Front-line Personnel Research Articles

SARS: a quality management test of our public health safety net.

Emergence of severe acute respiratory syndrome in March 2003 tested all aspects of BC Centre for Disease Control (BCCDC) operations. In addition to its public health responsibilities, BCCDC was pivotal in the science defining SARS. These events occurred under international scientific and media scrutiny over a 4-month period and were seen as an opportunity to learn about how the Centre performed under extreme pressure as a QM-based (quality-management-based) organization. A retrospective review of the QM practices over the previous 6-months was initiated on June 30, 2003. Key management documentation during the study period was reviewed. Structured interviews were conducted with front line personnel. Customized instrumentation was developed to correlate management decisions with recognized QM criteria: anticipatory management; keeping programs on track; ongoing adjustment, improvement, and revision; identifying and improving sources of error, waste, and redundancy; feedback from key stakeholders; and data-driven decision-making methods. The team structure between laboratory science and epidemiology was critical. This was attributed to the culture of scientific discovery of the organization. All knowledge gained was shared with other organizations around the world. The consensus is that British Columbia was very lucky this time around. This review is part of BCCDC's commitment to fighting emerging infectious diseases.

Developing and Deploying a Patient Safety Program in a Large Health Care Delivery System: You Can’t Fix What You Don’t Know About

The Veterans Administration (VA) identified patient safety as a high-priority issue in 1997 and implemented the Patient Safety Improvement (PSI) initiative throughout its entire health care system. In spring 1998 the External Panel on Patient Safety System Design recommended alternative methods to enhance reporting and thereby improve patient safety. REDESIGNING THE PSI INITIATIVE: The VA began redesigning the PSI initiative in late 1998. The dedicated National Center for Patient Safety (NCPS) was established. Using the panel's recommendations as a jumping-off point, NCPS began to identify known and suspected obstacles to implementation (such as possible punitive consequences and additional workload). NCPS adopted a prioritization scoring method, the Safety Assessment Code (SAC) Matrix, for close calls and adverse events, which requires assessing the event's actual or potential severity and the probability of occurrence. The SAC Matrix specifies actions that must be taken for given scores. Use of the SAC score permits a consistent handling of reports throughout the VA system and a rational selection of cases to be considered. A system for performing a root cause analysis (RCA) was developed to guide caregivers at the frontline. This system includes a computer-aided tool, a flipbook containing a series of six questions, and reporting of the findings back to the reporter. The final step requires that the facility's chief executive officer "concur" or "nonconcur" on each recommended corrective action. The RCA team outlines how the effectiveness of the corrective action will be evaluated to verify that the action has had the intended effect, and it ascertains that there were no unintended negative consequences. Based on successful implementation in two pilots, full-scale national rollout to the 173 facilities began in April 2000 and was concluded by the end of August 2000. NCPS supplied 3 days of training for individuals at each facility. The training included didactic components, an introduction to human factors engineering concepts, and small- and large-group simulation exercises. Facility leaders were reminded of the necessity to reinforce the point that assignment to an RCA team was considered an important duty. It is essential to design and implement a system that takes into account the concerns of the frontline personnel and is aimed at being a tool for learning and not accountability. The system must have as its primary focus the dissemination of positive actions that reduce or eliminate vulnerabilities that have been identified, not a counting exercise of the number of reports.

Innovative versus incremental new business services: Different keys for achieving success

