed to the Special Issue Vol. 5 No 2) but the provision of an overview of the state of the art in intellectual capital consulting practice. The papers therefore provide practitioners with good insights into current practice.

Originality/value

This special issue is the first to bring together in a structured and rigorous format different management consulting approaches to the measurement and management of intellectual capital and intangible assets.
Integrated building systems: strengthening building security while decreasing operating costs
Authors: Taylor Mike
Published: January 2007

Purpose

This paper details the benefits that integrated systems offer facility managers and owners who seek to improve security – and overall building performance – despite limited resources. And it provides a general roadmap for making integration a reality.

Design/methodology/approach

Combining real‐life examples with general industry knowledge, this paper examines how facility managers and owners can integrate technology like surveillance cameras, access control readers and smart card technology to improve security and the company's bottom line. Additionally, it explains organizational steps needed to successfully integrate these technologies, and tie them into core building functions and enterprise systems.

Findings

There is innovative technology emerging in the security market that offers significant improvements for facilities and security managers, as well as end users. But the real power lies within managing these technologies as part of an integrated security and building solution. With an integrated system, silos are eliminated, information is shared between departments and important building functions can be centralized – increasing safety and improving efficiency.

Practical implications

An informative paper that gives facility managers and owners a general understanding of integration and its associated benefits, and the necessary elements to make it happen.

Originality/value

While the concept of integration is not new, institutional practices often prevent companies from implementing and taking advantage of an integrated system. This paper goes beyond explaining the general features and benefits of integration, and informs the reader how to assess organizational needs and successfully make the transition.
An evolutionary approach to the architecture of effective healthcare delivery systems
Authors: Towill D.R. , Christopher M.
Published: January 2007

Purpose

Aims to show that material flow concepts developed and successfully applied to commercial products and services can form equally well the architectural infrastructure of effective healthcare delivery systems.

Design/methodology/approach

The methodology is based on the “power of analogy” which demonstrates that healthcare pipelines may be classified via the Time‐Space Matrix.

Findings

A small number (circa 4) of substantially different healthcare delivery pipelines will cover the vast majority of patient needs and simultaneously create adequate added value from their perspective.

Research limitations/implications

The emphasis is firmly placed on total process mapping and analysis via established identification techniques. Healthcare delivery pipelines must be properly engineered and matched to life cycle phase if the service is to be effective.

Practical implications

This small family of healthcare delivery pipelines needs to be designed via adherence to very specific‐to‐purpose principles. These vary from “lean production” through to “agile delivery”.

Originality/value

The proposition for a strategic approach to healthcare delivery pipeline design is novel and positions much currently isolated research into a comprehensive organisational framework. It therefore provides a synthesis of the needs of global healthcare.
Relating configuration and learning in Brazil and Australia
Authors: Terra da Silva Marcia , Davison Graydon
Published: January 2007

Purpose

This paper aims to investigate whether an organisation's configuration, with regard to its operating environment, could have a bearing on the learning that occurs within the organisation because the configuration can be considered an artefact capable of enabling learning and capable of facilitating the storage and utilisation of the results of learning. This raises an interesting question about the ability of organisations to shape the configuration that enables and facilitates them, which in turn would shape the learning itself.

Design/methodology/approach

Reported in this paper is research in healthcare organisations in Brazil and Australia that use a multidisciplinary model of care delivery which test these relationships.

Findings

The paper's findings indicate that in the Brazilian case learning has to do with the formal acquisition of knowledge for use within professions, by professionals who are in practice and teaching. In the Australian case learning has to do with the flexible acquisition of knowledge across professions, within and between teams.

Originality/approach

This paper is useful to those wishing to facilitate learning in an organisation.
A hermeneutic science: health economics and Habermas
Authors: Small Neil , Mannion Russell
Published: January 2007

Purpose

Mainstream health economics labours under a misleading understanding of the nature of the topic area and suffers from a concomitant poverty of thinking about theory and method. The purpose here is to explore this critical position and argue that health economics should aspire to being more than a technical discipline. It can, and should, engage with transformative discourse.

