Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics.

BACKGROUND: Nurses, midwives and paramedics comprise over half of the clinical workforce in the UK National Health Service and have some of the highest prevalence of psychological ill health. This study explored why psychological ill health is a growing problem and how we might change this. METHODS: A realist synthesis involved iterative searches within MEDLINE, CINAHL and HMIC, and supplementary handsearching and expert solicitation. We used reverse chronological quota screening and appraisal journalling to analyse each source and refine our initial programme theory. A stakeholder group comprising nurses, midwives, paramedics, patient and public representatives, educators, managers and policy makers contributed throughout. RESULTS: Following initial theory development from 8 key reports, 159 sources were included. We identified 26 context-mechanism-outcome configurations, with 16 explaining the causes of psychological ill health and 10 explaining why interventions have not worked to mitigate psychological ill health. These were synthesised to five key findings: (1) it is difficult to promote staff psychological wellness where there is a blame culture; (2) the needs of the system often over-ride staff psychological well-being at work; (3) there are unintended personal costs of upholding and implementing values at work; (4) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; and (5) it is challenging to design, identify and implement interventions. CONCLUSIONS: Our final programme theory argues the need for healthcare organisations to rebalance the working environment to enable healthcare professionals to recover and thrive. This requires high standards for patient care to be balanced with high standards for staff psychological well-being; professional accountability to be balanced with having a listening, learning culture; reactive responsive interventions to be balanced by having proactive preventative interventions; and the individual focus balanced by an organisational focus. PROSPERO REGISTRATION NUMBER: CRD42020172420.

Human resource management at the intensive care unit: A pragmatic review and future research agenda for building a learning health system.

Recently, the importance of efficient and effective health care has been recognized, especially during the acute phase of the Coronavirus Disease-2019 (COVID-19) pandemic. Intensive care units (ICUs) have faced an immense workload, with massive numbers of patients being treated in a very short period of time. In general, ICUs are required to deliver high-quality care at all times during the year. At the same time, high-quality organizational goals may not be aligned with the interests, motivation, and development of individual staff members (eg, nurses, and doctors). For management of the ICU, it is important to balance the organizational goals and development of the staff members ("their human capital"), usually referred to as human resource management. Although many studies have considered this area, no holistic view of the topic has been presented. Such a holistic view may help leadership and/or other stakeholders at the ICU to design a better learning health system. This pragmatic review aims to provide a conceptual model for the management of ICUs. Future research may also use this conceptual model for studying important factors for designing and understanding human resources in an ICU.

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement.

BACKGROUND: Discharge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England. METHODS: We interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights. RESULTS: 62 specific enablers and blockers to effective D2A practice emerged. DISCUSSION: These findings supported the development of a comprehensive service improvement toolkit. CONCLUSION: Five recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways.

Serendipity in research and development: The promise of putting into place patterns for paying attention.

The concept of serendipity or accidental discovery is typically discussed in the context of organizational research and development (RnD) through narratives involving 'renegade iconoclasts' laboring at the periphery. Recently, robust academic literature has emerged that grounds serendipity epistemologically. In the current work, this literature is introduced in the context of the typical activities of contemporary life science-focused RnD organizations. Practical patterns are described that can increase the likelihood of realizing accidental (serendipitous) RnD discoveries.

Examining HIV Organizational Structures and their Influence on Engagement with Young Black Gay, Bisexual, and other Men who have Sex with Men in Atlanta, Georgia.

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV. Structural influences on these disparities, including characteristics of the various organizations that serve YB-GBMSM living with HIV, remain understudied. We drew on Weick's model of organizing to conduct and analyze qualitative interviews with 28 HIV service providers representing healthcare and community-based organizations in Atlanta, Georgia. Enactment of HIV service provision was described as following simplified and standardized responses-defined as "rules", and/or more dynamic exchanges to formulate responses -otherwise known as "communication behavior cycles" (CBCs). Rules, including patient quotas and limited hours of operation, were viewed as rigid, out-of-touch, and inhibiting engagement with YB-GBMSM. CBCs, such as patient feedback loops and rejection of traditional hierarchies, fostered creative insights to combating the epidemic and increased levels of cultural awareness and community buy-in. Organizations should strive to enact CBCs, to foster culturally congruent approaches to service delivery for YB-GBMSM.

A Bird in Hand: An Examination of the Influence of Nursing School Proximal Density on Hospital Quality of Care Outcomes in U.S. Hospitals.

