Mindful organizing in patients’ contributions to primary care medication safety

Background: There is a need to ensure that the risks associated with medication usage in primary healthcare are controlled. To maintain an understanding of the risks, healthcare organizations may engage in a process known as “mindful organizing”. While this is typically conceived of as involving organizational members, it may in the healthcare context also include patients. Our study aimed to examine ways in which patients might contribute to mindful organizing with respect to primary care medication safety. Method: Qualitative focus groups and interviews were carried out with 126 members of the public in North-West England and the East Midlands. Participants were taking medicines for a long-term health condition, taking several medicines, had previously encountered problems with their medication, or were caring for another person in any of these categories. Participants described their experiences of dealing with medication-related concerns. The transcripts were analysed using a thematic method. Results: We identified four themes to explain patient behaviour associated with mindful organizing: knowledge about clinical or system issues; artefacts that facilitate control of medication risks; communication with healthcare professionals; and the relationship between patients and the healthcare system (in particular, mutual trust). Conclusions: Mindful organizing is potentially useful for framing patient involvement in safety, although there are some conceptual and practical issues to be addressed before it can be fully exploited in this setting. We have identified factors that influence (and be strengthened by) patients’ engagement in mindful organizing, and as such would be a useful focus of efforts to support patient involvement

Improvising Prescription: Evidence from the Emergency Room

© 2016 British Academy of Management. Global medical practice is increasingly standardizing through evidence-based approaches and quality certification procedures. Despite this increasing standardization, medical work in emergency units necessarily involves sensitivity to the individual, the particular and the unexpected. While much medical practice is routine, important improvisational elements remain significant. Standardization and improvisation can be seen as two conflicting logics. However, they are not incompatible, although the occurrence of improvisation in highly structured and institutionally complex environments remains underexplored. The study presents the process of improvisation in the tightly controlled work environment of the emergency room. The authors conducted an in situ ethnographic observation of an emergency unit. An inductive approach shows professionals combining ostensive compliance with protocols with necessary and occasional 'underlife' improvisations. The duality of improvisation as simultaneously present and absent is related to pressures in the institutional domain as well as to practical needs emerging from the operational realm. The intense presence of procedures and work processes enables flexible improvised performances that paradoxically end up reinforcing institutional pressures for standardization

Organizational mindfulness and mindful organizing: A reconciliation and path forward

Ray, Baker, and Plowman's (2011) study of organizational mindfulness highlights latent tensions in the mindfulness literature and promising avenues for future research. Their study provides a springboard for reconciling the literature by differentiating organizational mindfulness from mindful organizing, establishing where organizational mindfulness and mindful organizing are most important, and clarifying how and when each construct can be most fruitfully deployed in research and practice. Clearer theorizing leads to a set of research questions that seek to integrate multiple conceptions of individual and organizational mindfulness, establish their individual and organizational antecedents, explore the consequences for individuals and organizations, and in so doing, further increase the relevance of organizational mindfulness for business schools

Structuring for high reliability: HR practices and mindful processes in reliability-seeking organizations

This paper theoretically and empirically connects the literature on high-reliability organizations (HROs) to a broader set of organizations, which we call reliability-seeking organizations. Unlike HROs, which operate high-hazard technologies, reliability-seeking organizations operate in high-hazard environments. Reliability-seeking organizations are tightly coupled to their unpredictable and complex environments in such a manner that although the human mortality rate is low, the risk of small failures amplifying into organizational mortality is high. To cope with these environments, reliability-seeking organizations organize to remain open and flexible to emerging information and achieve the reliability demanded by their environments—intensity of innovation. These organizations utilize skilled temporary employees, positive employee relations, and an emphasis on training to innovate, and, in turn, generate greater financial performance. We test these hypotheses using a sample of 184 initial public offering (IPO) software firms that conducted their IPO between 1993 and 1996 and our results are consistent with our theorizing. Firms that utilized these human resource practices innovated more frequently and firms with more innovations had higher stock prices over time. Our findings combine to suggest a theoretical model of structural antecedents of a different type of reliability—intensity of innovation Copyright © 2003 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35038/1/221_ftp.pd

Inconceivable! Possibilistic thinking and the sociocognitive underpinnings of entrepreneurial responses to grand challenges

Due to the radical uncertainty associated with grand challenges, prior studies have emphasized the need for robust action, which preserves future options while taking existing means and institutional constraints seriously. In this conversation on entrepreneurial futures and possibilities, we suggest that for such approaches to avoid merely reproducing or incrementally improving upon existing ideas and institutions, they must be underpinned by a set of cognitive practices that encourage the systematic interrogation of existing assumptions, the surfacing of bold systemic interventions, and efforts to discourage early dismissals of such interventions based on historically grounded feasibility judgments. To encapsulate these cognitive practices, we introduce the concept of possibilistic thinking, noting how such thinking significantly reorients entrepreneurs’ attention and reasoning processes. We conclude by discussing the tensions associated with possibilistic thinking as well as opportunities for further research

