25 research outputs found
A ‘movement for improvement’?: a qualitative study of the adoption of social movement strategies in the implementation of a quality improvement campaign
Given the difficulties of implementing ‘top-down’ quality improvements, health service leaders have turned to methods that empower clinicians to co-produce ‘bottom-up’ improvements. This has involved the adoption of strategies and activities associated with social movements, with clinicians encouraged to participate in collective action towards the shared goal of improvement. This paper examines the adoption of social movement methods by hospital managers as a strategy for implementing a quality improvement ‘campaign’. Our case study suggests that, despite the claim of empowering clinicians to develop ‘bottom-up’ improvements, the use of social movement methods is narrowly concerned with engaging clinicians in a pre-determined programme of ‘top-down’ change. It finds a prominent role for ‘hybrid’ clinical leaders and other staff representatives in the mobilisation of the campaign, especially for enrolling clinicians in change activities. The work of these ‘hybrids’ suggests some degree of creative mediation between clinical and managerial interests, but more often alignment with the aspirations of management. The study raises questions about the translation of social movements theories as a strategy for managing change and re-inventing professionalism
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A multilevel neo-institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?
Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted 'strategies of action', guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as 'pragmatic', 'sensible' and also 'legitimate'. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire
Sapling size influences shade tolerance ranking among southern boreal tree species
1 Traditional rankings of shade tolerance of trees make little reference to individual size. However, greater respiratory loads with increasing sapling size imply that larger individuals will be less able to tolerate shade than smaller individuals of the same species and that there may be shifts among species in shade tolerance with size. 2 We tested this hypothesis using maximum likelihood estimation to develop individual-tree-based models of the probability of mortality as a function of recent growth rate for seven species: trembling aspen, paper birch, yellow birch, mountain maple, white spruce, balsam fir and eastern white cedar. 3 Shade tolerance of small individuals, as quantified by risk of mortality at low growth, was mostly consistent with traditional shade tolerance rankings such that cedar > balsam fir > white spruce > yellow birch > mountain maple = paper birch > aspen. 4 Differences in growth-dependent mortality were greatest between species in the smallest size classes. With increasing size, a reduced tolerance to shade was observed for all species except trembling aspen and thus species tended to converge in shade tolerance with size. At a given level of radial growth larger trees, apart from aspen, had a higher probability of mortality than smaller trees. 5 Successional processes associated with shade tolerance may thus be most important in the seedling stage and decrease with ontogeny
AD51B in Familial Breast Cancer
Common variation on 14q24.1, close to RAD51B, has been associated with breast cancer: rs999737 and rs2588809 with the risk of female breast cancer and rs1314913 with the risk of male breast cancer. The aim of this study was to investigate the role of RAD51B variants in breast cancer predisposition, particularly in the context of familial breast cancer in Finland. We sequenced the coding region of RAD51B in 168 Finnish breast cancer patients from the Helsinki region for identification of possible recurrent founder mutations. In addition, we studied the known rs999737, rs2588809, and rs1314913 SNPs and RAD51B haplotypes in 44,791 breast cancer cases and 43,583 controls from 40 studies participating in the Breast Cancer Association Consortium (BCAC) that were genotyped on a custom chip (iCOGS). We identified one putatively pathogenic missense mutation c.541C>T among the Finnish cancer patients and subsequently genotyped the mutation in additional breast cancer cases (n = 5259) and population controls (n = 3586) from Finland and Belarus. No significant association with breast cancer risk was seen in the meta-analysis of the Finnish datasets or in the large BCAC dataset. The association with previously identified risk variants rs999737, rs2588809, and rs1314913 was replicated among all breast cancer cases and also among familial cases in the BCAC dataset. The most significant association was observed for the haplotype carrying the risk-alleles of all the three SNPs both among all cases (odds ratio (OR): 1.15, 95% confidence interval (CI): 1.11–1.19, P = 8.88 x 10−16) and among familial cases (OR: 1.24, 95% CI: 1.16–1.32, P = 6.19 x 10−11), compared to the haplotype with the respective protective alleles. Our results suggest that loss-of-function mutations in RAD51B are rare, but common variation at the RAD51B region is significantly associated with familial breast cancer risk
Modeling individual-tree mortality in Pyrenean oak (Quercus pyrenaica Willd.) stands
International audienceTree mortality is an important process in forest ecosystem dynamics and is one of the least understood phenomena, because of the complex interactions between different environmental stresses, minimal understanding of whole-plant mortality processes, and a chronic shortage of data. * A multilevel logistic regression model was developed for predicting the probability of mortality in individual trees with the objective of improving long-term planning in Spanish pyrenean oak forests. The data came from one 10-year re-measurement of the permanent plot network belonging to the Spanish National Forest Inventory distributed throughout north-west Spain. * The probability of mortality decreased with increasing individual diameter at breast height and increasing ratio of the height of subject tree to the dominant height of the sample plot. The resulting mortality model was evaluated using an independent data set from a region close to the study area. * The regeneration of pyrenean oak generally takes place through stump and/or root sprouting; so stand dynamics differ from those of others species. The model developed is expected to improve the accuracy of stand forecasts in northwest Spain