While nurse staffing shortage is generally true, it is not universal, and it remains unclear the degree to which variation in local staffing markets might influence the relationship between nurse staffing and care quality. This study seeks to determine the effect of nurse staffing markets on the quality of hospital care delivered in U.S. hospitals by examining the relationship between the proximal density of nurse staffing resources to hospitals and patient-reported care quality outcomes. This examination analyzes hospital performance on (Hospital Consumer Assessment of Healthcare Providers and Systems) HCAHPS based on the proximal density of nursing schools. The analysis combines data from Centers for Medicare and Medicaid Services (CMS) Hospital Compare (N1 = 2959) and U.S. nursing school locations from the American Association of Colleges of Nursing (N2 = 811) via a series of binary logistic regressions to determine whether local nurse staffing availability is related to hospital's attainment of either low or high star quality ratings. A sensitivity analysis is also offered to determine the association with 1, 3, and 5-star ratings. The findings suggest that the odds of receiving both a low-star rating and a high-star rating of HCAHPS performance increase as proximal density increases while the odds of receiving a 3-star rating decrease. Hospitals are able to achieve the highest levels of performance as high performing hospitals in high-density markets seem to be taking advantage of resource availability to establish close, strong ties with nurse staffing resources as opposed to viewing nurses as an easily replaceable resource.

Balancing finances, politics, and public health: international student enrollment and reopening plans at US higher education institutions amid the COVID-19 pandemic.

Drawing from resource dependence theory, this study explores the extent to which international student enrollment related to institutional decisions to shift to in-person instructional strategies during the COVID-19 pandemic. We focus our study particularly on July 2020, a time during which tensions around international students' legal status in the US were especially high. Our results suggest that leaders at private not-for-profit institutions were significantly more likely to shift instructional strategies to include more in-person instruction, thus allowing more international students to enroll but also placing at risk the health of individuals on their campuses and in their local communities. A similar result was not found for public institutions. These results speak to the extent to which private institutions in the US have become financially dependent on international students' tuition and have clear implications for the financial futures of US higher education institutions. Supplementary Information: The online version contains supplementary material available at 10.1007/s10734-021-00768-7.

Applying Theory to Explain the Influence of Factors External to an Organization on the Implementation of an Evidence-Based Intervention.

Despite its widely acknowledged influence on implementation, limited research has been done on how the external environment (i.e., outer setting) determines when organizations adopt and implement new interventions. Determinant frameworks identify several outer setting-level factors such as funding streams, inter-organizational relationships, and peer pressure. However, these frameworks do not explain how or why outer-setting factors influence implementation. To advance research in this area, we argue for the importance of deriving theory-based propositions from organization theory to explain how outer setting factors influence organizations. Drawing on the work of the Organization Theory in Implementation Science (OTIS) project, we identified 20 propositions from five classic organization theories-Complexity Theory, Contingency Theory, Institutional Theory, Resource Dependence Theory, and Transaction Cost Economics. We then applied those propositions to hypothesize relationships among outer setting factors, implementation strategies, and implementation outcomes in five case studies of evidenced-based tobacco control interventions. The five case studies address the implementation of smoke-free policies, community health worker-led tobacco education and cessation programs, 5 A's (Ask, Advise, Assess, Assist, and Arrange), point-of-sale tobacco marketing policy interventions, and quitlines. The case studies illustrate how propositions may be used to guide the selection and testing of implementation strategies. Organization theories provide a menu of propositions that offer guidance for selecting and optimizing high-leverage implementation strategies that target factors at the level of outer setting. Furthermore, these propositions suggest testable hypotheses regarding the mechanisms underlying the influence of outer-setting factors on how and why organizations adopt and implement interventions.

The GP-OH (General Practice - Organizational Health) Survey: Development and Validation of a Novel Instrument to Measure Organizational Health in General Practice.

Primary care healthcare organizations are complex and multidimensional, and there has been much discussion about the potential dangers of focusing on outcomes as quality indicators in isolation without understanding the processes and system characteristics that drive them. Organizational health, as a concept, shifts the focus of measurement upstream and considers the elements needed for sustainable long-term success. This study has both designed and tested the first survey seeking to measure organizational health specifically within the context of primary care. A stepwise approach was taken to ensure that the validity and reliability of the survey was examined at multiple stages.Supplemental data for this article is available online at https://doi.org/10.1080/00185868.2021.1947164.

Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol.

