The complexity of leadership and organisations

The thesis contributes to the evolving process of moving the study of Complexity from the arena of metaphor to something real and operational. Acknowledging this phenomenon ultimately changes the underlying assumptions made about working environments and leadership; organisations are dynamic and so should their leaders be. Dynamic leaders are behaviourally complex. Behavioural Complexity is a product of behavioural repertoire - range of behaviours; and behavioural differentiation - where effective leaders apply appropriate behaviour to the demands of the situation. Behavioural Complexity was operationalised using the Competing Values Framework (CVF). The CVF is a measure that captures the extent to which leaders demonstrate four behaviours on four quadrants: Control, Compete, Collaborate and Create, which are argued to be critical to all types of organisational leadership. The results provide evidence to suggest Behavioural Complexity is an enabler of leadership effectiveness; Organisational Complexity (captured using a new measure developed in the thesis) moderates Behavioural Complexity and leadership effectiveness; and leadership training supports Behavioural Complexity in contributing to leadership effectiveness. Most definitions of leadership come down to changing people’s behaviour. Such definitions have contributed to a popularity of focus in leadership research intent on exploring how to elicit change in others when maybe some of the popularity of attention should have been on eliciting change in the leader them self. It is hoped that this research will provoke interest into the factors that cause behavioural change in leaders that in turn enable leadership effectiveness and in doing so contribute to a better understanding of leadership in organisations

The complexity of leadership and organisations

The thesis contributes to the evolving process of moving the study of Complexity from the arena of metaphor to something real and operational. Acknowledging this phenomenon ultimately changes the underlying assumptions made about working environments and leadership; organisations are dynamic and so should their leaders be. Dynamic leaders are behaviourally complex. Behavioural Complexity is a product of behavioural repertoire - range of behaviours; and behavioural differentiation - where effective leaders apply appropriate behaviour to the demands of the situation. Behavioural Complexity was operationalised using the Competing Values Framework (CVF). The CVF is a measure that captures the extent to which leaders demonstrate four behaviours on four quadrants: Control, Compete, Collaborate and Create, which are argued to be critical to all types of organisational leadership. The results provide evidence to suggest Behavioural Complexity is an enabler of leadership effectiveness; Organisational Complexity (captured using a new measure developed in the thesis) moderates Behavioural Complexity and leadership effectiveness; and leadership training supports Behavioural Complexity in contributing to leadership effectiveness. Most definitions of leadership come down to changing people’s behaviour. Such definitions have contributed to a popularity of focus in leadership research intent on exploring how to elicit change in others when maybe some of the popularity of attention should have been on eliciting change in the leader them self. It is hoped that this research will provoke interest into the factors that cause behavioural change in leaders that in turn enable leadership effectiveness and in doing so contribute to a better understanding of leadership in organisations.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Correction to: Openness in the NHS: a secondary longitudinal analysis of national staff and patient surveys.

An amendment to this paper has been published and can be accessed via the original article

‘We needed to talk about it’: The experience of sharing the emotional impact of health care work as a panellist in Schwartz Center Rounds® in the UK

Objectives Schwartz Center Rounds® (‘Rounds’) are multidisciplinary forums where health care staff come together to reflect upon the emotional impact of their work. In each Round, a small number of staff (panellists) share experiences through stories to trigger reflection in audience members. Previous research has identified impacts associated with Rounds’ attendance, but little is known about the experience and impact of Rounds from panellists’ perspectives. This study is the first to explore the role of disclosure and reflection through storytelling in Rounds, specifically exploring panellists’ motivations, experiences and reported impacts associated with panel participation. Methods Interviews with 50 panellists, from nine case-study sites in the United Kingdom, representing acute, community and mental health National Health Service trusts and hospices. Data were analysed using thematic analysis. Results Most panellists spoke positively about their experience of sharing their stories in Rounds. Reported impacts included: increased emotional resilience and acceptance of experiences; reduced negative assumptions about colleagues and increased approachability and trust increasing tolerance and compassion; the creation of a space to stop and think and to reframe negative patient experiences facilitating greater empathy and emotional disclosure becoming more visible and normative, thereby helping change culture. Impacts on staff were similar regardless of contextual variability, including their professional group or role, with the exception of impact on patient care, which was not mentioned by non-clinical staff. The extent of panel preparation and audience characteristics (e.g. size, composition and response to their stories) influenced panellists’ experiences and outcomes. Conclusions Rounds highlight the important role of disclosure and reflection through storytelling to support panellists with the emotional aspects of their work, providing a space for support with the emotional demands of health care, reducing the need for employees to be stoic. Panel participation also offers an important source of validation in organizations marked by scrutiny

