Organizational self-assessment based on ISO 9004:2009 standard: perceptions, comparisons, questions and actions

The self-assessment basedon Annex A of the ISO 9004:2009 standard is a very practical diagnostic tool and also very powerful for capturing the image of the organization quickly. It enables to have answers to questions suchas: what are the strengths and weakness of our organization? Do we have adequate processes, resources and competencies to reach our vision and goals? Are we measuring the parameters of importance or not? Do we communicate results adequately? Do we establish priorities to improve that which is aligned with the strategy? On the other hand, like any tool, it has a series of limitations: perceptions of the various members of the organization canbe very different; average score can possibly say very little about the actual situation of the organization, without a careful and open discussion about the extreme perceptions. From the results of 170 self-assessments made by organizations in Holland basedon ISO 9004:2009, some initial conclusions are reached about the application of self-assessment, analyzing the highest and lowest scores achieved. Finally, a series of suggestions and advices are made onhow to prepare, execute and close a self-assessment act

Moral injury related to immigration detention on Nauru: a qualitative study

Background: Immigration detention is associated with detrimental mental health outcomes but little is known about the underlying psychological processes. Moral injury, the experience of transgression of moral beliefs, may play an important role. Objective: Our aim was to explore moral injury appraisals and associated mental health outcomes related to immigration detention on Nauru. Methods: In this retrospective study, we conducted in-depth interviews with 13 individuals who had sought refuge in Australia and, due to arriving by boat, had been transferred to immigration detention on Nauru. At the time of the study, they lived in Australia following medical transfer. We used reflexive thematic analysis to develop themes from the data. Results: Major themes included 1) how participants' home country experience and the expectation to get protection led them to seek safety in Australia; 2) how they experienced deprivation, lack of agency, violence, and dehumanization after arrival, with the Australian government seen as the driving force behind these experiences; and 3) how these experiences led to feeling irreparably damaged. The participant statement 'In my country they torture your body but in Australia they kill your mind.' conveyed these three key themes in our analysis. Conclusion: Our findings suggest that moral injury may be one of the processes by which mandatory immigration detention can cause harm. Although refugees returned to Australia from offshore detention may benefit from interventions that specifically target moral injury, collective steps are needed to diminish deterioration of refugee mental health. Our results highlight the potentially deleterious mental health impact of experiencing multiple subtle and substantial transgressions of one's moral frameworks. Policy makers should incorporate moral injury considerations to prevent eroding refugee mental health. Keywords: Moral injury; Nauru; asylum seeker; immigration detention; post-migration living difficulties; refugee mental health

Multi-scale dynamics and rheology of mantle flow with plates

Fundamental issues in our understanding of plate and mantle dynamics remain unresolved, including the rheology and state of stress of plates and slabs; the coupling between plates, slabs and mantle; and the flow around slabs. To address these questions, models of global mantle flow with plates are computed using adaptive finite elements, and compared to a variety of observational constraints. The dynamically consistent instantaneous models include a composite rheology with yielding, and incorporate details of the thermal buoyancy field. Around plate boundaries, the local resolution is 1 km, which allows us to study highly detailed features in a globally consistent framework. Models that best fit plateness criteria and plate motion data have strong slabs with high stresses. We find a strong dependence of global plate motions, trench rollback, net rotation, plateness, and strain rate on the stress exponent in the nonlinear viscosity; the yield stress is found to be important only if it is smaller than the ambient convective stress. Due to strong coupling between plates, slabs, and the surrounding mantle, the presence of lower mantle anomalies affect plate motions. The flow in and around slabs, microplate motion, and trench rollback are intimately linked to the amount of yielding in the subducting slab hinge, slab morphology, and the presence of high viscosity structures in the lower mantle beneath the slab