In companies where new product development plays an important strategic role, managers necessarily contend with a portfolio of projects that range from high technology, new‐to‐the‐world, innovations to relatively simple improvements, adaptations, line extensions, or imitations of competitive offerings. Recent studies indicate that achieving successful outcomes for projects that differ radically in terms of innovativeness requires that firms adjust their NPD practices in line with the type of new product project they are developing. Based on a large‐scale survey of managers knowledgeable about new product development in their firm, this study focuses on new business‐to‐business service projects in an attempt to gain insights about the influence of product innovativeness on the factors that are linked to new service success and failure. The research results indicate that there are a small number of “global” success factors which appear to govern the outcome of new service ventures, regardless of their degree of newness. These include: ensuring an excellent customer/need fit, involving expert front line personnel in creating the new service and in helping customers appreciate its distinctiveness and benefits, and implementing a formal and planned launch program for the new service offering. Several other factors, however, were found to play a more distinctive role in the outcome of new service ventures, depending on how really new or innovative the new service was. For low innovativeness new business services, the results suggest that managers can enhance performance by: leveraging the firm's unique competencies, experiences and reputation through the introduction of new services that have a strong corporate fit; installing a formal “stage‐gate” new service development system, particularly at the front‐end and during the design stage of the development process; and ensuring that efforts to differentiate services from competitive or past offerings do not lead to high cost or unnecessarily complex service offerings. For new‐to‐the‐world business services, the primary distinguishing feature impacting performance is the corporate culture of the firm: one that encourages entrepreneurship and creativity, and that actively involves senior managers in the role of visionary and mentor for new service development. In addition, good market potential and marketing tactics that offset the intangibility of “really new” service concepts appear to have a positive performance effect.

Innovative versus incremental new business services: different keys for achieving success

In companies where new product development plays an important strategic role, managers necessarily contend with a portfolio of projects that range from high technology, new-to-the-world, innovations to relatively simple improvements, adaptations, line extensions, or imitations of competitive offerings. Recent studies indicate that achieving successful outcomes for projects that differ radically in terms of innovativeness requires that firms adjust their NPD practices in line with the type of new product project they are developing. Based on a large-scale survey of managers knowledgeable about new product development in their firm, this study focuses on new business-to-business service projects in an attempt to gain insights about the influence of product innovativeness on the factors that are linked to new service success and failure. The research results indicate that there are a small number of “global” success factors which appear to govern the outcome of new service ventures, regardless of their degree of newness. These include: ensuring an excellent customer/need fit, involving expert front line personnel in creating the new service and in helping customers appreciate its distinctiveness and benefits, and implementing a formal and planned launch program for the new service offering. Several other factors, however, were found to play a more distinctive role in the outcome of new service ventures, depending on how really new or innovative the new service was. For low innovativeness new business services, the results suggest that managers can enhance performance by: leveraging the firm’s unique competencies, experiences and reputation through the introduction of new services that have a strong corporate fit; installing a formal “stage-gate” new service development system, particularly at the front-end and during the design stage of the development process; and ensuring that efforts to differentiate services from competitive or past offerings do not lead to high cost or unnecessarily complex service offerings. For new-to-the-world business services, the primary distinguishing feature impacting performance is the corporate culture of the firm: one that encourages entrepreneurship and creativity, and that actively involves senior managers in the role of visionary and mentor for new service development. In addition, good market potential and marketing tactics that offset the intangibility of “really new” service concepts appear to have a positive performance effect.

The Service Profit Chain: How Leading Companies Link Profit and Growth to Loyalty, Satisfaction and Value

The Service Profit Chain: How Leading Companies Link Profit and Growth to Loyalty, Satisfaction and Value

Differing Perspectives on a Police Force's Equal Opportunities Grievance Procedure: Viewpoints of Police Managers and Front-Line Personnel

Comparable surveys of civilian staff and police personnel were conducted to evaluate the workings of a grievance procedure within a British metropolitan force. Differing assessments were found from the front-line workforce (n = 217), supervisors (n = 289) and complainants (n = 53) in terms of confidence in the process, beliefs about managers' competency in grievance handling and satisfaction with grievance resolution. These differences are discussed in light of the radical and liberal philosophies underlying equal opportunities policies. The percentages of women officers and their occupancy of senior rank are also discussed as outcomes of equality policies. Finally, suggestions are made for an integrated dispute resolution system combining local grievance handling with an overseeing, centralised unit.

Complaints Within Constraints: A Critical Review and Analysis of the Citizen's Charter Complaints Task Force

In June 1993 a Task Force within the Citizen's Charter Unit of the Cabinet Office initiated a review of complaints procedures in public sector organisations. Its work included an appraisal of private sector complaints handling practice to see if there were any lessons that could be usefully applied to the public sector. Its Main Report (1995) contained a number of interesting observations, some of which appear to challenge the logic of the structural reforms to the public sector. Effective complaints mechanisms require that all complaints, including those pertaining to policy, need to be dealt with by those who deliver services. A commitment to implementing the Task Force's recommendations would have resource implications and would involve changes in organisational culture and management style including the empowerment of front-line personnel. In terms of empowering citizens however, the Task Force's impact is likely to be minimal due to the constraints within which delivery agencies operate.