Openness in the NHS: a secondary longitudinal analysis of national staff and patient surveys

Abstract: Background: Improving openness—including candour when things go wrong, and willingness to learn from mistakes—is increasingly seen as a priority in many healthcare systems. This study explores perceptions of openness in England before and after the publication of the Francis report (2013), which examined failings of openness at one English hospital. We examine whether staff and patients’ views on openness, and experiences of giving voice to concerns, have changed since the report’s publication for better or worse. Methods: Organisational-level data was collated for all trusts from the NHS National Staff Survey (2007–2017), NHS Acute Inpatient Survey (2004–2016) and NHS Community Mental Health Service User Survey (2007–2017). Survey items related to openness were identified and longitudinal statistical analysis conducted (piecewise growth curve and interrupted latent growth curve analysis) to determine whether there was evidence of a shift in the rate or direction of change following publication of the Francis report. Results: For some variables there was a discernible change in trajectory after the publication of the Francis report. Staff survey variables continued to rise after 2013, with a statistically significant increase in rate for “fairness and effectiveness of incident reporting procedures” (from + 0.02 to + 0.06 per year; p < .001). For the patient surveys, the picture was more mixed: patient views about information provided by accident and emergency staff rose from a 0.3% increase per year before 2013 to 0.8% per year afterwards (p < .01), and inpatients being involved in decision making increased from a 0.4% rise per year before 2013 to 0.8% per year afterwards (p < .01); however, there were not rises in the other questions. Mental health patients reported a decrease after 2013 in being listened to (decreasing at a rate of 1.9% per year, p < .001). Conclusions: Data suggest that the Francis inquiry may have had a positive impact on staff and acute inpatients’ perceptions and experiences of openness in the NHS. However such improvements have not transpired in mental health. How best to create an environment in which patients can discuss their care and raise concerns openly in mental health settings may require further consideration

Towards a more inclusive human resource community:Engaging ethnic minority microbusinesses in human resource development programmes targeted at more productive methods of operating

The economic and social importance of ethnic minority microbusinesses (‘EMMBs’ with 1–9 employees) is neglected in human resource (HR) academic and policy discourse on productive ways of working. This article presents an action research approach to show how academics and intermediaries (local trusted industry representatives) can collaborate to promote HR development programmes targeted at more productive methods of operating in EMMBs. Our research collaboration involves academics, EMMBs (from the catering and creative sectors) and intermediaries. We develop perspectives on HR in small firms by showing how EMMBs can be engaged in initiatives of learning and development targeted at organisational change. The study contributes to recent calls for a more inclusive approach to HR theorising and practice

Realist evaluation of Schwartz rounds® for enhancing the delivery of compassionate healthcare:understanding how they work, for whom, and in what contexts

Background Healthcare work is known to be stressful and challenging, and there are recognised links between the psychological health of staff and high-quality patient care. Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to re-connect with their values through peer reflection, and to promote more compassionate patient care. Research to date has focussed on self-report surveys that measure satisfaction with Rounds but provide little analysis of how Rounds ‘work’ to produce their reported outcomes, how differing contexts may impact on this, nor make explicit the underlying theories in the conceptualisation and implementation of Rounds. Methods Realist evaluation methods aimed to identify how Rounds work, for whom and in what contexts to deliver outcomes. We interviewed 97 key informants: mentors, facilitators, panellists and steering group members, using framework analysis to organise and analyse our data using realist logic. We identified mechanisms by which Rounds lead to outcomes, and contextual factors that impacted on this relationship, using formal theory to explain these findings. Results Four stages of Rounds were identified. We describe how, why and for whom Schwartz Rounds work through the relationships between nine partial programme theories. These include: trust safety and containment; group interaction; counter-cultural/3rd space for staff; self-disclosure; story-telling; role modelling vulnerability; contextualising patients and staff; shining a spotlight on hidden stories and roles; and reflection and resonance. There was variability in the way Rounds were run across organisations. Attendance for some staff was difficult. Rounds is likely to be a ‘slow intervention’ the impact of which develops over time. We identified the conditions needed for Rounds to work optimally. These contextual factors influence the intensity and therefore degree to which the key ingredients of Rounds (mechanisms) are activated along a continuum, to produce outcomes. Outcomes included: greater tolerance, empathy and compassion for self and others; increased honesty, openness, and resilience; improved teamwork and organisational change. Conclusions Where optimally implemented, Rounds provide staff with a safe, reflective and confidential space to talk and support one another, the consequences of which include increased empathy and compassion for colleagues and patients, and positive changes to practice

Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation.

Background Work stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care. The purpose of this research was to evaluate the effectiveness of Rounds attendance on the psychological distress, work engagement, compassion and self-reflection of healthcare staff. Methods We used a pre-post control design to assess the effect of Rounds attendance across 10 UK healthcare organizations. This design was most appropriate given the voluntary nature of Rounds and ensured the study had ecological validity. Self-reported data were collected from attenders and non-attenders at baseline and at eight-months follow-up. The outcomes were psychological distress, work engagement, compassion and self-reflection. Results During the 8 months’ study duration, regular attenders (N = 51) attended Rounds on average 4 times (2–8). Attenders showed a significantly greater decrease in psychological distress (as measured with the General Health Questionnaire (GHQ)) than non-attenders (N = 233; odds ratio of 0.197; 95% confidence interval (0.047–0.823)). However, Rounds attendance had no significant effect on work engagement, compassion and self-reflection. Conclusions Rounds attendance was linked to a 19% reduction in psychological distress adjusting for covariates. As an organization-wide intervention, Rounds thus constitute an effective, relatively low-cost intervention to assist staff in dealing with the demands of their work and to improve their well-being

Comparison of haematological parameters determined by the Sysmex KX - 2IN automated haematology analyzer and the manual counts

<p>Abstract</p> <p>Background</p> <p>This study was designed to determine the correlation between heamatological parameters by Sysmex KX-21N automated hematology analyzer with the manual methods.</p> <p>Method</p> <p>Sixty (60) subjects were randomly selected from both apparently healthy subjects and those who have different blood disorders from the University of Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria. Three (3)mls of venous blood sample was collected aseptically from each subject into tri-potassium ethylenediamine tetra-acetic acid (K₃EDTA) for the analysis of haematological parameters using the automated and the manual methods.</p> <p>Results</p> <p>The blood film report by the manual method showed that 50% of the subjects were normocytic-normochromic while the other 50% revealed different abnormal blood pictures. Also, there were statistically significant differences (p < 0.05) in mean cell hemoglobin concentrations (MCHC) between the two methods. Similarly, the mean (S.E) values of hemoglobin, packed cell volume, platelet and total white cell counts demonstrated statistically significant difference (p < 0.001) and correlated positively when both methods were compared.</p> <p>Conclusion</p> <p>From the present study, it can be concluded that the automated hematology analyzer readings correlated well with readings by the standard manual method, although the latter method gave additional diagnostic information on the blood pictures. While patients' care and laboratory operations could be optimized by using manual microscopic examination as a reflective substitute for automated methods, usage of automated method would ease our workload and save time for patients.</p

Evaluation of Pyridoacridine Alkaloids in a Zebrafish Phenotypic Assay

Three new minor components, the pyridoacridine alkaloids 1-hydroxy-deoxyamphimedine (1), 3-hydroxy-deoxyamphimedine (2), debromopetrosamine (3), and three known compounds, amphimedine (4), neoamphimedine (5) and deoxyamphimedine (6), have been isolated from the sponge Xestospongia cf. carbonaria, collected in Palau. Structures were assigned on the basis of extensive 1D and 2D NMR studies as well as analysis by HRESIMS. Compounds 1–6 were evaluated in a zebrafish phenotype-based assay. Amphimedine (4) was the only compound that caused a phenotype in zebrafish embryos at 30 μM. No phenotype other than death was observed for compounds 1–3, 5, 6