Front-line Personnel Research Articles

GRP-131 Patient Safety – Analysing Medication-Related Adverse Events

BackgroundMedication-related adverse events (AEs) lead to increased morbidity, mortality and costs. In Denmark, frontline personnel in hospitals and in the primary care sector are obligated to report adverse events to...

Thinking Ethically About Medical Mistakes

Medical mistakes, especially ones with significant adverse events, can erode the trust and bonds between and among parents, patients, and health care professionals. Prevention of medical mistakes should be the goal of every health care organization, and participation in quality improvement processes aimed at patient safety is an ethical duty for all health care professionals. But when mistakes occur, health care organizations and professionals should rapidly move toward disclosure and apology. These duties of honesty, disclosure and apology are based ethically on core health care principles and values. Health care organizations should require disclosure-and-apology training, especially for front-line personnel; provide assistance to clinicians with these difficult conversations; and invest in resources to address the moral distress experienced by professionals, who are often the "second victims" of medical mistakes.

Factors Impeding Flexible Inpatient Unit Design

To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units. A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility. An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010. The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial. Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

Examining the influence of modularity and knowledge management (KM) on dynamic capabilities: Insights from a call center

Modularity in organizations can facilitate the creation and development of dynamic capabilities. Paradoxically, however, modular management can also stifle the strategic potential of such capabilities by conflicting with the horizontal integration of units. We address these issues through an examination of how modular management of information technology (IT), project teams and front-line personnel in concert with knowledge management (KM) interventions influence the creation and development of dynamic capabilities at a large Asia-based call center. Our findings suggest that a full capitalization of the efficiencies created by modularity may be closely linked to the strategic sense making abilities of senior managers to assess the long-term business value of the dominant designs available in the market. Drawing on our analysis we build a modular management-KM-dynamic capabilities model, which highlights the evolution of three different levels of dynamic capabilities and also suggests an inherent complementarity between modular and integrated approaches.

Working with South Asian male perpetrators of intimate partner violence in British Columbia, Canada

This article outlines effective intervention strategies for probation officers working with South Asian men in British Columbia, Canada, who have assaulted their partners. It is part of a larger qualitative research study aimed at determining effective intervention strategies for frontline personnel that work with South Asian men, as well as determining effective prevention strategies aimed at policy makers and members of South Asian communities. Seventeen in-depth interviews were conducted with South Asian frontline workers that included police officers, probation officers, counsellors, child protection workers and victim service workers. The audio-taped data was transcribed and analysed by identification of themes and subthemes. Probation officers need to respect their clients’ cultural values while still holding these men accountable for their behaviour. Interventions that address patriarchal attitudes, the stressors arising out of immigration/acculturation, influence of extended family, and substance abuse were identified as being key factors in changing behaviour.

Surveying Employee Attitudes on Corporate Social Responsibility at the Frontline Level of an Energy Transportation Company

AbstractAs large companies embrace and integrate the principles of corporate social responsibility (CSR) into their business practices, company personnel are expected to show actions that are connected to communicated corporate values and related policies. To enhance the likelihood that employees at the frontline level will accept these principles and become engaged with these values, it is in the firm's best interests to quantify and understand employee attitudes toward the social responsibility construct itself.The present work considers whether the variables of work climate perception, education level, and age directly influence one's social responsibility perspective at work, extending the Marz model to understand what may impact frontline CSR attitudes. A case study is presented, based on a survey of frontline personnel employed by a North American energy transportation company. This investigation uses an updated survey tool and method for polling a sample population. Survey development is described, analysis methods are explained, and results are presented with statistical measures to verify hypotheses related to employee engagement in CSR. Some potential implications of the results for corporate strategy are discussed. Copyright © 2012 John Wiley & Sons, Ltd and ERP Environment.

