BLS Report On Labor Union And Employee Association Membership, 1973

Report about white collar employees belonging to unions and employee associations for the period 1976-1978. October 3, 1979

News Briefs: Congressional Review of EEO Reorganization Plan, 1979

Report on Presldent Carter\u27s proposed federal Equal Employment Opportunity Commission reorganization plan to consolidate most of the government\u27s enforcement programs into EEOC over the years 1978-1980. April 26, 1978. No 17

Recruitment and Mental Health

[Excerpt] Large numbers of people in the UK have mild to moderate and severe mental health conditions. Mental ill health is common and can affect anyone of any age, gender, ethnicity or social group. Three in ten employees will experience mental health problems during a year. The most prevalent mental health problems for people of working age are: anxiety, depression, phobic anxiety disorders and obsessive compulsive disorders. Depression will rank second only to heart disease as the leading cause of disability worldwide by the year 2020. The majority of people with mental health problems are willing and able to work. Despite this, an estimated one million people are out of work. While businesses are beginning to get better at employing individuals with a history of mental ill health, there remain significant barriers for both individuals and employers. This report describes what employers and government could do differently that would make it easier to recruit people with mental health problems

Supporting early career researchers in Higher Education in Europe: The role of employers and trade unions

This report summarises the findings from a six country study (Cyprus, Finland, Germany, Italy, Romania and the United Kingdom)of the issues confronting early career researchers and how these can be improved through social partnership between higher education employers and trade unions. The project was funded by the European Commission Industrial Relations and Social Dialogue fund. Based on the research and the input of employer and union representatives, the UCEA researchers drafted recommendations for supporting ECRs in higher education in Europe, with a particular focus on employability, gender equality and mobility. The manner in which the recommendations for improvement are applicable in each Member State will however vary, considering the wide variation in higher education systems and the complexity of research and higher education policy and practice across Member States. The recommendations may be relevant at national, regional and institutional level depending on the Member State. European policy and action will also benefit from the consideration of these recommendations

Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis

BackgroundThe Quality and Outcomes Framework (QOF) incentivises general practices in England to provide proactive care for people with serious mental illness (SMI) including schizophrenia, bipolar disorder and other psychoses. Better proactive primary care may reduce the risk of psychiatric admissions to hospital, but this has never been tested empirically.MethodsThe QOF data set included 8234 general practices in England from 2006/2007 to 2010/2011. Rates of hospital admissions with primary diagnoses of SMI or bipolar disorder were estimated from national routine hospital data and aggregated to practice level. Poisson regression was used to analyse associations.ResultsPractices with higher achievement on the annual review for SMI patients (MH9), or that performed better on either of the two lithium indicators for bipolar patients (MH4 or MH5), had more psychiatric admissions. An additional 1% in achievement rates for MH9 was associated with an average increase in the annual practice admission rate of 0.19% (95% CI 0.10% to 0.28%) or 0.007 patients (95% CI 0.003 to 0.01).ConclusionsThe positive association was contrary to expectation, but there are several possible explanations: better quality primary care may identify unmet need for secondary care; higher QOF achievement may not prevent the need for secondary care; individuals may receive their QOF checks postdischarge rather than prior to admission; individuals with more severe SMI may be more likely to be registered with practices with better QOF performance; and QOF may be a poor measure of the quality of care for people with SMI

GPAQ-R: development and psychometric properties of a version of the general practice assessment questionnaire for use for revalidation by general practitioners in the UK.