Design/methodology/approach

It is argued that the hermeneutic sciences, emphasising interpretation not instrumentality or domination, offer a route into the change to which one seeks to contribute. The article specifically focuses on the way Habermas provides insights in his approach to knowledge, reason and political economy. How he emphasises complexity and interaction within cultural milieu is explored and primacy is given to preserving the life‐world against the encroachments of a narrow rationalization.

Findings

The argument for a critical re‐imagining of health economics is presented in three stages. First, the antecedents, current assumptions and critical voices from contemporary economics and health economics are reviewed. Second, the way in which health is best understood via engaging with the complexity of both the subject itself and the society and culture within which it is embedded is explored. Third, the contribution that hermeneutics, and Habermas's critical theory, could make to a new health economics is examined.

Originality/value

The paper offers a radical alternative to health economics. It explores the shortcomings of current thinking and argues an optimistic position. Progress via reason is possible if one reframes both in the direction of communication and in the appreciation of reflexivity and communality. This is a position that resonates with many who challenge prevailing paradigms, in economics and elsewhere.
The inception of the National Health Service
Authors: Harding Nancy
Published: January 2007

Purpose

It is commonplace to talk of the UK's National Health Service (NHS) as having its inception in 1948 in an Act of Parliament which brought together many hundreds of widely dispersed organisations into one, new organisation, “the” NHS. This paper aims to challenge the concept of “a” National Health Service and to argue that the (seeming) accomplishment of this “organisation” is the daily task of health managers.

Design/methodology/approach

The paper develops a theoretically‐based analysis of how an “organisation” is accomplished through ongoing processes of construction. First, critiques of the ontological status of this thing called “organisation” are considered. Then Laclau and Mouffe's discourse theory of political action, inspired by Derrida and Gramsci is used, to try to understand this apparent “thing” and the work of those charged with its management.

Findings

There has been little application of this theoretical perspective to understanding management in general and health management in particular but, given the highly politicised nature of health management, their theoretical perspective seems more than apposite. Application of Laclau and Mouffe's theory to the NHS leads to the conclusion that there is no such “thing” as the NHS. There is, rather, a presumption of the thingness of the NHS and one of the major tasks of managers working “within” this organisation is to achieve this sense of thingness.

Research limitations/implications

This is “work in progress” – these ideas continue to evolve, but feedback from readers is necessary.

Originality/value

This is the first time that Laclau and Mouffe's work has been used to analyse health organizations. The value of the paper is mostly for people working to develop critically‐informed understandings of how organizations work.
The meaning of emotion
Authors: Rowe Dorothy
Published: January 2007

Purpose

To describe the meaning of emotion.

Design/methodology/approach

Describes how emotion has recently become a popular concept for discussion, but it is not often recognised that human beings are, in essence, meaning‐creating creatures and that emotion is one of the forms of meaning they create.

Findings

What one experiences as “I”, “me”, “myself”, that is, one's sense of being a person, is a meaning‐structure, which has developed through one's interaction with one's environment. One's physiological make‐up is such that all the meanings are guesses about what is going on. Consequently the sense of being a person is always in danger of being invalidated by events. Emotions are meanings, which relate to the validation or invalidation of one's sense of being a person. It is necessary to survive both physically and as a person, but, if there is to be a choice between these two ways of surviving, one almost always chooses to survive as a person and let one's body go. This is seen in acts of heroism and in suicide.

Originality/value

Emphasises how the need to survive as a person is so important that children as young as 16 months are able to understand and respond to the emotional meanings of their parents and siblings even though they do not develop an intellectual understanding of the theory of mind until they are about four years old. All interactions between people in health‐care management involve validation and invalidation.
A health‐care model of emotional labour
Authors: Mann Sandi
Published: January 2007

Purpose

This paper aims to evaluate the literature on emotional labour in the health‐care sector and the benefits and costs of such performance for both the carer and the patient. The aim is to develop a new health care model of emotional labour that has implications for health‐care management in terms of policy and education as well as for future research in this field.

Design/methodology/approach

A new model to explain the antecedents and consequences of emotional labour within a health‐care setting is developed that builds on existing research.

Findings

The model distinguishes between types of emotional conflict to which emotional labour‐inducing events in health‐care settings might lead. The negative and positive consequences, specific to health‐care settings, of emotional labour performance are also outlined.

