Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations

BACKGROUND: A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety. METHODS: Hospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews. RESULTS: Ten participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient's journey was a major safety concern. DISCUSSION: The complexity of EP systems' adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety.Peer reviewe

Forging Partnerships in Health Care: Process and Measuring Benefits

Universally, there is concern that much academic learning has dealt mainly in theory, removing knowledge from context with a resultant lack of practical experience. Here, the catalyst for strengthening university-community engagement, emanated from a desire to foster greater propensity within students to make connections between their academic courses and responsibility toward the community and people in need, and thus develop enhanced skills in social interaction, teamwork and effectiveness. This paper explores a variety of models of university-community engagement that aim to achieve and model good practice in policy making and planning around healthcare education and service development. Ways of integrating teaching and learning with community engagement, so there is reciprocal learning with significant benefits to the community, students, the university and industry are described. The communities of engagement for a transdisciplinary approach in healthcare are defined and the types of collaborative partnerships are outlined, including public/private partnerships, service learning approaches and regional campus engagement. The processes for initiating innovation in this field, forging sustainable partnerships, providing cooperative leadership and building shared vision are detailed. Measuring shared and sustained benefits for all participants is examined in the context of effecting changes in working relationships as well as the impact on students in terms of increased personal and social responsibility, confidence and competence. For the health professions, it is considered vital to adopt this approach in order to deliver graduates who feel aware of community needs, believe they can make a difference, and have a greater sense of community responsibility, ethic of service and more sophisticated understandings of social contexts. In the longer term, it is proposed the strategy will deliver a future healthcare workforce that is more likely to have a strengthened sense of community, social and personal responsibility and thus effect positive social change

Building and sustaining Work Engagement – A participatory action intervention to increase Work Engagement in nursing staff

This study evaluated whether a participatory action research intervention with nursing staff on acute care older people NHS wards in the UK was effective for increasing work engagement. Mediation analyses between job resources, (social support, influence in decision-making), job demands, work-related needs (autonomy, competence, relatedness), and work engagement explored the presumed psychological mechanisms underlying the intervention. A nonrandomised, matched control group, pre-test, post-test design involved three intervention and five control wards. A significant decrease in relatedness, and a borderline significant decrease in competence, was observed in the intervention group compared to the control group, with no effect on work engagement (N=45). Work-related needs mediated between resources and work engagement, supporting the Job Demands-Resources model and Self-Determination Theory as an underlying explanatory theory. Intervention implementation was difficult, highlighting the need for participant and organisational readiness for change, and strong management support. This is the first known study to apply participatory techniques to increase work engagement in nursing staff and explore the underlying explanatory psychological mechanisms, offering a novel means of taking work engagement research forward. Crucially, it highlights the challenges involved in intervention research and the importance of including evaluations of intervention implementation alongside statistical evaluations to avoid erroneous conclusions

Individual and group-level job resources and their relationships with individual work engagement

OBJECTIVES: This study adds a multilevel perspective to the well-researched individual-level relationship between job resources and work engagement. In addition, we explored whether individual job resources cluster within work groups because of a shared psychosocial environment and investigated whether a resource-rich psychosocial work group environment is beneficial for employee engagement over and above the beneficial effect of individual job resources and independent of their variability within groups. METHODS: Data of 1,219 employees nested in 103 work groups were obtained from a baseline employee survey of a large stress management intervention project implemented in six medium and large-sized organizations in diverse sectors. A variety of important job resources were assessed and grouped to an overall job resource factor with three subfactors (manager behavior, peer behavior, and task-related resources). Data were analyzed using multilevel random coefficient modeling. RESULTS: The results indicated that job resources cluster within work groups and can be aggregated to a group-level job resources construct. However, a resource-rich environment, indicated by high group-level job resources, did not additionally benefit employee work engagement but on the contrary, was negatively related to it. CONCLUSIONS: On the basis of this unexpected result, replication studies are encouraged and suggestions for future studies on possible underlying within-group processes are discussed. The study supports the presumed value of integrating work group as a relevant psychosocial environment into the motivational process and indicates a need to further investigate emergent processes involved in aggregation procedures across levels

Burnout in Organizational Life

Burnout is a psychological response to work stress that is characterized by emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment. In this paper, we review the burnout literature from 1993 to present, identifying important trends that have characterized the literature. We focus our attention on theoretical models that explain the process of burnout, the measurement of burnout, means of reducing burnout, and directions for the future of burnout research.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

