To describe mid-level nurse managers' experiences of sensegiving in the context of hospital projects.
Sensegiving is about shaping and affecting how employees see themselves, their work and issues related to their work. It has been little studied in the context of hospital projects from mid-level nurse managers' point of view.
Mid-level nurse managers (n = 10) were interviewed about their experiences of projects from the viewpoint of sensegiving during change processes. Data was analysed using discourse analysis.
Three repertoires were constructed from the data: the repertoires of regeneration, control and humane.
Projects were considered as appropriate ways for sensegiving in hospitals from the viewpoint of mid-level nurse managers. In order to use projects effectively in hospitals as means for change management mid-level nurse managers ought to enhance their role as interpreters during the change process (i.e. strengthen their visioning, talk and dialogue skills).
Training on the nature of change as a social and interactive process could deepen mid-level nurse managers' understanding of the change process in the context of hospital projects.
Swedish health care is regulated to involve the patient in every intervention process. In the area of post-operative pain, it is therefore important to evaluate patient experience of the quality of pain management. Previous research has focused on mapping this area but not on comparing experiences between acutely and electively admitted patients. Hence, the aim of this study was to investigate the experiences of post-operative pain management quality among acutely and electively admitted patients at a Swedish surgical department performing soft-tissue surgery.
A survey study design was used as a method based on a multidimensional instrument to assess post-operative pain management: Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP). Consecutive patients at all wards of a university hospital's surgical department were included. Data collection was performed at hospital discharge.
In total, 160 patients participated, of whom 40 patients were acutely admitted. A significant difference between acutely and electively admitted patients was observed in the SCQIPP area of environment, whereas acute patients rated the post-operative pain management quality lower compared with those who were electively admitted.
There may be a need for improvement in the areas of post-operative pain management in Sweden, both specifically and generally. There may also be a difference in the experience of post-operative pain quality between acutely and electively admitted patients in this study, specifically in the area of environment. In addition, low levels of the perceived quality of post-operative pain management among the patients were consistent, but satisfaction with analgesic treatment was rated as good.
The aims of this investigation were to describe the development of a structured decision support information method at a major Danish university hospital and to present the results of a quantitative organisational evaluation of this method for integrated decision making at many levels of the management hierarchy.
The results of more than five years' development of the decision support method are described. Quantitative analyses of attitudes to the method included a survey of satisfaction with the method in general along with specific questions concerning its perceived effect on administrative and organisational success parameters.
The majority of respondents were of the opinion that the decision support method had had a positive influence on administrative parameters, such as control of expenses, administrative transparency, quality of decision-making processes and rational prioritization.
The decision support method has had a beneficial influence on mutual communication and understanding among administrative leaders, economists, doctors and politicians. This is particularly remarkable considering that earlier qualitative evaluations of the hospital investigated concluded that such communication and understanding were not optimal.
This paper aims to describe and analyze the prolonged efforts - spanning close to two decades - of developing and using electronic patient records in the large, university-based hospitals in Norway.
This study belongs to an interpretative approach to the development and use of information systems.
The increase in organizational, institutional, political and technological complexity has been seriously underestimated. This paper describes and analyses the prolonged efforts - spanning close to two decades - of developing and using EPRs in the large, university-based hospitals in Norway. The investments involved were considerable, implying that a crucial aspect of these efforts has been the way alliances have been forged with public institutions and agendas.
The conditions for small-scale, bottom-up and evolutionary approaches never succeeded in constructing themselves as a viable alternative to the larger, more sweeping electronic patient record initiative, reiterating a more general tendency to privilege the more comprehensive and daring projects.
The traditional order and delivery activities have been characterized by manual routines and a paper-based workflow management. Problems such as the time consuming processes in which a laboratory service order is created or that of getting the laboratory service report with results from the requested investigations from the laboratories and the entry of the same information by different persons at different points in the workflow with the possibilities of transfer errors are well known. The development of modern information technology, along with the developing of standards for communication protocols and the message structure for the electronic interchange of information (EDI) gives us the tools to change the way we work and manage workflow. An important input to the business process reengineering process is a thorough knowledge of the context within which the order-/delivery activities exist. One has to take into account that the activities are: 1) heavily integrated in the whole treatment and care process, 2) together with routines and the taking of samples and related requests many times are a part of the daily work of a ward, and 3) many decisions about the treatment of a patient are based on the results in the laboratory service report from the laboratories.