Practical implications

Emotional labour should be formally recognised as a key skill in facilitating the patient journey, with emotional skills being taught in innovative ways outside the formal classroom setting. Health‐care professionals should be offered training on coping with the effects of emotional labour performance. Finally, more research should be carried out to further develop the model, particularly in identifying causes of emotional labour within health‐care settings and in differentiating the effects that different kinds of emotional labour performance might have.

Originality/value

The paper draws together previous research on emotional labour within health‐care settings to develop a coherent model that can be used to guide future research and practice.
Different timetables for change: understanding processes in reorganizations
Authors: Bergin Elsmari , Helge Rønnestad Michael
Published: January 2007

Purpose

It is well‐known that a decrease in economic resources in health care results in increased workload, stress and pressure on personnel. The main aim of this study was to explore and understand how personnel in health care were influenced by multiple obligations in the context of a changing surrounding.

Design/methodology/approach

Personnel within psychiatry were interviewed in an open‐ended, interactive mode. The transcribed interviews were analysed using grounded theory as the method of study.

Findings

These professionals working within a turbulent work situation experienced a struggle between external demands and internal obligations of an ethical or ideological character. For many of them earlier psychological contracts were broken, earlier organizational culture was overthrown and their professional authority was threatened. They were required to change or abandon well‐established professional identities. Fundamental changes such as the transition of theoretical framework or revision of internal obligations have quite a different timetable from a technical change of method or organizational structure.

Practical implications

The findings of two timetables for change should be addressed when considering reorganizations. If these findings are applied to personnel in health care, seeing them also as patients in the system may be avoided.

Originality/value

The different timetables for external change and internal reorganization, with support from findings in in‐depth interviews, have not been described until now.
Gossip and emotion in nursing and health‐care organizations
Authors: Waddington Kathryn , Fletcher Clive
Published: January 2007

Purpose

The purpose of this paper is to examine the relationship between gossip and emotion in health‐care organizations. It draws on findings from empirical research exploring the characteristics and function of gossip which, to date, has been a relatively under‐researched organizational phenomenon.

Design/methodology/approach

A multidisciplinary approach was adopted, drawing on an eclectic range of discipline‐based theories, skills, ideas and data. Methods included repertory grid technique, in‐depth interviews and structured diary records of work‐related gossip. The sample comprised 96 qualified nurses working in a range of practice areas and organizational settings in the UK.

Findings

Template analysis was used to integrate findings across three phases of data collection. The findings revealed that gossip is used to express a range of emotions including care and concern about others, anger, annoyance and anxiety, with emotional outcomes that include feeling reassured and supported. It is the individual who gossips, while the organization provides the content, emotional context, triggers and opportunities.

Research limitations/implications

Nurses were chosen as an information‐rich source of data, but the findings may simply reflect the professional culture and practice of nursing. Future research should take into account a wider range of health‐care organizational roles and perspectives in order to capture the dynamics and detail of the emotions and relationships that initiate and sustain gossip.

Practical implications

Because gossip makes people feel better it may serve to reinforce the “stress mask of professionalism”, hiding issues of conflict, vulnerability and intense emotion. Managers need to consider what the emotions expressed through gossip might represent in terms of underlying issues relating to organizational health, communication and change.

Originality/value

This paper makes a valuable contribution to the under‐researched phenomenon of gossip in organizations and adds to the growing field of research into the role of emotion in health‐care organizations and emotion work in nursing.
Emotional labour at work and at home among Greek health‐care professionals
Authors: Montgomery Anthony J. , Panagopolou Efharis , Benos Alexos
Published: January 2007

Purpose

The emotionally taxing nature of health‐care work has been increasingly recognized. In parallel, the field of work and family has been searching for more specific antecedents of both work interference with family (WFI) and family interference with work (FWI). The current study aims to examine the relationship between surface acting and hiding negative emotions with WFI and FWI among Greek health‐care professionals.

Design/methodology/approach

The research is a cross‐sectional study of 180 Greek doctors and 84 nurses using self‐report measures.

Findings

Results indicated that, for doctors, surface acting at work was positively related to WFI and, for nurses, surface acting at home was positively related to FWI.