BACKGROUND: The General Practice Assessment Questionnaire (GPAQ) has been widely used to assess patient experience in general practice in the UK since 2004. In 2013, new regulations were introduced by the General Medical Council (GMC) requiring UK doctors to undertake periodic revalidation, which includes assessment of patient experience for individual doctors. We describe the development of a new version of GPAQ - GPAQ-R which addresses the GMC's requirements for revalidation as well as additional NHS requirements for surveys that GPs may need to carry out in their own practices. METHODS: Questionnaires were given out by doctors or practice staff after routine consultations in line with the guidance given by the General Medical Council for surveys to be used for revalidation. Data analysis and practice reports were provided independently. RESULTS: Data were analysed for questionnaires from 7258 patients relating to 164 GPs in 29 general practices. Levels of missing data were generally low (typically 4.5-6%). The number of returned questionnaires required to achieve reliability of 0.7 were around 35 for individual doctor communication items and 29 for a composite score based on doctor communication items. This suggests that the responses to GPAQ-R had similar reliability to the GMC's own questionnaire and we recommend 30 completed GPAQ-R questionnaires are sufficient for revalidation purposes. However, where an initial screen raises concern, the survey might be repeated with 50 completed questionnaires in order to increase reliability. CONCLUSIONS: GPAQ-R is a development of a well-established patient experience questionnaire used in general practice in the UK since 2004. This new version can be recommended for use in order to meet the UK General Medical Council's requirements for surveys to be used in revalidation of doctors. It also meets the needs of GPs to ask about patient experience relating to aspects of practice care that are not specific to individual general practitioners (e.g. receptionists, telephone access) which meet other survey requirements of the National Health Service in England. Use of GPAQ-R has the potential to reduce the number of surveys that GPs need to carry out in their practices to meet the various regulatory requirements which they face

Workplace bullying: measurements and metrics to use in the NHS. Final Report for NHS Employers.