Performing Under Uncertainty: Contextualized Engagement in Wildland Firefighting

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111802/1/jccm12076.pd

Synergistic antitumor activity of camptothecin-doxorubicin combinations and their conjugates with hyaluronic acid

Combinations of topoisomerase inhibitors I and II have been found to synergistically inhibit cancer cell growth in vitro, yet clinical studies of these types of combinations have not progressed beyond phase II trials. The results of clinical combinations of topoisomerase (top) I and II inhibitors typically fall within one of two categories: little to no improvement in therapeutic efficacy, or augmented toxicity compared to the single drug counterparts. Hence, despite the promising activity of top I and II inhibitor combinations in vitro, their clinical applicability has not been realized. Here, we report the use of polymer-drug conjugates as a means to co-deliver synergistic doses of top I and II inhibitors camptothecin (CPT) and doxorubicin (DOX) to tumors in vivo in a 4T1 breast cancer model. At specific molar ratios, DOX and CPT were found to be among the most synergistic combinations reported to date, with combination indices between 0.01 and 0.1. The identified optimal ratios were controllably conjugated to hyaluronic acid, and elicited significant tumor reduction of murine 4T1 breast cancer model when administered intravenously. This study elucidates a method to identify synergistic drug combinations and translate them to in vivo by preserving the synergistic ratio via conjugation to a carrier polymer, thus opening a promising approach to translate drug combinations to clinically viable treatment regimens

Safety climate, safety climate strength, and length of stay in the NICU

BACKGROUND: Safety climate is an important marker of patient safety attitudes within health care units, but the significance of intra-unit variation of safety climate perceptions (safety climate strength) is poorly understood. This study sought to examine the standard safety climate measure (percent positive response (PPR)) and safety climate strength in relation to length of stay (LOS) of very low birth weight (VLBW) infants within California neonatal intensive care units (NICUs). METHODS: Observational study of safety climate from 2073 health care providers in 44 NICUs. Consistent perceptions among a NICU\u27s respondents, i.e., safety climate strength, was determined via intra-unit standard deviation of safety climate scores. The relation between safety climate PPR, safety climate strength, and LOS among VLBW (\u3c 1500 g) infants was evaluated using log-linear regression. Secondary outcomes were infections, chronic lung disease, and mortality. RESULTS: NICUs had safety climate PPRs of 66 ± 12%, intra-unit standard deviations 11 (strongest) to 23 (weakest), and median LOS 60 days. NICUs with stronger climates had LOS 4 days shorter than those with weaker climates. In interaction modeling, NICUs with weak climates and low PPR had the longest LOS, NICUs with strong climates and low PPR had the shortest LOS, and NICUs with high PPR (both strong and weak) had intermediate LOS. Stronger climates were associated with lower odds of infections, but not with other secondary outcomes. CONCLUSIONS: Safety climate strength is independently associated with LOS and moderates the association between PPR and LOS among VLBW infants. Strength and PPR together provided better prediction than PPR alone, capturing variance in outcomes missed by PPR. Evaluations of NICU safety climate consider both positivity (PPR) and consistency of responses (strength) across individuals

Achtsamkeitstraining für die Firma? Gerne, aber bitte nachhaltig

Die weltweite Nachfrage nach Achtsamkeitstrainingskursen in Unternehmen hat in den letzten Jahren enorm zugenommen. Das große Interesse an Achtsamkeit liegt an der Hoffnung vieler Unternehmen weltweit, damit Stress im Firmenalltag abzubaün, mehr Gleichgewicht einzuleiten sowie in der Folge sogar Produktivitätssteigerungen realisieren zu können, aber auf sanfte, nachhaltige Art. Dennoch ist die Nachhaltigkeit von Achtsamkeitskursen in Unternehmen längst nicht so eingehend erforscht wie es die Popularität dieses Themas nahe legt. Das liegt hauptsächlich daran, dass bei vielen Kursen in Firmen Achtsamkeit mit Meditation gleichgestellt wird. Meditieren ist jedoch nur eine von vielen Methoden, um Achtsamkeit zu lernen und im Arbeitsalltag anzuwenden, und die Meditation ist nicht immer der beste Weg in die Achtsamkeit. In diesem Kapitel wird Schritt für Schritt erklärt, was Achtsamkeit ist und wie sie funktioniert, warum sie nicht dasselbe ist wie Achtsamkeitsmeditation und wie man Unternemen helfen kann, Achtsamkeit nachhaltig in ihre Firmenkultur einzubetten und somit langfristig zu erreichen, was sie sich durch Achtsamkeitskurse erhoffen