Management of organisational crises and patient safety: towards a more inclusive approach

The overall aim of the thesis is to realise a better, more holistic understanding of the management of smouldering crises and progress knowledge regarding the ‘latent conditions’ which underlie adverse patient safety incidents in healthcare organisations. In so doing, this thesis will move the debate concerning both the management of smouldering crises and patient safety in healthcare The dominant approach in crisis management theory has been to consider crises from an organisational perspective. In spite of more recent developments in the understanding of smouldering crisis which causally attribute the emerging crisis to limitations in management’s perspective, knowledge and capabilities, there has been insufficient emphasis upon understanding the contributory behaviour of grassroots level. Furthermore, whilst theory is empirically based, this has almost exclusively been founded on narratives offered by those who occupy senior management positions at the expense of considering employees who are closer to the crisis incubation point. Errors in medicine are rare. However, the consequences of adverse patient safety incidents can be devastating. In the healthcare sector, legislative and policy initiatives in the UK during the early part of this century placed patient safety high on the agenda. Consistent with the dominant paradigm in crisis management theory, systemic human error is seen to underpin adverse patient safety incidents. However, whilst progress has been made developing an understanding and addressing aspects of the causal route to such incidents through ‘latent conditions’, the degree of understanding regarding contributory behavioural factors has been more limited. This thesis rebalances the approach taken to date in the crisis management and patient safety literature by looking at smouldering crises from a less limited perspective than previously. It does so by exploring the views of individuals at grassroots level within an organisation. Adopting a qualitative research methodology and through purposive sampling, the research study utilises typical patient care scenarios in order to explore and understand the behaviour of employees in their workplace. The accounts of participants’ working life are examined using narrative analysis and the findings are crystallised in the author’s model of professional workplace behaviour, the ‘Faces of Self’. The author asserts that the limitations of management perspective, knowledge and capabilities which are responsible for the escalation of smouldering crises can be ameliorated if management are sensitive to and effective in the management of the organisation’s climate. In addition, effective improvement of both ‘hard’ and ‘soft’ ‘latent conditions’ by policy makers, leaders within organisations and management generally will create a more effective, motivated and satisfied healthcare professional in the patient care setting and negate some of the conditions in which the adverse patient safety incidents promulgate

An anthropological exploration of identity and social interaction in a multi-ethnic classroom

Drawing on research findings from an ethnography conducted with young children (exploring notions of difference, identity and patterns of interaction, this study uncovers how four and five year-olds conceptualise and operationalise identity in a multi-ethnic Early Years classroom in the North of England. Situated in a particular local context, the study provides an indepth insight into the experiences of a diverse group of children from North and Sub-Saharan African countries who have come together in a single school setting. I show how these children are influenced by social structures such as those pertaining to racism, gender inequality, Islamaphobia, ‘the war on terror’ and events in the Arab Spring. This original focus fills a gap in the literature which has predominantly focused on children from South Asian families currently living in the UK. Revealing how identities unfold over time, the research shows that children’s everyday social interactions are enabled and constrained by these wider structural discourses as they (re)negotiate their identities against this complex backdrop. Dynamic local and global politics, the arrival of new classmates, changes in family structures and Koranic school attendance all influence children’s everyday sense of self and are reflected in the development of peer relationships at school. Over the course of the 2010-11 academic year, I spent a day a week with Sunnyside’s reception class. Adhering to participatory principles that are intrinsic to both ethnography and childhood studies (Cheney 2011), children were involved in developing the focus of the study, the design of research tools, and later on in data collection and analysis. Research methods focused on children in order to gain their perspectives on their social world(s). However, informal conversations with practitioners and family members were also used in order to clarify particular themes arising in the study. Observations, conversations with children and research activities allowed 'snap-shots' to be taken, capturing particular moments or experiences that were then collaboratively analysed with children. When constructing the written ethnography these 'snap-shots' were drawn together into a 'photo gallery', allowing individuals’ narratives to be told and a deep understanding of their experiences to be illuminated. Throughout, ethnography’s distinct focus on culture, process of seeking to uncover emic perspectives, and narrative output (Wolcott 1999) were employed. Developing a theoretical framework that understands identity as performative, situated and dialectical, this thesis discusses the dual roles of structural discourses and social agency within the context of identity (re)negotiation. Framing identity within a ‘strong structuration’ framework that seeks to understand ontology-in-situ, this thesis uncovers how young children understand notions of self and others. It explores how wider social discourses of discrimination and hierarchies of difference play a part in how young children understand ethnic, religious and gender difference. The way in which children conceptualise and operationalise difference relates to the duality of structure, the intersectionality between different aspects of identity and the links that children make between macro and micro social contexts. The thesis unearths how young children explore their own and their peers’ identities amongst themselves before raising questions for how policy and practice can best support children in this aspect of their social development