The aim of this study was to determine clinical nurses' interest in and motivation for research. An additional aim was to identify management and organisational resources in order to improve nurses' research capacity in practice.
Clinical nurses find conducting research challenging, which accords with observations of the continuing research-practice gap.
This descriptive cross-sectional survey sampled 364 clinical nurses from a university hospital on the west coast of Norway.
The response rate was 61%. An increasingly positive attitude towards research emerged (40%), despite the fact that few were engaged in research-based activities. Clinical nurses emphasised that lack of designated time (60%), interest (31%) and knowledge (31%) constituted important research barriers, as did lack of research supervision and support (25%). Research supervision was one of the most significant needs to enhance clinical nurses' research skills, management and organisation of research activities (30%).
Conscious efforts strategically built on clinical and academic collaborative networks are required to promote and sustain clinical nurses' research capacity.
The findings of this survey should be useful in the building of clinical nurses' research capacity.
To compare hospital pharmacy practice in France and Canada by identifying similarities and differences in the two institution's pharmacy activities, resources, drug dispensing processes and responsibilities.
Centre hospitalier universitaire Sainte-Justine (SJ), Montréal, Québec, Canada and Hôpital Robert Debré (RD), Paris, France, are two maternal-child teaching hospitals. They share a similar mission focused on patient care, teaching and research.
The data were gathered from annual reports, department strategic plans and by direct observation.
The description and comparison of the legal environment, hospital demographics, pharmacy department data, drug dispensing processes and pharmacist activities in the two institutions.
The Centre hospitalier universitaire Sainte-Justine and Hôpital Robert Debré are similar with respect to their mission and general demographics; number of beds, annual hospital expenditures, number of admissions, visits and childbirths. The respective pharmacy departments differ in allocated resources. The main operational differences concern compounding, quality control programs and clinical activities. The French department also manages medical devices, medical gases, blood derivatives and the sterilisation unit. These comparisons highlight the more patient-oriented Canadian hospital pharmacy practice against the more product-oriented French hospital practice Factors contributing to these differences include academic curriculum, the attention paid to the legal environment by professional bodies, staffing patterns and culture.
There are differences between the hospital pharmacy practice in the studied hospitals in Canada and France. Hospital pharmacy practice in France seems to be more product oriented, and the practice in Canada seems more patient oriented.
To examine the relationship of a comprehensive health care orientation process with a hospital's attractiveness.
Little is known about indicators of the employee orientation process that most likely explain a hospital organisation's attractiveness.
Empirical data collected from registered nurses (nÂ =Â 145) and physicians (nÂ =Â 37) working in two specialised hospital districts. A Naive Bayes Classification was applied to examine the comprehensive orientation process indicators that predict hospital's attractiveness.
The model was composed of five orientation process indicators: the contribution of the orientation process to nurses' and physicians' intention to stay; the defined responsibilities of the orientation process; interaction between newcomer and colleagues; responsibilities that are adapted for tasks; and newcomers' baseline knowledge assessment that should be done before the orientation phase.
The Naive Bayes Classification was used to explore employee orientation process and related indicators. The model constructed provides insight that can be used in designing and implementing the orientation process to promote the hospital organisation's attractiveness.
Managers should focus on developing fluently organised orientation practices based on the indicators that predict the hospital's attractiveness. For the purpose of personalised orientation, employees' baseline knowledge and competence level should be assessed before the orientation phase.
The purpose of this paper is to describe and explain a clinician-led improvement of a hip fracture care process in a university hospital, and to assess the results and factors helping and hindering change implementation.
The paper has a mixed methods case study design. Data collection was guided by a framework directing attention to the content and process of the change, its context and outcomes.
Using a multiprofessional project team, beneficial changes in the early parts of the care process were achieved, but inability to change surgical staff work practices meant that the original goal of operating patients within 24 hours was not reached. After three years, top management introduced a hospital-wide process improvement programme, which "took over" the responsibility for improving hip fracture care.
A clear vision why change is needed and what needs to be done, which is well communicated by a respected clinical leader, can motivate personnel, but other influences are also needed to bring about change. Without a plan agreed and supported by top management, changes are likely to be limited to parts of the process and improvements to patient care may be minimal. These and other findings may be applicable to similar situations in other services.
This case study is an illustration of both the strengths and the weaknesses of a "bottom-up, clinician-champion-led improvement initiative" in a complex university hospital.