The Influence of Organizational Context on Quitting Intention

This study uses multilevel methods to investigate the effects of organizational context on job satisfaction and quitting intention among staff working in long-term mental health care settings. Two types of organizational features are examined: group job satisfaction and structural features of the work unit (unit size, workload, and level of client functioning on the unit). A review of the organizational literature reveals that most empirical research has investigated job satisfaction at the individual level of analysis rather than the group level. The authors argue that the affective context of a group has real and measurable consequences for individual attitudes and behavior, independent of individual attitudes toward the job. Using multilevel modeling, study findings support the premise that group job satisfaction exercises effects on intention to quit independent of individuals’ dispositions toward their jobs. These effects are both direct and interactive. The findings underscore the importance of affective context in shaping individual attitudes and behavioral intentions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68775/2/10.1177_0164027599212003.pd

Multilevel model of quality of life among United States veterans with serious mental illness.

This study is principally concerned with the social conditions of U.S. Veterans with serious mental illness discharged from inpatient psychiatric institutions. The study specifically investigates the relative impact of social structural characteristics (for example, case management exposure and treatment program orientation) and client attributes (for example, psychiatric, socio-demographic and socio-economic profiles) on the quality of life of U.S. veterans with serious mental illness. Quality of life can be defined as a product of the fit between attributes of the person and characteristics of higher environment. Accordingly, an ecological framework is adopted in this study to assess this notion of fitness. The proposed study utilizes data provided by the U.S. Department of Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center (SMITREC). The dependent variable incorporates Anthony Lehman's objective and subjective multidimensional scales of quality of life specifically designed for the SMI population. The independent variables include individual socio-demographic and psychiatric profile measures, the individual patient's case management exposure during program participation and treatment program type. This study employs Hierarchical Linear Modeling (HLM) to appropriately assess three levels of data; time points nested within individuals nested within treatment programs. Overall, during the course of treatment program participation, these clients obtain access to greater resources, engage in social and leisure activities to a greater extent and are more satisfied across a wide range of life domains. The results of this study indicate that case management has measurable effects on several domains of quality of life, particularly in relation to social and leisure activities. The general improvement in quality of life over time is particularly important in light of the highly dysfunctional population studied. Additionally, this study highlights some potential target areas for policy-makers, managers and researchers: aging clients with SMI, poor functioning clients and economically-disadvantaged clients within the U.S. veteran health care system. These sub-population groups appear to have the lowest level of quality of life across the sample. Future studies should investigate other aspects of the treatment environment in addition to such factors as access to good housing, safe neighborhoods and social support.Ph.D.Clinical psychologyHealth and Environmental SciencesMental healthPsychologyPublic healthPublic policySocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130741/2/9811107.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/130741/5/DeepBluepermissions_agreement - CC BY and CC BY-NC.doc

A New Framework for Building Participation in the Arts

Examines why people become involved in the arts, how arts organizations can influence their participation, and what lessons can be learned from leaders in the field. Includes an overview and critique of published research on arts participation

A Rapid Review of Interventions to Improve Care for People Who Are Medically Underserved with Multiple Sclerosis, Diabetic Retinopathy, and Lung Cancer.

In the United States, patients with chronic conditions experience disparities in health outcomes across the care continuum. Among patients with multiple sclerosis, diabetic retinopathy, and lung cancer, there is a lack of evidence summarizing interventions to improve care and decrease these disparities. The aim of this rapid literature review was to identify interventions among patients with these chronic conditions to improve health and reduce disparities in screening, diagnosis, access to treatment and specialists, adherence, and retention in care. Using structured search terms in PubMed and Web of Science, we completed a rapid review of studies published in the prior five years conducted in the United States on our subject of focus. We screened the retrieved articles for inclusion and extracted data using a standard spreadsheet. The data were synthesized across clinical conditions and summarized. Screening was the most common point in the care continuum with documented interventions. Most studies we identified addressed interventions for patients with lung cancer, with half as many studies identified for patients with diabetic retinopathy, and few studies identified for patients with multiple sclerosis. Almost two-thirds of the studies focused on patients who identify as Black, Indigenous, or people of color. Interventions with evidence evaluating implementation in multiple conditions included telemedicine, mobile clinics, and insurance subsidies, or expansion. Despite documented disparities and a focus on health equity, a paucity of evidence exists on interventions that improve health outcomes among patients who are medically underserved with multiple sclerosis, diabetic retinopathy, and lung cancer

Economic evaluation and mental health: sparse past . . . fertile future?