Research limitations/implications

The respondents were sampled on a convenience basis and the non‐random procedure may have introduced unmeasured selection effects. The present study is cross‐sectional and thus the postulated relationships cannot be interpreted causally.

Practical implications

Emotional management training and opportunities for emotional decompression for Greek health‐care professionals should be explored. In terms of medical education, the need to train students to understand and cope with emotional demands is an important first step. This research highlights the need for communication‐skills training courses facilitating emotional awareness and emotional management.

Originality/value

These findings position emotional labour as an important antecedent of both WFI and FWI.
Instilling and distilling a reputation for institutional excellence
Authors: Beil‐Hildebrand Margitta B.
Published: January 2007

Purpose

This ethnographic investigation of a general hospital aims to critically analyse a much lauded corporate culture. Rather than accepting the managerial and academic claims concerning the mobilisation of corporate culture at face value, this study builds upon a labour process analysis and takes a close look at how it actually seems to work.

Design/methodology/approach

The paper explores and describes how executive managers seek to design and impose corporate culture change and how it affects the nursing employees of this organisation. This was achieved by means of a six month field study of day‐to‐day life in the hospital's nursing division.

Findings

The results lend little support to the official claims that, if managerial objectives are realised, they are achieved through some combination of shared values and employee participation. The evidence lends more support to the critical view in labour process writing that modern cultural strategies lead to increased corporate control, greater employee subjection and extensive effort intensification. The contradiction this brings into the working lives of the employees leads to the conclusion that the rhetoric of corporate culture change does not affect the pre‐existing attitudes and value orientations of nursing employees. However, there were considerable variations in how employees received the managerial message and thus, by their degree of misbehaviour and adaptation, affected the organisation itself as well as using the cultural rhetoric against the management for their own ends.

Originality/value

The paper concludes that an extended labour process analysis is necessary to challenge the way in which corporate culture change is explored and described by management academics and practitioners.
Leading improvement
Authors: Øvretveit John
Published: January 2007

Purpose

To provide research‐informed guidance to leaders of quality and safety improvement and evidence‐based materials for education programmes for leaders

Design/methodology/approach

Search of databases and hard copy literature since 1985 into managers' and leaders' role in quality and safety improvement. Classification into “eA”: Empirical research strong evidence, “eB”: Empirical research, weak evidence and, “eC”: Conceptual discussion, not based on systematic empirical research. Summary, and synthesis of the best available evidence for a guidance checklist for leaders.

Findings

Although most literature emphasises the importance of committed leadership for successful quality and safety improvement, research evidence supporting this is scarce and often scientifically limited. The research shows evidence of the limitations and scope of leader actions for improving health care provision, the need to engage clinicians in this work and ways to do so, as well as the leadership role played by others apart from senior leaders. The ability of managers and other leaders skilfully to tailor Q&SI to the situation may be important but descriptions of how leaders do this and evidence supporting this proposition are lacking.

Research limitations/implications

More research is needed about whether or how the leader role is different according to the stage of quality and safety development of the organisation, the type of organisation, the type of context, the level and type of leader and the type of improvement and improvement method.

Practical implications

Implications for leaders' actions are provided in a “best evidence guidance” checklist. This provides more tangible and research‐informed guidance than the inspirational literature or studies from single organisations.

Originality/value

This paper provides the first overview and synthesis of a wide range of studies which can be used as a basis for future research and materials for educational programmes. It provides the first detailed guidance for leaders about specific actions which research suggests they need to take to improve quality and safety.
Using operational information and information systems to improve in‐patient flow in hospitals
Authors: Proudlove N.C. , Boaden R.
Published: January 2007

Purpose

To consider how information and information systems can be used to support improving patient flow in acute hospitals (a key target for the National Health Service in England), and the potential role of the National Programme for Information Technology currently being developed.

Design/methodology/approach

The literature plus past and present research, teaching and consulting experience with all levels of the National Health Service is drawn on to consider information provision and requirements.

Findings

The National Programme for Information Technology specifies many features designed to support improving patient flows, though timescales for implementation are longer than those for the pledged flow improvements, and operational use of this type of information system has been problematic in the National Health Service.

Research limitations/implications

The work is limited to the National Health Service and information systems in use and planned for it. The National Health Service access targets, flow improvement initiatives and the National Programme for Information Technology apply primarily to England.