A Roundtable Discussion: Toward a Cleaner Future

<i>A Roundtable Discussion:</i> Toward a Cleaner Future

Healthcare Personnel Perceptions of Hand Hygiene Monitoring Technology

To assess healthcare personnel (HCP) perceptions regarding implementation of sensor-based electronic systems for automated hand hygiene adherence monitoring. Using a mixed-methods approach, structured focus groups were designed to elicit quantitative and qualitative responses on familiarity, comfort level, and perceived impact of sensor-based hand hygiene adherence monitoring. A university hospital, a Veterans Affairs hospital, and a community hospital in the Midwest. Focus groups were homogenous by HCP type, with separate groups held for leadership, midlevel management, and frontline personnel at each hospital. Overall, 89 HCP participated in 10 focus groups. Levels of familiarity and comfort with electronic oversight technology varied by HCP type; when compared with frontline HCP, those in leadership positions were significantly more familiar with ([Formula: see text]) and more comfortable with ([Formula: see text]) the technology. The most common concerns cited by participants across groups included lack of accuracy in the data produced, such as the inability of the technology to assess the situational context of hand hygiene opportunities, and the potential punitive use of data produced. Across groups, HCP had decreased tolerance for electronic collection of spatial-temporal data, describing such oversight as Big Brother. While substantial concerns were expressed by all types of HCP, participants' recommendations for effective implementation of electronic oversight technologies for hand hygiene monitoring included addressing accuracy issues before implementation and transparent communication with frontline HCP about the intended use of the data.

(P1-106) Scarce Resources Planning Summit for Pediatric Critical Care and Transport Stakeholders

There are six children's hospitals in Chicago, Illinois and the surrounding region. These hospitals often have bed limitations due to high censuses in daily operations. The Pediatric Committee of the Chicago Healthcare System Coalition for Preparedness and Response had provided two conferences in pediatric emergency preparedness in Spring 2010 that identified a need to examine scarce critical care resources in the region. A “Pediatric Critical Care and Transport Stakeholder's Summit” was convened in April 2010. This meeting brought together the Pediatric Critical Care Medical and Nursing Directors along with Transport Team representatives from major hospitals to identify the key issues related to pediatric emergency preparedness and scarce resources. The four-hour Summit, was held in a Conference Center, away from any hospital or clinical setting, was organized into seven sections: (1) Welcome &amp; Introductions; (2) Issues Identification; (3) Scenario Introduction; (4) Specific Issues Indentification; (5) Prioritization of Specific Issues; (6) Development of Action Steps; and (7) Moving Forward. A Facilitator with specific knowledge of hospital-based preparedness led the Summit process. He utilized a pediatric scenario to engage the participants in discussion, interaction, and planning. Action steps, with statements of need and specific action items were developed, based on the following prioritized issues: (1) lack of pediatric training and experience for front line personnel; (2) alternate care sites/bed capacity/surge planning; (3) ethical issues; (4) transport; (5) credentialing/pediatric specialist availability; (6) incident command/community integration; (7) pediatric supplies and equipment; (8) patient indentification; (9) financial tracking/reimbursement; and (10) Crisis Standards of Care/Crisis Operation Standards Moving forward, the participants of the Summit will reconvene into small workgroups to develop plans and training for the areas specified above. In May, 2011 a statewide exercise utilizing the special population of children will occur to test these plans.

Complaining in Cyberspace: The Motives and Forms of Hotel Guests' Complaints Online

Traditionally, consumers who have been dissatisfied with service have typically complained to the frontline personnel or to a manager in either a direct (face-to-face, over the phone) manner, indirect by writing, or done nothing but told friends and family of the incident. More recently, the Internet has provided various “new” ways to air a grievance, especially when little might have been done at the point of service failure. With the opportunity to now spread word-of-mouth globally, consumers have the potential to impact the standing of a brand or a firm's reputation. The hotel industry is particularly vulnerable, as an increasing number of bookings are undertaken via the Internet and the decision process is likely to be influenced by what other previous guests might post on many booking-linked sites. We conducted a qualitative study of a key travel site to ascertain the forms and motives of complaints made online about hotels and resorts. 200 web-based consumer complaints were analyzed using NVivo 8 software. Findings revealed that consumers report a wide range of service failures on the Internet. They tell a highly descriptive, persuasive, and credible story, often motivated by altruism or, at the other end of the continuum, by revenge. These stories have the power to influence potential guests to book or not book accommodation at the affected properties. Implications for managers of hotels and resorts are discussed.

Care or Cry: Three years from Cyclone Gonu.What have we learnt?

This article examines and evaluates the history of natural disasters in Oman and presents the health care response to cyclone Gonu, and highlights the health care lessons learnt from the Cyclone as narrated by frontline personnel and it puts forward some practical recommendations for health care policy makers in order to strengthen the health care disaster preparations to combat future natural and man-made disasters. The lessons presented in this article are based on the reflections of frontline health care personnel who witnessed Cyclone Gonu. The reflections of experience collected as a part of a qualitative 17 semi-structured interviews conducted in Oman between December 2009 and January 2010. The study found that the lessons from passes events went by un-noticed and exposed some serious fragmentation in the coordination of different governmental sectors involved in emergency management and that there was no well-planned mechanism of alert and warning dissemination to people and communities. Overall, the major lessons that learnt from Cyclone Gonu would have been very useful if they had been taken into consideration and implemented during the health care response to cyclone Phet.