The aim of this report is to identify how workplace bullying can be tracked over time, to indicate what measures and metrics can be used to identify change, and to provide comparators for other sectors in the UK and internationally. Bullying can encompass a range of different behaviours. Deciding on a definition of workplace bullying can clarify what is regarded as bullying, but it may also narrow the focus and exclude relevant issues of concern. For example, bullying definitions typically state that negative behaviours should be experienced persistently over a period of time. The threshold for behaviours to be defined as ‘bullying’ could be set to include one or two negative acts per month over the previous six months; or more stringently to include only behaviours that occur at least weekly over the previous twelve months. Choosing an appropriate threshold for frequency and duration of behaviours raises several questions: should occasional negative behaviours be regarded as bullying? Would one or two serious episodes of negative behaviour be regarded as bullying? Some researchers use the criteria of weekly negative behaviours over six months to identify bullying, but others argue that occasional exposure to negative acts can act as a significant stressor at work (Zapf et al., 2011). We have identified a range of tools and metrics that can be used to track change over time. However, there are a number of important issues to consider when measuring bullying which may affect the interpretation of the results. In particular, bullying prevalence rates vary considerably depending on the type of metric and definition of bullying used. For example, one international review found prevalence rates ranging from less than 1% for weekly bullying in the last six months up to 87% for occasional bullying over a whole career (Zapf et al., 2011). There are three main types of direct measures of bullying: self-labelling without a definition, self-labelling with a definition, and the behavioural experience method. Self-labelling metrics typically ask a respondent to identify themselves as a target of bullying (e.g., “Have you been bullied at work?” with a yes/no response, or “How often have you been bullied at work?” with a frequency scale such as never/occasionally/monthly/weekly/daily). This approach is quick and easy to administer, but is more subjective as responses will be based on the respondent’s interpretation of bullying. This approach can be improved with the provision of a definition of bullying, and a request to use the definition when responding. However, following pilot work, Fevre et al. (2011) argued that respondents tended not to read and digest bullying definitions as they had already decided what bullying meant to them. The behavioural experience method offers a more objective approach, but is typically longer and more time consuming. This method involves respondents rating the frequency with which they have experienced different negative behaviours (e.g., “How often has someone humiliated or belittled you in front of others?” with a frequency scale such as never/now and then/monthly/weekly/daily). These behavioural inventories may not mention bullying, but capture the prevalence of specific negative acts, and a total score may be calculated. The threshold for the frequency and number of negative acts, or a total score, required for an experience to be regarded as bullying can be chosen by the researcher. Although this enhances the objectivity of the measure, it may be that the respondent themselves may not regard their experience as bullying. In a meta-analysis of bullying studies conducted across 24 countries, Nielsen et al. (2010) found an overall prevalence rate of 18.1% for self-labelling with no definition, 11.3% for self-labelling with a definition, and 14.8% using a behavioural experience checklist. For best practice, it is recommended that both the self-labelling with a definition and the behavioural experience method are used in bullying research (Zapf et al., 2011). It is also important to be specific about the type of bullying being measured. In particular, if the measure is designed to capture bullying at work between co-workers this should be explicitly stated, so that bullying from patients and their relatives is excluded. Interpretation of the results may also be somewhat complex. Although increases in bullying prevalence should undoubtedly be addressed, we need to be mindful that an increase in reported bullying may reflect a change in culture: changing expectations of the behaviour of colleagues and managers, or a move towards greater openness and willingness to address concerns that were previously ignored or condoned. A measure of employees’ trust in the organisation to respond appropriately to such allegations may act as a positive indicator. The perceived and actual anonymity of responses is a critical factor. Employees are understandably wary about providing sensitive information on bullying and have voiced concerns regarding being identified and the potential repercussions of reporting bullying (Carter et al., 2013). There is a considerable discrepancy between the prevalence of bullying as captured in anonymous questionnaires and direct reports of bullying made to the organisation (e.g., to managers or HR; Scott, Blanshard & Child, 2008). Protecting the anonymity of respondents, and ensuring that individuals cannot be identified, will be important factors in the administration of a bullying measure. Some metrics are already routinely collected by the NHS, and if examined closely could provide useful indicators of change. Direct indicators include complaints about bullying and responses to ongoing NHS staff surveys. Indirect metrics can be used to capture factors that are associated with bullying, such as psychological wellbeing (including stress, anxiety and depression), sickness rates, job satisfaction and organisational commitment. However, factors other than bullying will affect these measures. The prevalence of witnessed bullying could also be considered as an important metric. A large proportion of NHS staff report that they have witnessed bullying between staff, and this is associated with negative outcomes for individuals and teams (Carter et al., 2013). Comparing the NHS prevalence rates with other sectors in the UK and internationally is complex. Ideally comparators would have used the same definition, measurement method and reporting period, but the definitions and metrics often differ. Total populations are the ideal, but are rarely provided. Single site studies are less generalisable than multi-site studies, and total samples are preferred over open invitations to unknown populations which may be more likely to attract responses from those who have experienced bullying. This report begins with several definitions of bullying, describes direct and indirect measures of bullying, and compares the prevalence of bullying in the NHS to other sectors in the UK, and to the healthcare sector internationally

e-Roster Policy: Insights and implications of codifying nurse scheduling

Following a decade of dissemination, particularly within the British National Health Service (NHS), electronic rostering systems were recently endorsed within the Carter Review. However, e-rostering necessitates the formal codification of the roster process. This research investigates that codification through the lens of the 'Roster Policy', a formal document specifying the rules and procedures used to prepare staff rosters. This study is based upon analysis of twenty-seven publicly available policies, each approved within a four-year period from January 2010 to July 2014. This research finds that, at an executive level, codified knowledge is used as a proxy for the common language and experience otherwise acquired on a ward through everyday interaction, while at ward level the nurse rostering problem continues to resist all efforts at simplification. Ultimately, it is imperative that executives recognise that e-rostering is not a silver-bullet and that information from such systems requires careful interpretation and circumspection

CollAborative care and active surveillance for Screen-Positive EldeRs with subthreshold depression (CASPER) : a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness

Background: Efforts to reduce the burden of illness and personal suffering associated with depression in older adults have focused on those with more severe depressive syndromes. Less attention has been paid to those with mild disorders/subthreshold depression, but these patients also suffer significant impairments in their quality of life and level of functioning. There is currently no clear evidence-based guidance regarding treatment for this patient group. Objectives: To establish the clinical effectiveness and cost-effectiveness of a low-intensity intervention of collaborative care for primary care older adults who screened positive for subthreshold depression. Design: A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with a qualitative study embedded within the pilot. Randomisation occurred after informed consent and baseline measures were collected. Setting: Thirty-two general practitioner (GP) practices in the north of England. Participants: A total of 705 participants aged ≥ 75 years during the pilot phase and ≥ 65 years during the main trial with subthreshold depression. Interventions: Participants in the intervention group received a low-intensity intervention of collaborative care, which included behavioural activation delivered by a case manager for an average of six sessions over 7–8 weeks, alongside usual GP care. Control-arm participants received only usual GP care. Main outcome measures: The primary outcome measure was a self-reported measure of depression severity, the Patient Health Questionnaire-9 items PHQ-9 score at 4 months post randomisation. Secondary outcome measures included the European Quality of Life-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder seven-item scale, Connor–Davidson Resilience Scale two-item version, a medication questionnaire and objective data. Participants were followed up for 12 months. Results: In total, 705 participants were randomised (collaborative care n = 344, usual care n = 361), with 586 participants (83%; collaborative care 76%, usual care 90%) followed up at 4 months and 519 participants (74%; collaborative care 68%, usual care 79%) followed up at 12 months. Attrition was markedly greater in the collaborative care arm. Model estimates at the primary end point of 4 months revealed a statistically significant effect in favour of collaborative care compared with usual care [mean difference 1.31 score points, 95% confidence interval (CI) 0.67 to 1.95 score points; p < 0.001]. The difference equates to a standard effect size of 0.30, for which the trial was powered. Treatment differences measured by the PHQ-9 were maintained at 12 months’ follow-up (mean difference 1.33 score points, 95% CI 0.55 to 2.10 score points; p = 0.001). Base-case cost-effectiveness analysis found that the incremental cost-effectiveness ratio was £9633 per quality-adjusted life-year (QALY). On average, participants allocated to collaborative care displayed significantly higher QALYs than those allocated to the control group (annual difference in adjusted QALYs of 0.044, 95% bias-corrected CI 0.015 to 0.072; p = 0.003). Conclusions: Collaborative care has been shown to be clinically effective and cost-effective for older adults with subthreshold depression and to reduce the proportion of people who go on to develop case-level depression at 12 months. This intervention could feasibly be delivered in the NHS at an acceptable cost–benefit ratio. Important future work would include investigating the longer-term effect of collaborative care on the CASPER population, which could be conducted by introducing an extension to follow-up, and investigating the impact of collaborative care on managing multimorbidities in people with subthreshold depression

A qualitative study of primary care clinicians' views of treating childhood obesity

Background: The prevalence of childhood obesity is rising and the UK Government have stated a commitment to addressing obesity in general. One method has been to include indicators relating to obesity within the GP pay-for-performance Quality and Outcomes Framework (QOF) contract. This study aimed to explore general practitioners' and practice nurses' views in relation to their role in treating childhood obesity. Methods: We interviewed eighteen practitioners (twelve GPs and six nurses) who worked in general practices contracting with Rotherham Primary Care Trust. Interviews were face to face and semi structured. The transcribed data were analysed using framework analysis. Results: GPs and practice nurses felt that their role was to raise the issue of a child's weight, but that ultimately obesity was a social and family problem. Time constraint, lack of training and lack of resources were identified as important barriers to addressing childhood obesity. There was concern that the clinician-patient relationship could be adversely affected by discussing what was often seen as a sensitive topic. GPs and practice nurses felt ill-equipped to tackle childhood obesity given the lack of evidence for effective interventions, and were sceptical that providing diet and exercise advice would have any impact upon a child's weight. Conclusion: GPs and practice nurses felt that their role in obesity management was centred upon raising the issue of a child's weight, and providing basic diet and exercise advice. Clinicians may find it difficult to make a significant impact on childhood obesity while the evidence base for effective management remains poor. Until the lack of effective interventions is addressed, implementing additional targets (for example through the QOF) may not be effective