Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in the Netherlands: A comparison between hospitals

__Abstract__ Background: It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands. Methods. This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery. Results: No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r = 0.30; p < 0.01), relational coordination (r = 0.17; p < 0.05), team climate (r = 0.29; p < 0.01), formal internal communication (r = 0.46; p < 0.01), and informal internal communication (r = 0.36; p < 0.01) were positively associated with integrated care delivery. Stepwise multilevel analyses showed that formal internal communication (p < 0.001) and situational awareness (p < 0.01) were associated with integrated care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients. Conclusions: The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients

Continuity Culture: A Key Factor for Building Resilience and Sound Recovery Capabilities

This article investigates the extent to which Jordanian service organizations seek to establish continuity culture through testing, training, and updating of their business continuity plans. A survey strategy was adopted in this research. Primary and secondary data were used. Semistructured interviews were conducted with five senior managers from five large Jordanian service organizations registered with the Amman Stock Exchange. The selection of organizations was made on the basis of simple random sampling. Interviews targeted the headquarters only in order to obtain a homogenous sample. Three out of five organizations could be regarded as crisis prepared and have better chances for recovery. The other two organizations exhibited characteristics of standard practice that only emphasizes the recovery aspect of business continuity management (BCM), while paying less attention to establishing resilient cultures and embedding BCM. The findings reveal that the ability to recover following major incidents can be improved by embedding BCM in the culture of the organization and by making BCM an enterprise-wide process. This is one of few meticulous studies that have been undertaken in the Middle East and the first in Jordan to investigate the extent to which service organizations focus on embedding BCM in the organizational culture

Relational Contracts and Organizational Capabilities

A large literature identifies unique organizational capabilities as a potent source of competitive advantage, yet our knowledge of why capabilities fail to diffuse more rapidly—particularly in situations in which competitors apparently have strong incentives to adopt them and a well-developed understanding of how they work—remains incomplete. In this paper we suggest that competitively significant capabilities often rest on managerial practices that in turn rely on relational contracts (i.e., informal agreements sustained by the shadow of the future). We argue that one of the reasons these practices may be difficult to copy is that effective relational contracts must solve the twin problems of credibility and clarity and that although credibility might, in principle, be instantly acquired, clarity may take time to develop and may interact with credibility in complex ways so that relational contracts may often be difficult to build

Whiteness, Blackness and Settlement: Leisure and the Integration of New Migrants

At times of economic uncertainty the position of new migrants is subject to ever closer scrutiny. While the main focus of attention tends to be on the world of employment the research on which this paper is based started from the proposition that leisure and sport spaces can support processes of social inclusion yet may also serve to exclude certain groups. As such, these spaces may be seen as contested and racialised places that shape behaviour. The paper draws on interviews with White migrants from Poland and Black migrants from Africa to examine the normalising of whiteness. We use this paper not just to explore how leisure and sport spaces are encoded by new migrants, but how struggles over those spaces and the use of social and cultural capital are racialised

Paradox as a Metatheoretical Perspective

Organizations are rife with tensions – flexibility vs. control, exploration vs. exploitation, autocracy vs. democracy, social vs. financial, global vs. local. Researchers have long responded using contingency theory, asking “under what conditions should managers emphasize either A or B?” Yet increasingly studies apply a paradox perspective, shifting the question to: “how can we engage both A and B simultaneously?” Despite accumulating exemplars, commonalities across paradox studies remain unclear, and ties unifying this research community weak. To energize further uses of a paradox perspective, we build from past reviews to explicate its role as a metatheory. Contrasting this lens to contingency theory, we illustrate its meta-theoretical nature. We then dive deeper to sharpen the focus and widen the scope of a paradox perspective. Identifying core elements viewed from a paradox perspective – underlying assumptions, central concepts, nature of interrelationships and boundary conditions – offers a guide, informing the practice of paradox research. Next, we illustrate diverse uses of this lens. We conclude by exploring implications and next steps, stressing the rising need for paradox research, as complexity, change and ambiguity intensify demands for both/and approaches in theory and practice

Effective health care for older people living and dying in care homes: A realist review

Background: Care home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes. Methods: We conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effective in some situations and not others. We searched electronic databases and related grey literature. Finally the findings were reviewed with an external advisory group. Results: Strategies that support and sustain relational working between care home staff and visiting health care professionals explained the observed differences in how health care interventions were accepted and embedded into care home practice. Actions that encouraged visiting health care professionals and care home staff jointly to identify, plan and implement care home appropriate protocols for care, when supported by ongoing facilitation from visiting clinicians, were important. Contextual factors such as financial incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support relational working to occur, but of themselves appeared insufficient to achieve change. Conclusion: How relational working is structured between health and care home staff is key to whether health service interventions achieve health related outcomes for residents and their respective organisations. The belief that either paying clinicians to do more in care homes and/or investing in training of care home staff is sufficient for better outcomes was not supported.This research was funded by National Institute of Health Research Health Service Delivery and Research programme (HSDR 11/021/02)

Evaluation design of a reactivation care program to prevent functional loss in hospitalised elderly: A cohort study including a randomised controlled trial

Background: Elderly persons admitted to the hospital are at risk for hospital related functional loss. This evaluation aims to compare the effects of different levels of (integrated) health intervention care programs on preventing hospital related functional loss among elderly patients by comparing a new intervention program to two usual care progra

Resilience and rewiring of the passenger airline networks in the United States

The air transportation network, a fundamental component of critical infrastructure, is formed from a collection of individual air carriers, each one with a methodically designed and engineered network structure. We analyze the individual structures of the seven largest passenger carriers in the USA and find that networks with dense interconnectivity, as quantified by large k-cores for high values of k, are extremely resilient to both targeted removal of airports (nodes) and random removal of flight paths paths (edges). Such networks stay connected and incur minimal increase in an heuristic travel time despite removal of a majority of nodes or edges. Similar results are obtained for targeted removal based on either node degree or centrality. We introduce network rewiring schemes that boost resilience to different levels of perturbation while preserving total number of flight and gate requirements. Recent studies have focused on the asymptotic optimality of hub-and-spoke spatial networks under normal operating conditions, yet our results indicate that point-to-point architectures can be much more resilient to perturbations.Comment: 11 pages, 8 figures, replaced by the version to appear in Physical Review

Powers of Romance: The Liminal Challenges of Managing Organizational Intimacy

© The Author(s) 2014 Problematic organizational relationships have recently been at the core of highly visible media coverage. Most analyses of sexual relations in organizations have been, however, simplistic and unidimensional, and have placed insufficient systematic emphasis on the role of governmentality in the social construction of organizational romance. In this article, we proceed in two theoretical steps. First, we elaborate a typology of organizational romance that covers different manifestations of this nuanced process. We think of these as organizational strategies of governmentality. Second, we elaborate and identify liminal cases that fall into the interstices of the four predominant ways of managing sexual relationships in organizations. We think of these as vases of liquid love and life that evade the border controls of regulation by governmentality. Finally, we relate these issues to debates about the nature of the civilizational process and suggest hypotheses for future research