Ambulance provision for children: a UK national survey

BackgroundThe purpose of this national survey of UK ambulance services was to provide an up-to-date assessment of service provision for children in the prehospital setting and to identify the challenges...

Secondary Case Review Methods and Anatomic Pathology Culture

In this issue of the Journal , Owens and colleagues1 at the University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, describe the development of a patient safety information technology (IT) tool. Because this tool only recently has been implemented, Owens et al1 chose not to evaluate the effectiveness of the tool as a patient safety improvement initiative and preferred to evaluate the tool on its effect on timeliness, another Institute of Medicine (IOM) quality metric.2 The work of Owens et al1 highlights the relationship of patient safety to other quality domains, error detection, and quality improvement in surgical pathology. The IOM defined 6 domains of quality: safety, effectiveness, efficiency, timeliness, equity, and patient centeredness.2 During the past several decades, most of the published work in the anatomic pathology medical literature has focused on the domains of safety and timeliness. The 6 quality domains are not independent, as illustrated by the data reported by Owens et al.1 For many surgical pathologists, the mantra has become “get it right and get it (out) fast,” and efforts to change a specific practice domain (eg, safety) may lead to unforeseen changes in other domains (eg, timeliness). The fact that Owens et al1 measured turnaround time indicated that they were concerned that possible delays in case sign-out may have occurred because of newly introduced processes. Owens et al1 reported a slight increase in median case turnaround time following implementation of their patient safety IT tool. Outlier analysis was not performed, which possibly is a more important measure. Barriers to improve a specific quality metric are many and include the lack of organizational commitment or focus and investment in competing quality metrics. Organizational culture strongly affects the ability of front-line personnel to improve health care delivery, especially safe …

‘We will remember Steven’: Cornwall after The Murder of Steven Hoskin: A serious case review

This paper reviews the progress that Cornwall County has made since the murder of Steven Hoskin and the resulting Serious Case Review (Flynn, 2007). Interviews were held with senior and frontline personnel, whose agencies were in contact with Steven and the people who moved into his bedsit. The agencies have progressed significantly, in terms of attitude and reforming the way in which they work. The outcomes and processes that have resulted from the action plans that were drawn up have been welcomed, although there are still challenges to overcome.

Comparing safety climate in naval aviation and hospitals

Evidence of variation in safety climate suggests the need for improvement among at least some hospitals. However, comparisons only among hospitals may underestimate the improvement required. Comparison of hospitals with analogous industries may provide a broader perspective on the safety status of our nation's hospitals. The purpose of this study was to compare safety climate among hospital workers with personnel from naval aviation, an organization that operates with high reliability despite intrinsically hazardous conditions. We surveyed a random sample of health care workers in 67 U.S. hospitals and, for generalizability, 30 veterans affairs hospitals using questions comparable with those posed at approximately the same time (2007) to a census of personnel from 35 squadrons of U.S. naval aviators. We received 13,841 (41%) completed surveys in U.S. hospitals, 5,511 (50%) in veterans affairs hospitals, and 14,854 (82%) among naval aviators. We examined differences in respondents' perceptions of safety climate at their institution overall and for 16 individual items. Safety climate was three times better on average among naval aviators than among hospital personnel. Naval aviators perceived a safer climate (up to seven times safer) than hospital personnel with respect to each of the 16 survey items. Compared with hospital managers, naval commanders perceived climate more like frontline personnel did. When contrasting naval aviators with hospital personnel working in comparably hazardous areas, safety climate discrepancies increased rather than decreased. One individual hospital performed as well as naval aviation on average, and at least one hospital outperformed the Navy benchmark for all but three individual survey items. Results suggest that hospitals have not sufficiently created a uniform priority of safety. However, if each hospital performed as well as the top-performing hospital in each area measured, hospitals could achieve safety climate levels comparable with naval aviation. Major interventions to bolster hospital safety climate continue to be required to improve patient safety.

