Since the publication of "Towards a Culturally Competent System of Care" (1989), dozens of books and training materials on cultural competence and its sister field in the private sector, managing diversity, have been published. Yet, despite the consistent call for commitment to a long-term developmental process, organizations too often maintain the simplistic view, if they express any at all, that recruitment of bilingual and bicultural service providers and training in culturally related topics alone will lead to a culturally competent organization.
Consider the following story: A patient in a teaching hospital is about to be examined by a resident physician. When asked by the patient to wash his hands, the resident refuses, saying he has done so recently. The staff physician then enters the room and the patient speaks of his disappointment regarding the actions of the resident. The staff physician is displeased and states that the patient should not be mistrusting his physicians. Later, when booking his follow-up appointment, the patient asks not to be seen by the resident. The staff physician overhears and, in front of other patients, angrily tells the patient not to return to his clinic because of his disruptive behaviour.
The application of knowledge on organization and leadership is important for the promotion of health at workplace. The purpose of this article is to analyse the leadership and organization, including the organizational culture, of a Swedish industrial company in relation to the health of the employees. The leadership in this company has been oriented towards developing and actively promoting a culture and a structure of organization where the employees have a high degree of control over their work situation. According to the employees, this means extensive possibilities for personal development and responsibility, as well as good companionship, which makes them feel well at work. This is also supported by the low sickness rate of the company. The results indicate that the leadership and organization of this company may have been conducive to the health of the employees interviewed. However, the culture of personal responsibility and the structure of self-managed teams seemed to suit only those who were able to manage the demands of the company and adapt to that kind of organization. Therefore, the findings indicate that the specific context of the technology, the environment and the professional level of the employees need to be taken into consideration when analysing the relation between leadership, organization and health at work.
There is a need for more knowledge on how to manage companies towards healthier and more prosperous organizations with low levels of absenteeism. Relational Justice can be a useful concept when managing such organizations.
Organizational factors can help to explain why some companies have relatively low absenteeism rates, even though they are equal to other companies in many other aspects. Previous studies suggest that management may be one important factor. Efficient management may depend on good relations between the leaders and the employees. The concept of Relational Justice is designed to capture these relations. Consequently, a Relational Justice framework may be used to understand why some companies have a low incidence of absenteeism.
Managers from a representative body of Swedish companies.
Interviews were analyzed to explore whether the items representing the concept of Relational Justice can be used to further understand the strategies, procedures and structures that characterize organizations and management in companies with a low incidence of absenteeism.
Strategies, procedures or principles related to Relational Justice were common and highlighted in companies with an incidence of absenteeism. The most frequently occurring factors were; to be treated with kindness and consideration, personal viewpoint considered and to be treated impartially.
The results suggested that a Relational Justice framework could be used to increase understanding of the organizational and managerial factors typical for companies with a low incidence of absenteeism. A Relational Justice approach to organizational management may be used to successfully lower absenteeism, change organizations and promote healthy and prosperous companies.
Safety culture has been shown to affect patient safety in healthcare. While the United States and United Kingdom have studied the dimensions that reflect patient safety culture in family practice settings, to date, this has not been done in Canada. Differences in the healthcare systems between these countries and Canada may affect the dimensions found to be relevant here. Thus, it is important to identify and compare the dimensions from the United States and the United Kingdom in a Canadian context. The objectives of this study were to explore the dimensions of patient safety culture that relate to family practice in Canada and to determine if differences and similarities exist between dimensions found in Canada and those found in previous studies undertaken in the United States and the United Kingdom. A qualitative study was undertaken applying thematic analysis using focus groups with family practice offices and supplementary key stakeholders. Analysis of the data indicated that most of the dimensions from the United States and United Kingdom are appropriate in our Canadian context. Exceptions included owner/managing partner/leadership support for patient safety, job satisfaction and overall perceptions of patient safety and quality. Two unique dimensions were identified in the Canadian context: disclosure and accepting responsibility for errors. Based on this early work, it is important to consider differences in care settings when understanding dimensions of patient safety culture. We suggest that additional research in family practice settings is critical to further understand the influence of context on patient safety culture.
Workplace violence is a global phenomenon with recent research demonstrating that the incidence of violence is high and increasing, particularly in health-care settings. The current study reported the prevalence of workplace violence in nursing and examined the impact of it on nurses' work life and health based on a national Canadian survey. Results demonstrated that workplace violence significantly increases the likelihood of nurses' absenteeism, job dissatisfaction and poor physical and mental health, and can negatively impact quality of nursing care. Various workplace violence interventions and the need for further research in addressing the issue of violence are discussed.
The World Health Organization is the leading international agency in health. WHO's reputation reached a peak in the 1970s with the then director-general Halfdan Mahler's advocacy of Health for All by the Year 2000 and the successful worldwide eradication of smallpox. The 1980s and 1990s saw WHO lose much of its authority. Too easily, the blame was put on one man-Mahler's successor, Hiroshi Nakajima. In 1998, Gro Harlem Brundtland, Figure 1 a former Prime Minister of Norway, took office and WHO began a period of major strategic and structural reform. Almost 4 years into her first term as director-general, I visited WHO's headquarters in Geneva to learn about Dr Brundtland's successes and failures. Figure 2 The ground rules of my visit were that I could talk with anybody and attend almost any meeting (budget discussions were excluded). I interviewed Dr Brundtland, executive directors, members of the staff association, and directors and project managers of programmes such as StopTB, Roll Back Malaria, HIV-AIDS, violence prevention, polio eradication, essential drugs and medicines, and sustainable development. At senior levels, WHO is confident and clear about its purpose-in a way that matches Mahler's vision and goes beyond it in results. Brundtland told me that her most important achievements were to have "strengthened the credibility of WHO" and to have "raised the awareness of health on to the political and global development agendas". But there is a troubling schism between the aspirations of its leadership and the realities faced by the organisation on the ground. Rapid change during the past 4 years has reinvigorated WHO's mandate, but poor management has created new tensions that the organisation's leadership seems unwilling to address.
Creating a culture of safety in healthcare systems is a goal of leaders in the patient safety movement. Commitment of leadership to safety in the Saskatchewan Institute of Applied Science and Technology (SIAST) Nursing Division has resulted in the development of the Patient Safety Project Team (PSPT) and a steady shift in the culture of the organization toward a systems approach to patient safety. Graduates prepared with the competencies necessary to be diligent about their practice and skilled in determining the root causes of system error in healthcare will become leaders in shifting the healthcare culture to strengthen patient safety. The PSPT believes this cultural shift begins with the education system. It involves modifications to curricula content, facilitation of multidisciplinary processes, and inclusion of theory and practice that reflect critical inquiry into healthcare and nursing education systems to ensure patient safety. In this paper the practical approaches and initiatives of the PSPT are reviewed. The integration of Patient Safety Core Curriculum modules for competency development is described. The policy for reporting adverse events and near misses is outlined. In addition, the student-focused reporting tool, the results and the implications for teaching in the clinical setting are discussed. Processes used to engage faculty are also addressed.