Objective : To identify the determinants of level and intensity of psychosocial treatment activity among staff who deliver services to the severely and mentally ill. Methods : The study sample consisted of 769 treatment providers working in 77 units in 29 VA mental health facilities. Level of psychosocial care was measured as the number of patient contacts and total hours spent in psychosocial care over a 1 week period. Intensity of psychosocial care was measured as the average time per patient contact. We used hierarchical linear modeling (HLM) to examine the association between level and intensity of care and three categories of determinants—individual provider attributes, work characteristics and treatment setting characteristics. Results : Providers' occupation is related to both the level and intensity of care. Providers with administrative responsibilities also have fewer patient contacts and lower intensity of such contacts. Providers who perceived their pay and benefits more positively had fewer patient contacts and less intensive patient contacts. Positive relationships with patients and providers were also associated with greater levels and intensity of psychosocial treatment activity among providers. Finally, statistically significant differences in psychosocial treatment activity among units were identified although such differences are not attributable to unit size, patient cohort severity or unit workload. Conclusions : Level and intensity of psychosocial treatment activity vary systematically by individual attributes of providers, characteristics of the work they perform and attributes of the treatment setting. These factors may provide the basis for designing interventions to modify provider behavior in a manner consistent with emerging financial pressures and treatment modalities for the seriously mentally ill. Copyright © 1999 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35223/1/63_ftp.pd

Team leadership and patient outcomes in US psychiatric treatment settings

Previous studies suggest that psychiatric patients mirror the behaviors of the staff members who treat them, but there is little empirical evidence about how staff dynamics affect patients over time. The goals of this study were to examine associations between: (1) team leader discipline and mutual respect among treatment team members; and (2) mutual respect among team members and improvements in patient quality of life. Two models were tested on data from psychiatric treatment teams within the US Veterans Administration. The first examined associations between the discipline of each team's emergent leader and the level of mutual respect among that team's members. The second model tested associations between mutual respect among staff and changes over time in patients' quality of life. The subjects for model 1 were psychiatric staff members (n=785) whose responses were aggregated for team-level analyses (n=78). Mutual respect was highest in social worker-led teams and lowest in physician-led teams. The subjects for model 2 were 1638 seriously mentally ill patients in 44 of the units examined in the first model. When mutual respect among staff was greater, patients improved more over time in their satisfaction with the quality of their housing, relations with families, social life, and finances. Together, these analyses imply that mutual respect may improve patient outcomes and that leadership by some disciplines may facilitate such dynamics. In general, leaders may consider learning from other disciplines' strengths to improve their impact.US Teams Leadership Psychiatric Respect Patient outcomes

Embedded Intergroup Relations in Interdisciplinary Teams

Many organizations are making a deliberate effort to use teams to carry out work as an alternative to more traditional, hierarchical approaches to defining jobs or supervising employees. The authors posit that structure and composition of work teams are likely to systematically affect group dynamics of such teams. Using the related frameworks of social identification theory and embedded intergroup relations theory, they examine the proposition that greater diversity of team member characteristics and larger team size negatively affect members' perceptions of team integration. Hypotheses were tested on 1,004 individuals working on 105 interdisciplinary treatment teams in a national sample of 29 Department of Veterans Affairs psychiatric hospitals. Five of six hypotheses received support for at least one of three dimensions of team integration examined in this article. The strongest support was found for the effects of diversity on perceptions of team functioning. Results are generally consistent with the basic premise of the embedded intergroup relations model: As teams become more diverse along most identity group and organizational group characteristics, intergroup relations among team members suffer and perceived level of team integration declines. The authors offer several suggestions about how managers and team leaders might use these findings to improve team integration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67673/2/10.1177_0021886397334001.pd