Practical implications

Some bed/flow management information systems currently in use incorporate tools and capabilities in advance of what is outlined in the National Programme for Information Technology, and some rare cases of culture changes in information system use have been achieved. One should learn from these to inform development and implementation of National Programme systems. These existing information systems and approaches may also be useful to hospitals considering systems prior to implementation of the National Programme for Information Technology.

Originality/value

There has been very little consideration of the use of operational information and information systems for bed/flow management in the literature. Development and implementation of National Programme for Information Technology systems should build from an understanding of the practice and context of bed/flow management.
Project management and action research: two sides of the same coin?
Authors: Whitehead Dean
Published: January 2007

Purpose

To put forward the, to date, unidentified viewpoint that organisational action research and project management have many shared properties – making it a useful exercise to compare and contrast them in relation to organisational management structures and strategies.

Design/methodology/approach

A conceptual exploration, drawing on a wide range of supporting literature, is used here.

Findings

Project management represents a mainstay strategy for much of the organisational research seen in health care management – and has done for many years. More recently, the exploratory literature on project management has identified many limitations – especially when matched against “traditional” examples. Many health services have witnessed a more recent organisational management drive to seek out alternative strategies that incorporate less hierarchical and more participatory research methods. Action research certainly fits this bill and, on further examination, can be incorporated into a project management ethos and vice versa.

Research limitations/implications

The views expressed here are of a theoretical construct and have not been implemented, as they are presented in this paper, in practice. The intention, however, is to do so in some of the author's future studies.

Practical implications

If the management of health service organisations are to evolve to incorporate desirable structures that promote consumer‐oriented empowerment and participation (where the consumers also include the workforce), then having a wider array of research tools at one's disposal is one way of facilitating this. Incorporating action research principles into project management approaches, or the other way round, or marrying them both to form a “hybrid” research strategy – it is argued here – represents an appropriate and representative way forward for future organisational management studies.

Originality/value

In terms of originality, this represents a conceptual piece of work that puts forward constructs that have, to date, not featured in the health care literature. Its value lies in suggesting further options for organisational‐oriented health care research.
Talking towards excellence: a theoretical underpinning of the dialogue between doctors and managers
Authors: Plochg Thomas , Klazinga Niek S.
Published: January 2007

Purpose

To explore theoretically the reasons for the modest uptake of clinical governance practices by taking the literature on the origin of tensions between doctors and managers as the starting‐point.

Design/methodology/approach

The approaches of doctors and managers to the division and coordination of medical work are analysed theoretically from a twofold perspective that combines insights from sociologists' theories on “professionalism” and administrative scientists' theories on “management science”.

Findings

The combined perspective theoretically explains the problems between doctors and managers that frustrate the uptake of clinical governance practices. By inference from this theoretical analysis, a twofold agenda for a constructive dialogue is proposed. Doctors and managers must develop a shared vision of the division and coordination of medical work as well as discussing the values, norms and goals underlying patient care. It is questionable, however, whether this agenda is currently adequately addressed.

Originality/value

This paper provides a theoretical underpinning for the dialogue between doctors and managers. It may be enlightening for all doctors and managers working in the field.
An audit investigating documentation of hospital urethral catheterisation and the improvements using proforma stickers
Authors: Tempest H.V. , Kumar N. , Rucker J. , Knight A. , Saleemi A.
Published: January 2007

Purpose

An audit was undertaken, aimed at investigating documentation of hospital urethral catheterisation in patients’ notes.

Design/methodology/approach

Standards were devised by the urology department and documentation of these standards was recorded. After identifying deficiencies in the quality of record keeping, proforma catheterisation stickers were produced and distributed throughout the hospital wards. The standards were then re‐audited a month later.

Findings

There was only 3 per cent full documentation using the catheterisation standards set for this study in the initial audit. In the re‐audit there was a 55 per cent usage rate of stickers. Of the notes with stickers 84 per cent had full documentation compared to only 2 per cent without stickers.

Practical implications

The use of proforma stickers improves documentation of urethral catheterisation in patients’ notes.