BACKGROUND: Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of cognitive-behavioral therapy (CBT) techniques in community mental health centers. CBT is a leading psychosocial EBP for psychiatric disorders that remains underused despite substantial efforts to increase its implementation. METHODS: We will leverage ongoing CBT implementation efforts in two large public health systems (Philadelphia and Texas) to recruit 300 mental health clinicians and 600 of their clients across 40 organizations. Our primary implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. As CBT comprises discrete components that vary in complexity and acceptability, we will measure clinician use of six discrete components of CBT. After finishing their CBT training, participating clinicians will complete measures of organizational and behavior change constructs delineated in the model. Clinicians also will be observed twice via audio recording delivering CBT with a client. Within 48 h of each observation, theorized moderators of the intention-behavior gap will be collected via survey. A subset of clinicians who report high intentions to use CBT but demonstrate low use will be purposively recruited to complete semi-structured interviews assessing reasons for the intention-behavior gap. Multilevel path analysis will test the extent to which intentions and determinants of intention predict the use of each discrete CBT component. We also will test the extent to which theorized determinants of intention that include psychological, organizational, and contextual factors explain variation in intention and moderate the association between intentions and CBT use. DISCUSSION: Project ACTIVE will advance implementation theory, currently in its infancy, by testing the generalizability of a promising causal model of implementation. These results will inform the development of implementation strategies targeting modifiable factors that explain substantial variance in intention and implementation that can be applied broadly across EBPs.

"I Trust in Staff's Creativity"-The Impact of COVID-19 Lockdowns on Physical Activity Promotion in Nursing Homes Through the Lenses of Organizational Sociology.

Objectives: The health-enhancing benefits or regular physical activity (PA) reach into old age. With the emergence of the coronavirus disease of 2019 (COVID-19) pandemic and the associated national lockdowns and restrictions, nursing home residents were restrained from being physically active. In our study, we aimed to assess the impact of the COVID-19-related restrictions on PA promotion in nursing homes from an organizational-sociological lens. Methods: We collected data in eight nursing homes in Germany. Data collection included (i) semistructured interviews focusing on COVID-19-related restrictions and their effects on nursing homes from the home administrators' perspectives; (ii) open-ended surveys with nursing home staff and relatives focusing on daily routines and contact restrictions; and (iii) collection of documents such as care concepts, mission statements, and weekly activity plans. We analyzed all data with a reflexive thematic analysis approach. Results: We identified three stages of COVID-19-related changes in nursing homes that impacted PA promotion, as follows: (1) external closure and search for emergency control, (2) organizational adaptations to create a livable daily life in the internal environment, and (3) slow reintegration of interactions with the external organizational environment. Document analysis revealed that PA promotion was not part of decision programs or internal staff work descriptions. Rather, PA promotion was delegated to external service providers. The assignment of PA promotion to external providers was not structurally anchored in decision programs, which makes PA promotion not sustainable, particularly during unforeseen events that limit access to the organization. During the pandemic, executive staff believed in internal staff to buffer competencies with regard to PA promotion. Thus, executive staff often considered PA promotion relevant, even during the pandemic, but thought that PA promotion is a task that can be fulfilled by unqualified but motivated internal staff. Conclusion: While our study participants showed a high level of coping-capacity belief, it remains unclear which long-term impacts of COVID-19 on PA promotion in nursing homes are to be expected. At the practice level, executive staff in nursing homes that aim to promote PA within their organization should become aware that PA promotion needs to be incorporated into organizational structures to be implemented and continued in challenging times such as in a pandemic.

Board effects on innovation in family and non-family business.

This paper contributes to the corporate governance and innovation literature by providing empirical evidence with respect to the influence of composition of the board and its leadership structure on innovation. Also, this study seeks to investigate if such influence differs when comparing family and non-family business. Data were collected from 86 Spanish companies of innovative sectors from 2003 to 2014. The results show that innovation is affected positively by board size, especially in the case of family businesses, and gender diversity, especially in non-family businesses. Similarly, findings also point out that duality is better than the independence of functions in the case of non-family businesses. Finally, obtained results support that independent directors have a negative impact on innovation and such negative influence is even stronger in family firms. These findings contribute to an inconclusive literature regarding board effects on innovation, highlighting different recommendations depending on whether the companies are family businesses or not.

The nexus between capital structure, firm-specific factors, macroeconomic factors and financial performance in the textile sector of Pakistan.

The study aimed to analyse the role of the capital structure in the financial performance of 90 textile firms listed in Pakistan Stock Exchange (PSX) during the period 2008-2017. The dependent variable was return on equity as a proxy for financial performance. The independent variables were the debt to equity, total debt to total assets, asset turnover ratios, sales growth, taxation, and export growth, while the firm size was taken as a control variable. The panel regression estimation technique was employed for analysis purposes, and both cross-sectional and time-series data were collected for this study. This study used the random-effect regression estimation model based on the Hausman diagnostic test statistics. The results indicate that the capital structure debt to equity variable has a negative and significant relationship with financial performance while the asset turnover ratio and firm performance showed a negative and statistically insignificant relationship. Export growth and sales growth have a considerable positive connection with financial performance; however, firm size has a negative and significant impact on firm performance, in favour of our alternative research hypothesis. The remaining variables include tax payable and the total debt to total assets ratio, which have an insignificant connection with financial performance (ROE) and validate the agency theory. With better corporate governance by putting more pressure on managers or increasing managerial ownership, institutional investors can reduce the capital, leverage risk and the overall firm capital cost that help to improve the firm's financial performance and economic stability.

Corporate crisis management on social media: A morality violations perspective.

Communication via a social network function enabled by social media has greatly empowered consumers' secondary crisis communication, as compared to a firm's crisis communication, and has thus changed corporate crisis management. This study aims to uncover consumers' decision process of engaging in secondary crisis communication in a social media context. Drawing on the social control perspective and impression management theory, this study examines the role of perceived morality violations and consumers' susceptibility to social influence in shaping consumers' secondary crisis communication in corporate crises. Moreover, leveraging cognitive dissonance theory, this study further examines the effects of corporate responses on the process of consumers' secondary crisis communication. A survey design with four scenarios was conducted to test a series of hypotheses relating to the decision process of secondary crisis communication. Our empirical results demonstrate that consumers' approach to secondary crisis communication on social media depends largely to the degree to which they perceive moral violations in the firms' crisis response. The findings also show that consumers tend to want to believe they are doing the "right thing" when considering secondary crisis communication and thus are afraid of being disliked by others for their purchasing decisions related to a firm in crisis. Such social conformance can result in a snowballing of negative word of mouth in product-harm crises cases. Findings contribute to the literature on social media crisis management and consumers' communication behavior on social media during product-harm crises.

How incident reporting systems can stimulate social and participative learning: A mixed-methods study.

Incident reporting systems (IRSs) have been widely adopted in healthcare, calling for the investigation of serious incidents to understand what causes patient harm. In this article, we study how the Dutch IRS contributed to social and participative learning from incidents. We integrate quantitative and qualitative data in a mixed-methods design. Between 1 July 2013 and 31 March 2019, Dutch hospitals reported and investigated 4667 incidents. Healthcare inspectors scored all investigations to assess hospitals' learning process following incidents. We analysed if and on what aspects hospitals improved over time. Additionally, we draw from semi-structured interviews with incident investigators, quality managers, healthcare inspectors and healthcare professionals. Healthcare inspectors score incident investigation reports better over time, suggesting that hospitals conduct better investigations or have become adept at writing reports in line with inspectors' expectations. Our qualitative data suggests the IRS contributed to practices that support social and participative learning-the professionalisation of incident investigation teams, the increased involvement of patients and families in investigations-and practices that do not-not linking learning from the investigation teams to that of professionals, not consistently monitoring the recommendations that investigations identify. The IRS both hits and misses the mark. We learned that IRSs need to be responsive to the (developing) capabilities of healthcare providers to investigate and learn from incidents, if the IRS is to stimulate social and participative learning from incidents.

Leadership styles, work engagement and outcomes among information and communications technology professionals: A cross-national study.

The present study examined relationships among leadership styles, work engagement and work outcomes designated by task performance and innovative work behavior among information and communication technology professionals in two countries: Ethiopia and South Korea. In total, 147 participants from Ethiopia and 291 from South Korea were made to fill in the self-reporting questionnaire intended to assess leadership styles, work engagement, task performance, and innovative work behavior. To test the proposed hypotheses, multiple linear regression analysis was utilized. The results showed that transformational leadership style had a significant positive relationship with employees' work engagement and innovative work behavior, while transactional leadership style had a significant positive relationship with employees' task performance. However, laissez-faire leadership style had a significant negative relationship with task performance. Work engagement had significant positive relationships with the indicators of work outcomes. Besides, work engagement partially mediated the relationship between leadership styles and work outcomes. The observed associations and mediation were consistent across the two national samples considered, indicating the soundness of the assumptions across countries. The findings provide insights into how leadership styles correspond with employees' work outcomes.