81 research outputs found
A realist evaluation of the management of a well- performing regional hospital in Ghana
<p>Abstract</p> <p>Background</p> <p>Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study.</p> <p>Methods</p> <p>We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews.</p> <p>Results</p> <p>We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment.</p> <p>Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development.</p> <p>Conclusion</p> <p>This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers.</p
The validity of measures of self-reported well-being
Using a new analytic approach, construct validity estimates are developed for proposed social indicators of self-reported well-being. Two separate investigations are reported: the first involves data on six aspects of well-being each assessed by six methods from 222 adults in one geographic area; the second, a partial replication and extension, involves a more limited set of indicators measured on a sample of 1297 respondents representative of all American adults.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43686/1/11205_2004_Article_BF00286161.pd
Anti-C1q antibodies in systemic lupus erythematosus
Anti-C1q has been associated with systemic lupus erythematosus (SLE) and lupus nephritis in previous studies. We studied anti-C1q specificity for SLE (vs. rheumatic disease controls) and the association with SLE manifestations in an international multi-center study
Maintaining the EnvironmentalâRacial Order in Northern New Mexico
The environmental - racial order in northern New Mexico is maintained through a process of racial triangulation in which Anglos, Native Americans, and Hispanos are valued relative to one another along axes of environmental stewardship and victimization (Kim C J, 1999, "The racial triangulation of Asian Americans" Politics and Society 27 105 - 138). Both axes involve the juxtaposing of three long-standing images: (1) Spanish injustices to the Indians; (2) the inability of Mexicans to manage their land properly; and (3) Indians being preeminent environmental stewards. In contrast to Kim's formulation of racial triangulation, however, the axes also involve imagery that contradicts these images: the debauched, poverty-stricken Indian; and European culture as a despoiler of the environment. Also in contrast to Kim's formulation, racial triangulation can involve the creation of new identities. In the 1960s Hispano activists began claiming to be heirs to a hybrid culture that included elements of both Native American and Spanish cultures. While this claim to hybridity enabled the creation of new oppositional discourses, the reconciling of contradictory imagery by historicizing the discourses and by other means undermines the new Hispano oppositional discourses as well as Hispano identity itself Racial triangulation is thus a fluid and contested process in which identity formation and the interchange between predominant and oppositional discourses are constitutive of power relations. Contradictory imagery in the discourse facilitates the maintenance of the environmental - racial order, even as it enables subordinates to challenge their racialized positions and to effect change in the distribution of material wealth, rights, and privileges
Another edsel: The collective misperception of the demand for the certification of MA sociologists
Simulation Studies of the Reliability of Computer-Aided Model Specification Using the TETRAD II, EQS, and LISREL Programs
Clinical characteristics of pediatric cutaneous lupus erythematosus: experience from a tertiary referral center in Korea
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