Ambulance provision for children: a UK national survey

<h3>Aims</h3> The purpose of this national survey of UK ambulance services was to provide an up-to-date assessment of service provision for children in the prehospital setting. The survey also sought to identify challenges faced by services in providing optimal services to this group. The findings help inform future service provision and set the context for further audit, research and confidential enquiry. <h3>Method</h3> A questionnaire was sent to Clinical Directors of the 16 UK NHS ambulance services in April 2009. Non-responders were followed up three times after the initial deadline. <h3>Results</h3> Questionnaires were returned by 13 (81%) respondents. Paramedics and most emergency medical technicians receive a limited amount of paediatric training. Only a minority undertake certified courses (eg, PHPLS, PEPP). An increasing amount of equipment suitable for children is becoming available and paramedics are permitted to use more skills than in the past. However, services for children vary depending on location. Some children9s needs are not met due to insufficient equipment or inadequate skills. For example, paediatric airway adjuncts (short of intubation) were often lacking and only 62% reported having pulse oximetry suitable for use in children. A third of services (4/13) considered it “possible or highly likely” that someone with no specific training could be the first to respond to a child in an emergency, and over half (7/13) indicated that the likelihood that the first response to a child could be someone with no current recognised certified qualification specific to paediatrics was “high”. There are also large areas of the country where no additional medical support is available at any time of day. <h3>Conclusions</h3> The prehospital phase of a child9s care pathway is part of a continuum and cannot be viewed in isolation. Despite improvements, paediatric care by frontline personnel is limited by resources and skill availability and, when assessed by comparison by national guidelines (eg, JRCALC), accepted standards are often lacking. Audit, research and training initiatives should be carried out collaboratively between ambulance services and acute trusts to guide training, local service requirements and resource allocation. This will reduce variation and maintain the safety of patients and quality of care.

THE EMPOWERMENT OF FRONTLINE SERVICE STAFF IN 3PL COMPANIES

Research on third‐party logistics (3PL) service providers has focused more on managing customer relationships than on managing the frontline personnel who interact with customers on a daily basis. Thus, even though the overall need for 3PL's to be market‐oriented is well‐recognized, relatively little is known about how 3PL companies support and develop frontline service staff to provide better service. This study draws on 3PL company site managers' responses to a postal survey that examines the influences of internal communication, customer service training and managerial coaching for customer contact employees on the relationship between market orientation and frontline service recovery empowerment.

In for the Long Haul: Knowledge Translation Between Academic and Nonprofit Organizations

Although scientists are continually refining existing knowledge and producing new evidence to improve health care and health care delivery, far too little scientific output finds its way into the tool kits of practitioners. Likewise, the questions that clinicians would like to be answered all too rarely get taken up by researchers. In this article we focus on knowledge translation challenges accompanying a longitudinal research program with nonprofit organizations providing direct and indirect health and social services to disadvantaged groups in one region of Canada. Three essential factors influencing authentic and reciprocal knowledge transfer and utilization between nonprofit service providers and researchers are discussed: strong institutional partnerships, the use of skilled knowledge brokers, and the meaningful involvement of frontline personnel.

Content and Adequacy of Specialized Police Training to Handle Youth-Related Incidents

Examinations of specialized police training to handle youth-related incidents are typically approached with researcher-defined concepts rather than key concepts derived from the perceptions of police officers. In response to disagreements in the literature on the usefulness and applicability of training for specific law enforcement functions, this research builds on previous literature by investigating the content and perceived adequacy of specialized training received based on their duty assignment. A grounded theory analysis of 59 interviews conducted in 2002, with 67 Canadian police officers who received training from one of the two training facilities (Justice Institute of British Columbia and the Royal Canadian Mounted Police [RCMP] Depot) finds similarities and differences in the perceptions of training content and adequacy for training, supervisory, and frontline personnel. The differences are most pronounced between the trainers and practitioners than they are between supervisors and frontline officers. Definitions of training adequacy are considerably conditioned by the informal socialization process in the police culture. The data suggest that the academy focus on training generalists has the effect of increasing the impact and importance of informal socialization by field training officers on officer perceptions and procedures for handling youth-related incidents.

Exploratory assessment of the Macao casino dealers’ job perceptions

Quality is the cornerstone of success in any business and is perceived to be a key factor in acquiring and sustaining competitive advantage. Good service quality can be enhanced by managing the performance of employees, especially front-line personnel, by first understanding their attitudes and job perceptions. The exploratory study reported herein investigates the job perceptions of casino dealers in Macao via in-depth face-to-face interviews with 51 such dealers. The perceived barriers prohibiting them from delivering quality service are identified, and they include the lack of a fair and transparent reward and promotion system, serious communication difficulties and conflicts due to cultural differences, the language barriers amongst local dealers and foreign supervisors, feelings of job insecurity attributed to the economic downturn and the influx of imported labour, and poor internal communication. The implications for the development of quality casino services are also discussed in this paper.