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

Human Dectin-1 Deficiency Impairs Macrophage-Mediated Defense Against Phaeohyphomycosis

Subcutaneous phaeohyphomycosis typically affects immunocompetent individuals following traumatic inoculation. Severe or disseminated infection can occur in CARD9 deficiency or after transplantation, but the mechanisms protecting against phaeohyphomycosis remain unclear. We evaluated a patient with progressive, refractory Corynespora cassiicola phaeohyphomycosis and found that he carried biallelic deleterious mutations in CLEC7A encoding the CARD9-coupled, β-glucan-binding receptor, Dectin-1. The patient\u27s PBMCs failed to produce TNF-α and IL-1β in response to β-glucan and/or C. cassiicola. To confirm the cellular and molecular requirements for immunity against C. cassiicola, we developed a mouse model of this infection. Mouse macrophages required Dectin-1 and CARD9 for IL-1β and TNF-α production, which enhanced fungal killing in an interdependent manner. Deficiency of either Dectin-1 or CARD9 was associated with more severe fungal disease, recapitulating the human observation. Because these data implicated impaired Dectin-1 responses in susceptibility to phaeohyphomycosis, we evaluated 17 additional unrelated patients with severe forms of the infection. We found that 12 out of 17 carried deleterious CLEC7A mutations associated with an altered Dectin-1 extracellular C-terminal domain and impaired Dectin-1-dependent cytokine production. Thus, we show that Dectin-1 and CARD9 promote protective TNF-α- and IL-1β-mediated macrophage defense against C. cassiicola. More broadly, we demonstrate that human Dectin-1 deficiency may contribute to susceptibility to severe phaeohyphomycosis by certain dematiaceous fungi

Influence of Anchors on Numeric and Non-Numeric Judgments

Individuals regularly make judgments about aspects of the world (e.g. time, probability, number of things, etc.) based on partial information. During these judgments, the anchoring bias can occur when subjects are exposed to a relevant or irrelevant piece of information that can influence their judgments on subsequent decisions. The effect of anchoring on numeric judgments has been investigated extensively. In previous studies, participants would be given a high or low numeric anchor and their following judgments would be observed for bias. There is some emerging evidence supporting the hypothesis that non-numeric judgments can also be influenced by anchors, however to our knowledge, no published works have directly compared the effect of anchoring on numeric and non-numeric judgments. The overarching goal of this study, then, is to examine whether non-numeric anchors influence the judgments made by the participant to the same degree that numeric anchors do. In addition to the classic numeric trial (e.g. estimating the true population of a state), all participants also make judgments in two forms of non-numeric trials. Quasi-numeric trials require participants to make judgments about a target subject matter comparatively instead of numerically (e.g. selecting a city whose population most closely matches that of a target city). Non-numeric trials require participants to make judgments about the color of a target object comparatively. Plausible high or low anchors for each trial are randomly assigned to participants at the beginning of the study session. As expected, all numeric trials resulted in significant anchoring effects. However, only one non-numeric and no quasi-numeric trials showed significant results. A follow up study is currently be conducted to further look into the effects of the anchoring bias on non-numeric and quasi-numeric judgments

The interactive effect of team and manager absence on employee absence: A multilevel field study

Although it is commonly assumed that manager and team absence levels have a significant impact on an individuals’ absence level, research has yet to simultaneously test the effect of these sources, as well their interactive effect on employee absence behaviour. Using archival attendance records for 955 employees, grouped in 79 teams, and the absence records of their respective managers from a large professional services organization, this study considers absence behaviour through the lens and social learning theory and social information processing theory to suggest that absence norms are socially constructed based on social influences of the absence pattern of one's team and manager. Through the use of hierarchical linear modelling to account for group-level influences on absence behaviour, findings suggest that team-level absence exerts a greater influence on employee absence than manager absence and that manager absence exerts a moderating influence on this relationship. Implications for attendance management as well as future research are considered