Qualitative Analysis of Emotionally Disturbed Boys in Residential Summer Camp

ABSTRACT Detailed field notes were made on emotionally disturbed boys at a residential summer camp over a period of eight weeks. Analysis suggests that in a crisis situation, inner city boys sought close bonds with front-line staff and tended to open up and reveal personal stories of past abuse. Conversely, suburban children in crisis tended to close down and not reveal any past abuse stories, and to distance themselves. Implications for training front-line personnel in how to listen to personal stories of emotional experience are discussed.

“Motivated by Hatred or Prejudice”: Categorization of Hate-motivated Crimes in Two Police Divisions

Recent legislative responses to a perceived increase in hate crimes have resulted in efforts to quantify the rates of occurrence of such crimes. However, there remains little understanding of the processes by which statutory requirements are implemented at the level of front-line personnel like the police. This article examines the situated decisionmaking practices of police detectives in two divisions of a large urban police department charged with collecting official hate crime data. The authors argue that police detectives engage in certain routine practices in order to determine the hate-related status of an incident and that these practices are inflected by the particular institutional arrangements of the divisions and the department in which they operate. They describe in detail the various categorization practices employed in these two divisions and the ways that a seemingly common orientation to the prevalence of hate crimes have differential consequences for the reporting of hate crimes in each division.

Stress and coping in tourist attraction employees

Front-line employees in tourism attractions are vital elements in the quest for service quality and visitor satisfaction. The tourism attraction work environment presents a variety of demands and pressures which may become sources of stress for personnel. Stress can have negative impacts on both the employee and the organization. It is therefore important to identify and understand the stressors experienced by employees in order to develop appropriate management methods. The study reported in this article investigated the stressors experienced by 102 front-line attraction personnel in 14 Australian tourist settings. The coping strategies used to deal with stressors were also recorded. The results indicate that although certain structural characteristics of the employee's job caused stress, management and management behaviour was the principal source of stress for respondents.

Management is performance: strategies for client-centered practice in social service organizations.

The political nature of human services is a given. The multiple constituency dilemma coupled with the retrenchment of the 1970s and 1980s has led to a great gulf separating managers from clients, and managers from front-line personnel. These political factors have been reinforced by management theory and the blind adoption of "state-of-the-art" management technologies developed in business and the military, and the separation has gained legitimacy. The result is less than optimal service, a dissatisfied workforce, and continued attacks for being inefficient, self-serving, and ineffective. The purpose of this article is to portray an alternative form of human service management. Its vision places clients center stage in our organizations and places the manager as the director and producer. It accepts the premises that "management is the principle engine of progress" (Levitt, 1976) and that management is performance. It then lays a foundation for client-centered management by presenting four principles for social service administrators who desire to adopt this perspective in their daily practice. An elaboration of the skills and methods of client-centered management can be found in a recently published text (Rapp & Poertner, 1991).

The UK Citizen’s Charter: Origins and Implementation in Three Agencies

The article examines the political and managerial origins of John Major’s Citizen’s Charter initiative and assesses its early implementation in three governmental agencies: the Employment Agency; Inland Revenue; and British Rail. Six managerial and implementation issues are explored including: changes in awareness of the exact business an agency is in; early issues in defining service standards; performance pay; recruitment and training; the empowerment of front-line personnel; and the codetermination of services between citizen and public servant. The inherent tensions between improved services and public investment are also reviewed in the context of John Major’s political need to show both continuity with, and departures from, Thatcherism.

Japanese automobile manufacturing in an American setting

The growing force of Japanese manufacturing in the automobile industry is analyzed in its postwar formative stages, its export surges during the oil shortages of the last decade, and the current start-up of assembly plants in the United States. The immigrant plants demonstrate a new successful operating paradigm which revolves around a cooperative compact with labor and continuous innovation in cost and quality control work routines. The U.S. factory floor is being transformed under the Japanese paradigm as work responsibility is invested in front-line personnel recruited from the surrounding American locale.