When the going gets tough: Employee reactions to large‐scale organizational change and the role of employee Machiavellianism

Large-scale, long-term change initiatives take time to unfold, which can be a source ofuncertainty and strain. Investigating the initial 19 months of a large-scale change, weargue that during these stages, employees' change-related beliefs become more negativeover time, which negatively affects their work engagement and, ultimately, increasestheir turnover intentions. Furthermore, we investigate the impact of a trait, Machiavel-lianism, on change reactions and propose that employees high in Machiavellianism reactmore negatively during change processes as they are especially susceptible to uncer-tainty and stress. We test our (cross-level) moderated mediation model in a three-wavelongitudinal study among employees undergoing a large-scale change (T1: n = 1,602; T2:n =1,113;T3:n = 759). We find that employees' beliefs about the impact and value ofthe change are indeed negatively related to change duration and that decreases in theseperceptions come with a decline in engagement and increases in turnover intentions.Moreover, employees high in Machiavellianism react more strongly to a deterioration inchange-related beliefs, showing stronger reductions in engagement and strongerincreases in turnover intentions than employees low in Machiavellianism. Our studyoffers explanations for the negative effects of large-scale changes including an explana-tory factor for disparate employee reactions to change over time

The role of rewards and demands in burnout among surgical nurses

Job rewards have both, an intrinsic and an extrinsic motivational potential, and lead to employees’ development as well as help them to achieve work goals. Rewards can balance job demands and protect from burnout. Due to changes on the labour market, new studies are needed. The aim of our study was to examine the role of demands and individual rewards (and their absence) in burnout among surgical nurses. Materials and Methods: The study was conducted in 2009 and 2010 with 263 nurses who worked in surgical wards and clinics in hospitals in Southern Poland. The hypotheses were tested by the use of measures of demands and rewards (Effort-Reward Imbalance Questionnaire by Siegrist) and burnout syndrome (Maslach Burnout Inventory). A cross-sectional, correlational study design was applied. Results: Nurses experienced the largest deficiencies in salary and prestige. Exhaustion was explained by stronger demands and lack of respect (large effect). Depersonalization was explained by stronger demands, lack of respect and greater job security (medium effect). Reduced personal achievement was explained by more demands and greater job security (small effect). Conclusions: Excessive demands and lack of esteem are key reasons for burnout among surgical nurses. Job security can increase burnout when too many resources are invested and career opportunities do not appear. These results may help to improve human resource management in the healthcare sector

“Emotional Exhaustion and Perceived Corporate Social Responsibility: A Case Study of a Port Logistics Organization”

In an era of economic crisis, and at the shadow of major ethical scandals in organizations, Corporate Social Responsibility (CSR) strategy has emerged as a crucial element to reestablish the bond between corporations and all other stakeholders such as the local community, society and labor force. Crisis makes employees more stressful, since they work on unwarranted jobs causing them emotional exhaustion. This study aims to examine the association between employee emotional exhaustion and perceived corporate social responsibility (CSR). For this purpose, this study conducted a survey which examines if CSR (ethical, social, environmental dimensions) is negatively related to emotional exhaustion of employees on a sample of 93 employees of a port logistics management services organization. A structured questionnaire was developed in order to measure emotional exhaustion and employee perceptions about CSR activities. Building on the claim that employee perceptions of CSR activities may significantly related to emotional state, this paper examines three CSR dimensions (social, ethical and environmental) and emotional exhaustion. The results of this study indicate that environmental CSR exerts a negative significant effect on Emotional exhaustion. These finding will be of great value as they can contribute on understanding the impact of environmental CSR on emotional exhaustion with detrimental effects on employees’ productivity, job performance, and creativity. The importance of CSR environmental aspects and the relative strategies guiding CSR impact on emotional exhaustion affecting job-related outcomes are also discussed

Action Research as a Burnout Intervention: Reducing Burnout in the Federal Fire Service

Despite a rapidly growing body of work on the nature of stress and burnout in organizations, relatively little research has been conducted to develop strategies for reducing burnout. In this article, we discuss collaborative action research as a mechanism for the reduction of burnout. The authors demonstrate the efficacy of this approach in the context of a federal fire department. Findings suggest that action research has potential as a mechanism for the reduction of burnout, particularly because it is a more holistic approach that can be tailored to fit the needs of an organization.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline