A realist evaluation of the management of a well- performing regional hospital in Ghana

<p>Abstract</p> <p>Background</p> <p>Realist evaluation offers an interesting approach to evaluation of interventions in complex settings, but has been little applied in health care. We report on a realist case study of a well performing hospital in Ghana and show how such a realist evaluation design can help to overcome the limited external validity of a traditional case study.</p> <p>Methods</p> <p>We developed a realist evaluation framework for hypothesis formulation, data collection, data analysis and synthesis of the findings. Focusing on the role of human resource management in hospital performance, we formulated our hypothesis around the high commitment management concept. Mixed methods were used in data collection, including individual and group interviews, observations and document reviews.</p> <p>Results</p> <p>We found that the human resource management approach (the actual intervention) included induction of new staff, training and personal development, good communication and information sharing, and decentralised decision-making. We identified 3 additional practices: ensuring optimal physical working conditions, access to top managers and managers' involvement on the work floor. Teamwork, recognition and trust emerged as key elements of the organisational climate. Interviewees reported high levels of organisational commitment. The analysis unearthed perceived organisational support and reciprocity as underlying mechanisms that link the management practices with commitment.</p> <p>Methodologically, we found that realist evaluation can be fruitfully used to develop detailed case studies that analyse how management interventions work and in which conditions. Analysing the links between intervention, mechanism and outcome increases the explaining power, while identification of essential context elements improves the usefulness of the findings for decision-makers in other settings (external validity). We also identified a number of practical difficulties and priorities for further methodological development.</p> <p>Conclusion</p> <p>This case suggests that a well-balanced HRM bundle can stimulate organisational commitment of health workers. Such practices can be implemented even with narrow decision spaces. Realist evaluation provides an appropriate approach to increase the usefulness of case studies to managers and policymakers.</p

Nonlinear complexity analysis of brain fMRI signals in schizophrenia

Peer reviewedPublisher PD

Placing relationships in the foreground: the role of workplace friendships in engagement

We explore the role of workplace friendships as a lens for understanding the emotional element and relational context for personal engagement (Kahn, 1990). The review of engagement theory differentiates personal engagement, recognising the role emotions play in enabling individuals’ ‘preferred selves’. Workplace relationships and friendship provide a conceptual discussion of individuals in social and workplace roles in engagement, drawing on friendship, emotion, attachment theories, particularly Kahn’s work. A case study drawn from recent research illustrates our discussion before concluding with ideas for the development of a future research agenda in answer to recent calls for work on the social context of engagement

Interoception in anxiety and depression

We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advantage of this conceptualization is the ability to specifically examine the interface between basic interoception, self-referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states

Considering planned change anew: stretching large group interventions strategically, emotionally and meaningfully

Large Group Interventions, methods for involving “the whole system” in a change process, are important contemporary planned organizational change approaches. They are well known to practitioners but unfamiliar to many organizational researchers, despite the fact that these interventions address crucial issues about which many organizational researchers are concerned. On the other hand, these interventions do not appear to be informed by contemporary developments in organizational theorizing. This disconnect on both sides is problematic. We describe such interventions and their importance; illustrate them with extended descriptions of particular Future Search and Whole‐Scale™ change interventions; summarize research on strategy, emotion, and sensemaking that may inform them; and suggest questions about the interventions that may stimulate research and reflection on practice. We also discuss conditions that may foster effective engagement between Large Group Interventions practitioners and organizational researchers. Our approach represents a way to conduct a review that combines scholarly literature and skilled practice and to initiate a dialog between them

Environmental Morale and Motivation

This chapter discusses the role of environmental morale and environmental motivation in individual behavior from the point of view of economics and psychology. It deals with the fundamental public good problem, and presents empirical (laboratory and field) evidence on how the cooperation problem can be overcome. Four different theoretical approaches are distinguished according to how individuals’ underlying environmental motivation is modeled. Specifically, we look at the interaction between environmental policy and environmental morale through the lens of cognitive evaluation theory (also known as crowding theory)