Conceptual foundations of organizational structure: re-structuring of women's health services.

PURPOSE: Researchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services. DESIGN/METHODOLOGY/APPROACH: The researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into "mainstream" health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis. FINDINGS: "Women's marginalization" was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization - that is, merely being at risk of unmet health needs. ORIGINALITY/VALUE: As a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.

New ways to get policy into practice.

PURPOSE: Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of "street-level bureaucracy" has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice. DESIGN/METHODOLOGY/APPROACH: This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics. FINDINGS: Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing "assimilist" from "externalist" positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients' personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work. ORIGINALITY/VALUE: A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.

The importance of role sending in the sensemaking of change agent roles.

PURPOSE: The purpose of this paper is to investigate what happens when a lack of role-sending results in ambiguous change agent roles during a large scale organisational reconfiguration. The authors consider the role of sensemaking in resolving role ambiguity of middle manager change agents and the consequences of this for organisational restructuring. DESIGN/METHODOLOGY/APPROACH: Data were collected from a case study analysis of significant organisational reconfiguration across a local National Health Service Trust in the UK. Data consists of 82 interviews, complemented by analysis of over 100 documents and field notes from 51 hours of observations collected over five phases covering a three year period before, during and after the reconfiguration. An inductive qualitative analysis revealed the sensemaking processes by which ambiguity in role definition was resolved. FINDINGS: The data explains how change agents collectively make sense of a role in their own way, drawing on their own experiences and views as well as cues from other organisational members. The authors also identified the organisational outcomes which resulted from this freedom in sensemaking. This study demonstrates that by leaving too much flexibility in the definition of the role, agents developed their own sensemaking which was subsequently very difficult to manipulate. PRACTICAL IMPLICATIONS: In creating new roles, management first needs to have a realistic vision of the task and roles that their agents will perform, and second, to communicate these expectations to both those responsible for recruiting these roles and to the agents themselves. ORIGINALITY/VALUE: Much of the focus in sensemaking research has been on the importance of change agents' sensemaking of the change but there has been little focus on how change agents sensemake their own role in the change.

Financial crisis and collapsed banks: psychological distress and work related factors among surviving employees--a nation-wide study.

AIM: The study considered psychological distress among surviving bank employees differently entangled in downsizing and restructuring following the financial crisis of 2008. METHODS: A cross-sectional, nationwide study was conducted among surviving employees (N = 1880, response rate 68%). Multivariate analysis was conducted to assess factors associated with psychological distress. RESULTS: In the banks, where all employees experienced rapid and unpredictable organizational changes, psychological distress was higher among employees most entangled in the downsizing and restructuring process. Being subjected to downsizing within own department, salary cut, and transfer to another department, was directly related to increased psychological distress, controlling for background factors. The associations between downsizing, restructuring, and distress were reduced somewhat by adding job demands, job control, and empowering leadership to the model, however, adding social support had little effect on these associations. CONCLUSION: Employees most entangled in organizational changes are the most vulnerable and should be prioritized in workplace interventions during organizational changes.

Análise da implantação de uma proposta assistencial em um hospital de ensino sob a ótica de enfermeiros / Analysis for the implementation of a health care proposal in a school hospital based on the nurses' perception / La percepción de enfermeras de un hospital de instrucción en la implantación de una propuesta assistencial como componente de la evaluación en salud

Objetivamos compreender a experiência de enfermeiras, na implantação de uma proposta assistencial, visando a adesão à Iniciativa Hospital Amigo da Criança. É uma pesquisa qualitativa, realizada na seção de alojamento conjunto do Hospital Universitário da USP, da qual participaram cinco enfermeiras. A coleta de dados foi realizada através de entrevistas e as narrativas analisadas na perspectiva de Janesick. Dessas narrativas foram extraídas quatro categorias interpretadas sob a ótica de autores que investigam o tema mudança. O estudo permitiu verificar a importância do envolvimento dos clientes internos nos processos de mudança, fornecendo subsídios para a reorganização das atividades assistenciais e gerenciais do referido serviço.

In this study, we seek to understand the experience of nurses in setting up a health care proposal to attain compliance to the initiative: Hospital, a Child's Friend. It is a qualitative survey carried out in the mother-infant joint-lodging of the University Hospital of the University of São Paulo, with the participation of five nurses. Data was collected through interviews and narrative was analyzed from the point of view of Janesick. From these narratives, we extracted for categories interpreted from the point-of-view of authors who research the "change" theme. We found that the involvement of the nurses in processes of change is important and provides input for reorganizing the health care and managerial activities of the service.

Se busca entender la experiencia de enfermeras al implantar una propuesta asistencial con miras a la adherencia a la Iniciativa Hospital Amigo del Niño. Se trata de una investigación cualitativa realizada en la sección del alojamiento conjunto del Hospital Universitario de la USP (Universidad de San Pablo), en la que han participado cinco enfermeras. La recogida de datos ha sido efectuada con entrevistas y los relatos se han analizado dentro de la perspectiva de Janesick. A partir de los relatos se han establecido cuatro categorías interpretadas desde la óptica de autores que investigan sobre cambios. El estudio ha permitido comprobar la importancia del compromiso de los clientes internos en los procesos de cambios, proporcionando subsidios para reorganizar actividades asistenciales y de gestión.