Patient-centred quality improvement audit.

PURPOSE: This article aims to describe the research process, and the development of the instrument now employed in auditing patients' perceptions of quality improvement in a community health care trust in a coastal town in Essex, England. DESIGN/METHODOLOGY/APPROACH: The new instrument is currently being implemented and the findings thus far are described. FINDINGS: The instrument has measured health outcomes in terms of quality improvement from the users' perspective, and has also highlighted gaps between what the service offers in terms of quality and users' perceptions of what is delivered. The study demonstrates the importance of the professional role in quality improvement. ORIGINALITY/VALUE: Patient-centred quality improvement audit should be undertaken regularly so that both non-clinical managers and health care professionals can establish whether or not they are providing services that are patient-friendly and effective from the user's viewpoint. In the course of their work, professionals and managers discuss patients and speak on their behalf in various forums, and knowing what patients actually expect and perceive before speaking on their behalf may be of great benefit in such instances.

Perceptions of work-time and leisure-time among managers and field staff in a UK primary health care trust.

AIMS: The aims of the research were to explore the issues around the perception of District Nurses in an inner London Primary Health Care Trust of their use of work-time and leisure-time, and to reveal how the boundaries between these two aspects can become blurred and impinge on each other. BACKGROUND: Time use is helpful in considerations of wider issues such as satisfaction at work and work-life balance. METHODS: The data were collected by a questionnaire to seek the views of managers and field staff on issues such as the impact on the quality of patient care of the nurses' perception of work-time and leisure-time. RESULTS: The research identified the different perception of "work-time" that employees have in relation to their place within the hierarchical structure. CONCLUSIONS: The findings answered the question of whether time is perceived differently, dependent on one's occupation within the Trust.

Emotion at work: identifying the emotional climate of night nursing.

This paper introduces the concept of the emotional climate of the workplace and explores how it both shapes and is shaped by the emotions experienced, expressed and redefined by nurses. It extracts emotional aspects of an organizational climate framework developed by Litwin and Stringer and examines these with respect to nurse's experiences. The primary research was carried out at a general hospital NHS Trust in the East Midlands of the UK using a grounded theory methodology. The research methods included semi-structured interviews and observation. The themes identified include many of those found by Litwin and Stringer, others which represent variations upon these, and a new set, which, when combined, identify the emotional climate of the organization. The findings have confirmed that the "experiment" of using a 33-year-old positivistic framework to investigate aspects of qualitative research has enabled a robust contribution to the conceptual area of emotional climate.

The temporal landscape of night nursing.

AIMS OF THE STUDY: The study arose secondarily from a study with a different primary purpose (to consider attitudes towards the implementation of changes to working practices). Its aim is to provide a 'map' of the temporal landscapes of night nurses. BACKGROUND: Our temporal landscapes are made up of recognizable domains, with permeable borders - private time and public time, home time and work time, past, present and future time, cyclical time. Just as a geography of space contains recognizable natural features - rivers, deserts, mountains - and features created by human beings - canals, roads, skyscrapers - so our temporal landscape contains natural features - day and night, the seasons - and features created by us - the ordering of social, economic, legal, and organizational time into, among others, the practices of family life, financial periods, and workloads. METHODS: Data were collected during longitudinal ethnographic research - observation, formal interviews, informal conversations - with the emphasis on areas such as shift work, workload, and the temporal aspects of caring. CONCLUSIONS: The result is the production of a map, albeit a rough one, of the temporal landscape inhabited by night nurses as they go about their working lives.

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service.

The role of ritualistic ceremonial in removing barriers between subcultures in the National Health Service Background. One of the ways in which it is possible to achieve successful organizational change is through the elimination of those ceremonies that reinforce or preserve the negative aspects of professional and work group autonomy, thus maintaining the barriers between subcultures. Conversely, the encouraging of ceremonies which reinforce positive aspects is likely to achieve more flexible, team-orientated changes. Aim. The paper considers those ceremonies, which perpetuate barriers in a National Health Service (NHS) Trust, and explores new ceremonies which may question, weaken or eliminate current dysfunctional practices. Design. Our research approach was mainly phenomenological, as we wished to elicit the symbolic significance of organizational routines. The primary source of data was spoken language. The findings are based on purposive sampling of informants by means of semi-structured interview and observation. Other types of information were also collected, including business plans, reports and brochures. Informants included the Chief Executive and four Board members, three consultants, the director of nursing and midwifery, 10 middle managers and eight junior, nonmedical and nonmanagerial employees. Findings. Two broad bands of ceremonies have been identified - those which preserve the existing norms and autonomy of professional and worker groups, which we have named Ceremonies of Preservation, and those which encourage change, which we have called Ceremonies of Change. Considerable data are provided to help to 'tell the story'. Conclusion. The paper argues that attention to ceremonial in the wider change process may facilitate the desired, specific change or changes in practice. It suggests that changes which confront unnecessary demarcation, but which do not undermine professional integrity, can create real benefits for NHS hospitals.