Originality/value

This paper identifies a way of improving documentation of urethral catheterisation in patients’ notes.
Continuous quality improvement using a practice improvement model
Authors: Kellett Stephen , Clarke Suzanne , Matthews Linda
Published: January 2007

Purpose

Cape and Barkham's practice improvement model (PIM) describes how healthcare systems can be designed to facilitate the usage of self‐generated clinical outcomes in the delivery of subsequent interventions. This article aims to describe the application of the PIM in the implementation of group‐based cognitive‐behavioural therapy, for clients referred from Primary Care with anxiety disorders.

Design/methodology/approach

The groups were evaluated using and pre‐ and post‐intervention design using a variety of validated measures of psychological functioning as part of a wider audit and evaluation system. The conclusions drawn from the audit and evaluation system, in the form of PIMs, were fed‐back into the design of successive groups in the attempt to increase subsequent effectiveness. Group 1 had no PIM applied, group 2 had a single PIM applied and group 3 had two PIMs applied.

Findings

The introduction of the single PIM for group 2 increased the effectiveness of clinical outcomes, while for group 3, the introduction of two PIMs increased effectiveness again in comparison to group 1, but not in comparison to group 2.

Practice implications

The results indicate that the active use of feedback of outcomes from interventions conducted can be utilised to design and then evaluate the application of resultant PIMs. This represents attempts to introduce and operationalise the concept of continuous quality improvement in the delivery of a clinical service.

Originality/value

The evaluation of PIMs is in its practical and methodological infancy and this initiative represents the first attempt to utilise PIMs in the design of Primary Care psychological services.
Copying patient letters – making it work
Authors: Brockbank Katrina
Published: January 2007

Purpose

That patients should be able to receive a copy of any letter written about them is part of the British Government's policy to increase patients' involvement in their care and treatment. All National Health Service (NHS) organisations are expected to implement this by April 2005. This paper aims to describe how one acute Trust has used basic change management principles to implement the initiative.

Design/methodology/approach

Examines the approach of the Salisbury Health Care NHS Trust, where initially a survey of all consultants, senior nurses and allied health professionals was carried out.

Findings

Initial concerns that patients would not understand the letter were generally unfounded with 98.9 per cent of patients saying that they understood their letter. Of patients, 96.9 per cent said that they found receiving a copy letter useful.

Originality/value

The research demonstrated a high percentage of patients wanting a copy letter, which has huge resource implications in terms of secretarial time, additional stationery and postage costs. Change is difficult and an emotionally charged issue however, using examples of good practice and taking a multi‐faceted approach to the change process the initiative has been successfully implemented.
Treatment of acute behavioural disturbance
Authors: Jacob Rebecca , Hunt Neil
Published: January 2007

Purpose

To improve the quality of care of patients who are given parenteral medication for an episode of disturbed or violent behaviour in the context of a psychotic illness.

Design/methodology/approach

Current guidelines are described, and adherence to the standards is audited, with particular emphasis on the performance of physical observations following an episode of behavioural disturbance. Comparisons are made with the findings of previous audits performed at Addenbrooke's and Fulbourn Hospital, Cambridge.

Findings

The results revealed an improvement in following the guidelines whilst highlighting concerns regarding the unwarranted and potentially dangerous use of intravenous medication in these situations. The results also demonstrated a significant improvement in routine physical observations performed, following treatment of acute behavioural disturbance.

Practical implications

Careful risk management is needed when considering the safety of both patients and staff when dealing with behaviourally disturbed psychotic patients.

Originality/value

The completion of this audit cycle suggests that regular review and dissemination of guidelines, as well as conducting a comprehensive audit cycle, have led to safer prescribing and evidence based practice.
Is our evidence‐based practice effective?
Authors: Holden John , Wooff Emma
Published: January 2007

Purpose

The purpose of this article is to review all patients having received a steroid injection for rheumatic problems in the period 1995‐2003 by one general practitioner.

Design/methodology/approach

Self‐completion questionnaire given to patients at the time of the injection to be returned after one month.

Findings

Most of the 435 patients (92 per cent) were pleased that they had received the injection. Pain was relieved better than mobility. Results for different sites were similar. Complication rates were low and many patients had further steroid injections.

Practical implications

It is feasible to collect large series reviewing the outcome of interventions in general practice. Results can be usefully compared with those obtained in randomised controlled trials.

