Patients-people-place : developing a framework for researching organizational culture during health service redesign and change

BACKGROUND: Organizational culture is considered by policy-makers, clinicians, health service managers and researchers to be a crucial mediator in the success of implementing health service redesign. It is a challenge to find a method to capture cultural issues that is both theoretically robust and meaningful to those working in the organizations concerned. As part of a comparative study of service redesign in three acute hospital organizations in England, UK, a framework for collecting data reflective of culture was developed that was informed by previous work in the field and social and cultural theory. METHODS: As part of a larger mixed method comparative case study of hospital service redesign, informed by realist evaluation, the authors developed a framework for researching organisational culture during health service redesign and change. This article documents the development of the model, which involved an iterative process of data analysis, critical interdisciplinary discussion in the research team, and feedback from staff in the partner organisations. Data from semi-structured interviews with 77 key informants are used to illustrate the model. RESULTS: In workshops with NHS partners to share and debate the early findings of the study, organizational culture was identified as a key concept to explore because it was perceived to underpin the whole redesign process. The Patients-People-Place framework for studying culture focuses on three thematic areas (‘domains’) and three levels of culture in which the data could be organised. The framework can be used to help explain the relationship between observable behaviours and cultural artefacts, the values and habits of social actors and the basic assumptions underpinning an organization’s culture in each domain. CONCLUSIONS: This paper makes a methodological contribution to the study of culture in health care organizations. It offers guidance and a practical approach to investigating the inherently complex phenomenon of culture in hospital organizations. The Patients-People-Place framework could be applied in other settings as a means of ensuring the three domains and three levels that are important to an organization’s culture are addressed in future health service research

Assessment of the influence of surgical technique on postoperative pain and wound tenderness in cats following ovariohysterectomy

Elective ovariohysterectomy was performed on 66 cats. Surgical approach was flank (group F) or midline (group M) allocated by block randomisation. Pre-anaesthetic medication was acepromazine (0.1 mg/kg) via intramuscular injection. Anaesthesia was induced with intravenous thiopentone, and maintained with halothane in 100% oxygen. Carprofen (4 mg/kg) was administered by the subcutaneous route immediately after induction of anaesthesia. Postoperative pain and wound tenderness were assessed at 1, 3, 6, 9, 11-12 and 20-24h after the end of surgery, and the assessment outcome marked on visual analogue scales (VAS). Intervention analgesia (if pain VAS was >40 mm) was pethidine 4 mg/kg via intramuscular injection. Area under the curve (AUC) for VAS for pain and VAS for wound tenderness for each cat were calculated. AUC for wound tenderness was significantly greater for group F (P = 0.007). There was no significant difference for AUC for pain between the groups. In conclusion, wounds after flank ovariohysterectomy are significantly more tender than after midline ovariohysterectomy in the cat. This indicates that interactive methods, including wound palpation, must be used to assess postoperative pain and the findings should be appropriately weighted in the overall assessment

Electroencephalographic responses to a noxious surgical stimulus in mules, horses, and ponies

The aim of this study was to investigate the electroencephalographic (EEG) response of equidae to a castration stimulus. Study 1 included 11 mules (2 1/2-8 years; 230-315 kg) and 11 horses (1 1/2-3 1/2 years; 315-480 kg); study 2 included four ponies (15-17 months; 176-229 kg). They were castrated under halothane anesthesia after acepromazine premedication (IV [study 1] and intramuscular [study 2]) and thiopental anesthetic induction. Animals were castrated using a semiclosed technique (study 1) and a closed technique (study 2). Raw EEG data were analyzed and the EEG variables, median frequency (F50), total power (Ptot), and spectral edge frequency (F95), were derived using standard techniques at skin incision (skin) and emasculation (emasc) time points. Baseline values of F50, Ptot, and F95 for each animal were used to calculate percentage change from baseline at skin incision and emasculation. Differences were observed in Ptot and F50 data between hemispheres in horses but not mules (study 1) and in one pony (study 2). A response to castration (&gt;10% change relative to baseline) was observed in eight horses (73% of animals) and four mules (36% of animals) for F50 and nine horses (82%) and four mules (36%) for Ptot. No changes in F95 data were observed in any animal in study 1. Responses to castration were observed in three ponies (75% of animals) for F50, one pony (25%) for F95, and all ponies for Ptot. Alteration of acepromazine administration and castration technique produced a protocol that identified changes in EEG frequency and power in response to castration.</p