Ökad vårdkvalitet- en studie om delat ledarskap inom hälso- och sjukvården

Bakgrund: Hälso- och sjukvården genomgår kontinuerligt omorganiseringar och utsätts för ständiga ekonomiska besparingar. Samtidigt ställer sjukvårdens snabba utvecklingstakt krav på ett ledarskap som kan hantera den problematik som en komplex verksamhet innebär. Konsekvenserna av förändringsarbetet har blivit att avdelningar har slagits samman och cheftätheten har blivit glesare. De chefer som är kvar blir ansvariga för upp till nittio medarbetare samtidigt som de har fått utökade ansvarsområden. Chefernas höga arbetsbelastning påverkar utvecklingsarbetet samt kvaliteten på vården som ges. Syfte: Syftet är att undersöka vilka bakomliggande motiv som ligger till grund för införande av delat ledarskap inom hälso- och sjukvård i Sverige. Syftet är även att undersöka vilka förutsättningar som behövs för att delat ledarskap ska bli framgångsrikt samt vilka vinster det delade ledarskapet kan generera för hälso- och sjukvården. Metod: Studien baseras på en kvalitativ forskning som vetenskaplig metod. Det empiriska materialet består av tio stycken djupintervjuer. Urvalet består av tre områdeschefer och sju enhetschefer som arbetar på två sjukhus i södra Sverige. Resultat: Resultatet visar att bakomliggande motiv till införandet av delat ledarskap inom hälso- och sjukvård baseras på en för hög arbetsbelastning för ensamma enhetschefer samt för stora medarbetargrupper och avsaknaden av ett personalnära arbete. Därtill framkommer att förutsättningar som är viktiga för att ett delat ledarskap ska bli framgångsrikt är att det finns en gemensam grundsyn hos chefparet. Däremot ska individuella egenskaper och personlighet kompletteras där det är särskilt viktigt att sammanföra kombinationen med en innovatör och en slutförare i chefparet. Därmed blir rekryteringsprocessen en viktig förutsättning för ett bra samarbete i ett delat ledarskap. Ytterligare förutsättningar som framkommer som viktiga är prestigelöshet hos personerna som delar ett ledarskap samt att arbetsuppgifter växlas mellan personerna i paret. De vinster ett delat ledarskap kan generera inom hälso- och sjukvården framkommer i uppsatsen vara reducerad ensamhet, samt ett ökat välmående hos enhetscheferna då arbetsbördan i och med ett delat ledarskap delas av två. På verksamhetsnivå framkommer vinster i form av att mer tid frigörs för verksamhetsutveckling samt att enhetscheferna får mer tid för personalen.Introduction: The health care system is undergoing continuous reorganizations and subjected to constant demands for financial savings. The rapid pace of development requires leadership that can deal with the issues that arise in this complex operation, however, the impact of these changes have resulted in consolidated departments and fewer staff. The managers who are left will be responsible for up to ninety employees per department head in addition to other extended responsibilities. This added responsibility extends the managers already heavy workload, and in turn, effects the quality of care that is available for each patient. Purpose: The purpose is to examine the underlying motives for the introduction of shared leadership in the health care industry in Sweden. It also aims to examine the conditions necessary for shared leadership to succeed, and the profit this program can generate for the healthcare institutions. Methodology: The study is based on qualitative research as a scientific method. The empirical material consists of ten in-depth interviews. The sample consists of three regional managers and seven unit managers at two hospitals in southern Sweden. Findings: The results show that the underlying motive for the introduction of shared leadership in health care is based on a high workload for single unit managers, as well as for large employee groups, and the lack of a personnel-related work. In addition, it appears that the conditions essential to a shared leadership program to be successful, is that the heads of the shared leadership program must have complimentary personal attributes, as well as individual ideas to supplement each others work. This will make the recruitment process challenging, in order find candidates that are able to understand the importance of strong communication and collaboration with their leadership partner. Additional complications can arise if the two leaders are not sharing the workload equally, and must be aware that they are a team, and neither employee is senior to the other. In addition to the benefits that shared leadership can generate within the health care system, leadership teams will experience reduced feelings of loneliness and increased feelings of well-being when workload is shared. The performance of the unit as a whole will increase with more time to engage in business development, and additional time for personnel related work. Keywords: Shared leadership, shared governance, health care, benefits, unit managers

Slab stress and strain rate as constraints on global mantle flow

Dynamically consistent global models of mantle convection with plates are developed that are consistent with detailed constraints on the state of stress and strain rate from deep focus earthquakes. Models that best fit plateness criteria and plate motion data have strong slabs that have high stresses. The regions containing the M_W 8.3 Bolivia and M_W 7.6 Tonga 1994 events are considered in detail. Modeled stress orientations match stress patterns from earthquake focal mechanisms. A yield stress of at least 100 MPa is required to fit plate motions and matches the minimum stress requirement obtained from the stress drop for the Bolivia 1994 deep focus event. The minimum strain rate determined from seismic moment release in the Tonga slab provides an upper limit of ~200 MPa on the strength in the slab

Parental intimate partner homicide and its consequences for children: protocol for a population-based study

BACKGROUND: The loss of a parent due to intimate partner homicide has a major impact on children. Professionals involved have to make far-reaching decisions regarding placement, guardianship, mental health care and contact with the perpetrating parent, without an evidence base to guide these decisions. We introduce a study protocol to a) systematically describe the demographics, circumstances, mental health and wellbeing of children bereaved by intimate partner homicide and b) build a predictive model of factors associated with children's mental health and wellbeing after intimate partner homicide. METHODS/DESIGN: This study focuses on children bereaved by parental intimate partner homicide in the Netherlands over a period of 20 years (1993 - 2012). It involves an incidence study to identify all Dutch intimate partner homicide cases between 1993 and 2012 by which children have been bereaved; systematic case reviews to describe the demographics, circumstances and care trajectories of these children; and a mixed-methods study to assess mental health, wellbeing, and experiences regarding decisions made and care provided. DISCUSSION: Clinical experience and initial research suggest that the children involved often need long-term intensive mental health and case management. The costs of these services are extensive and the stakes are high. This study lays the foundation for an international dataset and evidence-informed decision making