Originality/value

This is the largest review of steroid injections carried out in a single general practice in the UK. It provides information with which others can compare their own practice and results, especially in primary care.
Low back pain: barriers to effective clinical governance
Authors: Langworthy Jennifer , Clow Wendy , Breen Alan
Published: January 2007

Purpose

The purpose of this article is to investigate acceptability, dissemination and use of a multidisciplinary audit toolkit to monitor evidence‐based care for acute low back pain and to identify barriers to implementation of the RCGP evidence‐based LBP guideline and associated audit process.

Design/methodology/approach

A survey was carried out of 707 clinical governance leads (CGLs) and 336 clinical audit leads in English/Welsh Health Authorities, NHS Trusts, Primary Care Groups and Primary Care Trusts. Subsequently, structured telephone interviews with 50 CGLs and 22 CALs in 72 Primary Care Trusts were qualitatively analysed.

Findings

Substantive barriers specific to implementation of the RCGP LBP guideline and associated audit toolkit could not be identified. Issues were raised pertaining to the wider healthcare system, which itself may restrain implementation of evidence‐based health care for LBP sufferers. Qualitative analysis revealed six categories responsible for poor clinical governance. Results suggest that LBP is not a priority area and that without National Service Framework status this is unlikely to change.

Research limitations/implications

Response to the initial survey was only 37 per cent; thus results may not be representative of all relevant UK NHS organisations. It coincided with a particularly busy period of change and ongoing reform, making it difficult to reach relevant personnel. This problem was accentuated by frequent change of persons in the post of clinical governance lead. All of this may have impacted on the response rate. In addition, some organisations/individuals were reluctant to be identified for the purpose of this study.

Originality/value

This study identifies the practical difficulties of delivering the clinical governance agenda, particularly in non‐priority areas, as reported by those responsible for doing so.
Psychosocial care within a multidisciplinary breast cancer team
Authors: Lewis Sarah , White Craig A. , Dorris Liam
Published: January 2007

Purpose

The purpose of this article is to identify the range of psychosocial care components used by a multidisciplinary breast cancer team.

Design/methodology/approach

A questionnaire was developed to assess the range of psychosocial care components used by the team, their confidence using them and their training needs in relation to them. A total of 15 people completed the questionnaire from seven different professions.

Findings

The breast cancer team carried out a wide range of psychosocial care components despite little formal training to support their work. They valued the importance of psychosocial interventions and recognised their learning needs in relation to them.

Research limitations/implications

The small sample size limited ability to detect correlations and significant trends within the data. Future research could sample other cancer teams and use the questionnaire before and after training to detect changes in the use of psychosocial care components.

Practical implications

The psychosocial needs of cancer patients are best met when all members of the team are aware of and respond to those needs. This study suggests that team members' confidence in using psychosocial care components should be regularly assessed and training provided. It is proposed that a questionnaire is a valuable way of gathering information and evaluating training.

Originality/value

This paper would be of value to a manager or clinician aiming to develop a multidisciplinary approach to the psychosocial care of cancer patients.
The dark side of organizations: forensic management – an emerging theoretical perspective
Authors: Gray Harry
Published: January 2007

Purpose

Most writing about organizations assumes that everyone is sensible and rational and there is a simple and homogenous culture. The paper describes why organizations are in fact difficult to manage and why leadership is always problematical.

Design/methodology/approach

The article is based on a review of the literature plus experience.

Findings

The dark side of organizations needs recognizing.

Practical implications

Organizational members need to pay attention to unrecognized elements of organizational life.

Originality/value

The article exposes much of the naïve writing in management and leadership.
What is the key to combating the IT skills gap?
Authors: Sweeney Alan
Published: January 2007

Purpose

The aim of the paper is to highlight the IT skills gap and promote training and development as a solution.

Design/methodology/approach

The objectives are achieved by tackling the topic of IT skills gap and training and development head‐on. The approach to the subject is business‐focussed, keeping in mind the target audience are key decision makers within a wide number of industry sectors.

Findings

The paper discusses how organisations can use third‐party training specialists can help to plug IT skills gaps.

Practical implications

This paper should encourage organisations to look carefully at their workforce, noting skills gaps, and consider training and development programmes for their staff.