Efficient implementations of machine vision algorithms using a dynamically typed programming language

Current machine vision systems (or at least their performance critical parts) are predominantly implemented using statically typed programming languages such as C, C++, or Java. Statically typed languages however are unsuitable for development and maintenance of large scale systems. When choosing a programming language, dynamically typed languages are usually not considered due to their lack of support for high-performance array operations. This thesis presents efficient implementations of machine vision algorithms with the (dynamically typed) Ruby programming language. The Ruby programming language was used, because it has the best support for meta-programming among the currently popular programming languages. Although the Ruby programming language was used, the approach presented in this thesis could be applied to any programming language which has equal or stronger support for meta-programming (e.g. Racket (former PLT Scheme)). A Ruby library for performing I/O and array operations was developed as part of this thesis. It is demonstrated how the library facilitates concise implementations of machine vision algorithms commonly used in industrial automation. I.e. this thesis is about a different way of implementing machine vision systems. The work could be applied to prototype and in some cases implement machine vision systems in industrial automation and robotics. The development of real-time machine vision software is facilitated as follows 1. A JIT compiler is used to achieve real-time performance. It is demonstrated that the Ruby syntax is sufficient to integrate the JIT compiler transparently. 2. Various I/O devices are integrated for seamless acquisition, display, and storage of video and audio data. In combination these two developments preserve the expressiveness of the Ruby programming language while providing good run-time performance of the resulting implementation. To validate this approach, the performance of different operations is compared with the performance of equivalent C/C++ programs

Governing the future of a shrinking city: Hoyerswerda, East Germany

The notion of ‘shrinking cities’ emerged in the context of population loss and economic decline in East Germany around the turn of the 21st century. Different practices, policies, academic research and public debates developed, which were mainly concerned with how to deal with this problem. However, the emergence of shrinkage as an urban problem in Germany and what it entails have so far rarely been examined. This includes the starting points and assumptions on which different approaches to shrinkage are based. In employing Foucault’s notion of problematisation in a research perspective of governmentality, this thesis argues that taken-for-granted practices and rationalities of governing shrinkage can be decentred and attention can be drawn to the contingencies of practices, rationalities and techniques which emerged in relation to shrinking cities. A particular focus on conflicts and contestations shows the extent to which practices and assumptions are contested or not. Fieldwork was undertaken in the city of Hoyerswerda in Saxony, once the booming Second Socialist City of the GDR, which has lost almost half its inhabitants since German Unity in 1990. The empirical material gathered comprises semi-structured interviews and a diverse set of documents. The main analytical focus was on how spaces, times, subjectivities and subjects were problematised in the future discourses and practices in Hoyerswerda and on the issues around which conflicts, contestations and counter-conducts emerged. The research found a unanimous agreement in the examined shrinkage discourses that a difference can be made locally if shrinkage is governed properly. The differences of opinion and the conflicts over policies centre around rationalities, practices and techniques of how to govern shrinkage and which spaces, times and subjectivities are considered beneficial or detrimental to the future. The main conflict in the government of shrinkage in Hoyerswerda concerns the question of how to deal with the city’s GDR past: which historical and spatial continuities to avoid or to foster and the subjectivities associated with these spaces and times

Readers and Reading in the First World War

This essay consists of three individually authored and interlinked sections. In ‘A Digital Humanities Approach’, Francesca Benatti looks at datasets and databases (including the UK Reading Experience Database) and shows how a systematic, macro-analytical use of digital humanities tools and resources might yield answers to some key questions about reading in the First World War. In ‘Reading behind the Wire in the First World War’ Edmund G. C. King scrutinizes the reading practices and preferences of Allied prisoners of war in Mainz, showing that reading circumscribed by the contingencies of a prison camp created an unique literary community, whose legacy can be traced through their literary output after the war. In ‘Book-hunger in Salonika’, Shafquat Towheed examines the record of a single reader in a specific and fairly static frontline, and argues that in the case of the Salonika campaign, reading communities emerged in close proximity to existing centres of print culture. The focus of this essay moves from the general to the particular, from the scoping of large datasets, to the analyses of identified readers within a specific geographical and temporal space. The authors engage with the wider issues and problems of recovering, interpreting, visualizing, narrating, and representing readers in the First World War

“Driving to the edge of the cliff”: Transgender mental health

Editoria

Evaluation of prisoner learning: Initial impacts and delivery

The aim of the research was a process and impact evaluation of prisoner education. Looking specifically at the impacts on post-release reoffending, employment, benefit dependency and learning outcomes amongst Offender Learning and Skills Service learners in phases 3 and 4 (OLASS3 and OLASS4), as well as changes made to service delivery under OLASS4 (which started in August 2012)