Family care conferences in long-term care: Exploring content and processes in end-of-life communication

© Cambridge University Press 2017. Objective: End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation.Method: A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement.Results: The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians.Significance of Results: Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians

Thinking strategically about assessment

Drawing upon the literature on strategy formulation in organisations, this paper argues for a focus on strategy as process. It relates this to the need to think strategically about assessment, a need engendered by resource pressures, developments in learning and the demands of external stakeholders. It is argued that in practice assessment strategies are often formed at the level of practice, but that this produces contradiction and confusion at higher levels. Such tensions cannot be managed away, but they can be reflected on and mitigated. The paper suggests a framework for the construction of assessment strategies at different levels of an institution. However, the main conclusion is that the process of constructing such strategies should be an opportunity for learning and reflection, rather than one of compliance

Organizational professionalism in globalizing law firms.

Are the challenges of globalization, technology and competition exercising a dramatic impact on professional practice whilst, in the process, compromising traditional notions of professionalism, autonomy and discretion? This paper engages with these debates and uses original, qualitative empirical data to highlight the vast areas of continuity that exist even the largest globalizing law firms. Whilst it is undoubted that growth in the size of firms and their globalization bring new challenges, these are resolved in ways that are sensitive to professional values and interests. In particular, a commitment to professional autonomy and discretion still characterises the way in which these firms operate and organize themselves. This situation is explained in terms of the development of an organizational model of professionalism, whereby the large organization is increasingly emerging as a primary locus of professionalization and whereby professional priorities and objectives are increasingly supported by organizational logics, systems and initiatives

Organizational Mortality of Small Firms: The Effects of Entrepreneurial Age and Human Capital

This paper addresses the issue of internal determination of organizational outcomes. It is argued that in small and simply structured organizations a considerable proportion of the variance in organizational activities and outcomes is associated with individuals. In particular, the paper uses human capital theory to derive hypotheses about individual determinants of organizational mortality. These hypotheses are tested with event-history data of firm registrations and de-registrations in a West German region. The hypotheses are corroborated by the data, but the effects may nonetheless be due to processes linking individual characteristics with organizational performance other than those suggested by the human capital approach

The reflective learning continuum: reflecting on reflection

The importance of reflection to marketing educators is increasingly recognized. However, there is a lack of empirical research which considers reflection within the context of both the marketing and general business education literature. This paper describes the use of an instrument which can be used to measure four identified levels of a reflection hierarchy: habitual action, understanding, reflection and intensive reflection and two conditions for reflection: instructor to student interaction and student to student interaction. Further we demonstrate the importance of reflective learning in predicting graduates’ perception of program quality. Although the focus was on assessment of MBA level curricula, the findings have great importance to marketing education and educators

Re-Focusing - Building a Future for Entrepreneurial Education & Learning

The field of entrepreneurship has struggled with fundamental questions concerning the subject’s nature and purpose. To whom and to what means are educational and training agendas ultimately directed? Such questions have become of central importance to policy makers, practitioners and academics alike. There are suggestions that university business schools should engage more critically with the lived experiences of practising entrepreneurs through alternative pedagogical approaches and methods, seeking to account for and highlighting the social, political and moral aspects of entrepreneurial practice. In the UK, where funding in higher education has become increasingly dependent on student fees, there are renewed pressures to educate students for entrepreneurial practice as opposed to educating them about the nature and effects of entrepreneurship. Government and EU policies are calling on business schools to develop and enhance entrepreneurial growth and skill sets, to make their education and training programmes more proactive in providing innovative educational practices which help and facilitate life experiences and experiential learning. This paper makes the case for critical frameworks to be applied so that complex social processes become a source of learning for educators and entrepreneurs and so that innovative pedagogical approaches can be developed in terms both of context (curriculum design) and process (delivery methods)

Small is beautiful? Emerging organizational strategies among Italian professionals

The traditional debate about professional groups has mainly focused on conflicts between professions and organizations, reinforcing dualisms and dichotomies. Few scholars have investigated the extent to which professionalism and organizations are intertwined while focusing on the case of professionals integrated into large organizations, and even less attention has been paid to emerging forms of organization among self-employed professionals. Taking as an example organizational trends among architects (liberal professionals) and management consultants (emerging professionals) in Italy, this article investigates how small, flexible, and (often) interprofessional organizations promoted by self-employed professionals are increasingly instrumental in overcoming market pressures and responding to emerging social needs in times of crisis and austerity.Le debat traditionnel à propos des groupes professionnels a principalement concerné les conflits entre professions et organisations, renforçant ainsi les dualisations et dichotomies entre ces deux groupes. Peu de chercheurs ont enquêté à quel point la profession et l'organisationnel sont interdependants lors de l'étude de l'integration de professionnels à de grandes organisations. En fait, moins d'attention a été portée aux formes organisationnelles émergentes entre les professionnels indépendants. En prenant exemple sur les architectes (professionnels libéraux) et les professionnels dans le conseil en management (professionnels émergents) qui travaillent en Italie, cet article analyse comment les organisations des professionnels indépendants, qui sont petites, flexibles et (souvent) interprofessionnelles, se transforment en outils pour faire face à la pression du marché et pour répondre aux besoins émergents en temps de crises et austérité

Project-Based Organizing and Strategic Management: A Long-Term Research Agenda on Temporary Organizational Forms

The last several years have witnessed a growing scholarly interest in project-based organizations. This interest mirrors the diffusion of this organizational form across a wide range of industries, well beyond those where organizations have been traditionally organized by projects. To date, however, research on project based organizations has not yet offered a systematic investigation of the interactions between project-based organizing and strategic management research. An examination of the existing literature indicates that some of the answers to key strategy questions remain incomplete, at times contradictory, and at best ambiguous. This volume moves the discussion to the next level by offering a comprehensive yet integrated view of cutting edge research on project-based organizing to shed light on some of these ambiguities and clarify the relationship between project-based organizing and strategic management. To accomplish this, the volume includes the contributions of several leading scholars who have been active researchers on this subject. The articles develop and extend key strategic aspects of project-based organizing, raise many new important questions, and identify fruitful areas for future research

The Paradox of Power in CSR: A Case Study on Implementation

Purpose Although current literature assumes positive outcomes for stakeholders resulting from an increase in power associated with CSR, this research suggests that this increase can lead to conflict within organizations, resulting in almost complete inactivity on CSR. Methods A single in-depth case study, focusing on power as an embedded concept. Results Empirical evidence is used to demonstrate how some actors use CSR to improve their own positions within an organization. Resource dependence theory is used to highlight why this may be a more significant concern for CSR. Conclusions Increasing power for CSR has the potential to offer actors associated with it increased personal power, and thus can attract opportunistic actors with little interest in realizing the benefits of CSR for the company and its stakeholders. Thus power can be an impediment to furthering CSR strategy and activities at the individual and organizational level

Self-Organizing Networks in Complex Infrastructure Projects

While significant importance is given to establishing formal organizational and contractual hierarchies, existing project management techniques neglect the management of self-organizing networks in large-infrastructure projects. We offer a case-specific illustration of self-organization using network theory as an investigative lens. The findings have shown that these networks exhibit a high degree of sparseness, short path lengths, and clustering in dense “functional” communities around highly connected actors, thus demonstrating the small-world topology observed in diverse real-world self-organized networks. The study underlines the need for these non-contractual functions and roles to be identified and sponsored, allowing the self-organizing network the space and capacity to evolve