Originality/value

This paper is the first article issued to DLO on behalf of Computeach, the IT training specialists.
Learning in knowledge‐intensive organisations – moving from training to learning
Authors: Sloman Martyn
Published: January 2007

Purpose

To highlight the shift from training to learning.

Design/methodology/approach

This was case‐study driven.

Findings

There has been a shift from training to learning.

Practical implications

It is about how the individual learns. The type of training or learning must meet the needs of both the individual and the organization.

Originality/value

This is valuable to trainers, employers, managers and staff.
Hazardous effects of sewage water on the environment
Authors: Sadiq Butt Masood , Sharif Kamran , Ehsan Bajwa Babar , Aziz Abdul
Published: January 2007

Purpose

Pakistan is an agricultural country having the world's largest canal irrigation system. Indus basin that covers 70 percent of irrigated area for crop production is the major source of water in the country. Owing to rapid increase in population and uncertain environmental conditions, this water is not adequate to cope with the crop water requirement and needs additional means to provide extra water for agricultural purposes. The main source of irrigation is canal and ground water but the quality of ground water is so poor for the sustainability of agriculture system. To cope with the present demand, use of municipal sewage water that consists of domestic liquid waste, as well as industrial effluents, is becoming a common practice. The present study aims to reflect the hazardous effects of sewage water on the environment, with the main focus on heavy metals and chemical composition of soil and vegetables.

Design/methodology/approach

Industrial effluent was collected from one ghee mill, one flour mill, three textile industries and three hosieries located in Faisalabad, an industrial city of Pakistan highly affected with water pollution. All water samples were analyzed for pH, EC, SAR and RSC. Water analysis was also carried out for various nutrients and heavy metals (K+1, P2+, Fe2+, Cu2+, Zn2+, Mn2+, Ni2+ and Pb2+). Soil samples from various depths (0‐15, 15‐30, 30‐60, 60‐90 and 90‐120 cm) were taken to analyze for EC, pH, SAR, Na+1, SO4, K+1, P2+, Fe2+, Cu2+, Zn2+, Mn2+, Ni2+ and Pb2+ after irrigation with canal water and sewage water. Cadmium, lead and copper concentration was determined in various vegetables grown in areas irrigated with canal water and industrial effluents to determine their final concentration in the final product ultimately affecting the human health.

Findings

Although the sewage water is a source of many nutrients, it also includes a significant amount of heavy metals like Fe2+, Cu2+, Zn2+, Mn2+, Ni2+, Pb2+ and pathogens. Extensive use of this effluent for irrigation purpose has resulted in an upsurge of such metals in soils and various crops, which ultimately resulted in clinical problems in human beings.

Originality/value

The present study reflects the composition of sewage water and heavy metal accumulation in soil, as well as crops. It further highlights the different potential hazards to humans due to these contaminants.
An appraisal of environment management systems
Authors: Chavan Meena
Published: January 2007

Purpose

The main aim of this paper is to prove that an Environmental Management System (EMS) can be a powerful tool for organizations to both improve their environmental performance, and enhance their business efficiency.

Design/methodology/approach

A case study methodology is used putting forth the “Implementation of an EMS system at Pioneer Building and Construction”, a registered company in the construction industry whose primary business activities relate to development and construction of projects on a contract basis.

Findings

The findings stated that by implementing an EMS, Pioneer obtained a 10 per cent cost reduction; an estimated $1.2 million now could be saved annually as the annual costs were $12 million – which more than offsets the costs sustained in the implementation of ISO 14001.

Practical implications

This paper validates that although the causes of environmental degradation are well known, the business logic for environmental improvement has been largely operational and technical. Few firms have incorporated sustainability into their strategic thinking. A sustainable business should use its unique position to develop and achieve sustainable production and sustainable consumption at the same time. A responsible and sustainable system of environmental management should start with pollution prevention then expand into control and environmental design. The practical implications of this paper are to assist small business to embark on their implementation of the EMS.

Originality/value

EMS relevant information specifically with regards to the building and construction industry within the small business sector has been observed in this paper which is very important for similar such organizations to get cracking on their implementation of an EMS which is valuable in terms of improving their efficiency as well as being a social obligation for the future generation and the economy.