Optimization of task allocation for community health workers in Haiti

The utilization of front-line health personnel such as community health workers (CHWs) has been, and remains, a critical element in satisfying the basic health care needs of poor and otherwise underserved populations in developing regions. In response to current health conditions in Haiti, CHWs have now focused significant efforts on providing comprehensive preventive health services to children under five years of age, and their mothers. Particular attention is being given to four target problems: nutritional deficiency diseases, short birth intervals, immunization-preventable diseases, and diarrheal diseases. The purpose of this paper is to develop and apply a simple mathematical model of the following operational problem facing health planners in two regions of Haiti (Cité Soleil, formerly Cité Simone, and Mirebalais): determine those best proportions of personnel time and commodity and economic resources devoted to specified CHW tasks/interventions and under fives subgroups that will (1) maximize overall value or health benefit to the community, while ensuring that (2) no resource levels are exceeded, but that (3) all minimum performance levels are met (or exceeded). Extensions of the problem as they might arise in Cité Soleil and Mirebalais are also presented and subsequently incorporated into original model. Guidelines are offered for the quantification, sensitivity analysis, and solution of the model.

The Impact of Internal Marketing on Customer Service in a Retail Bank

Despite technological advances banking still concerns people. Frontline personnel form a critical means of competition in the marketplace and motivating them is a key task. Internal marketing provides the framework for such activities. Data gathered and analysed prior to and after the implementaton of an internal marketing programme confirms that it does impact on the quality of the service provided, recognising the value of communication in informing and motivating staff and creating positive attitudes and a sense of belonging. Apart from size there is little to differentiate banks from one another as all carry a similar range of services and charge similar rates. The bank that shows its superiority in the customer contact area should have a competitive tool and a means of successfully differentiating itself from competitors.

A methodology for design, evaluation, and improvement of village health worker supervision schemes in rural Tanzania

The utilization of village health workers (VHWs) and other front-line health personnel represents an increasingly important form of primary health care delivery in developing regions. In attempting to build and maintain cohorts of effective VHWs, it must be recognized that appropriate worker supervision is an element crucial to success. However, identification of “best” supervision scheme designs remains a difficult and time-consuming task. So too do the tasks of scheme evaluation and correction/improvement. For these reasons, such efforts have been noticeably absent in the development of most VHW programs. The current paper attempts to reduce these difficulties in proposing a methodology that formalizes the process of designing VHW supervision schemes. In so doing, the methodology performs 3 critical and intimately related functions: (1) identification of a “best” or reference VHW supervision scheme; (2) assessment/evaluation of the existing VHW supervision scheme (whatever its form); and (3) appropriate corrections/improvements to the current or revised scheme, moving it closer in design and performance to the reference scheme. The methodology is developed and applied within the context of an on-going project to design effective VHW supervision schemes in rural Tanzania.

Primary prevention: Up the revolution!

In a recent article George Albee stated that the fourth mental health revolution was on the verge of beginning. This revolution would be primary prevention oriented. The present article examines evidence that such a revolution is underway or ready to begin and concludes that the evidence is not strong for such a position. A continuing problem is that the front-line personnel in community mental health centers do not appear to know what primary prevention is, and, even if they do, they are under pressure to provide fee-for-service treatment to individuals. Suggestions are made to remedy this situation.

Developing Cognitive Potential in Vocational High School Students

The present study was designed to ex amine the effectiveness of Feuerstein's Instrumental Enrich ment program in improving the cognitive performance of educationally retarded adolescents in vocational secondary schools. Five experimental and four control class groups took part in the one-year study. The experimental classes were instructed using the instrumental enrichment program by their specially trained regular teachers for approximately 45 minutes per day, 3 to 5 days per week, while the control group classes spent equivalent time in contact with their own teachers in the course of their usual program. Pre-post test analysis revealed significant effects of the FIE program on the cognitive performance of the experimental class students when compared with controls. As early as 1956, severe doubt was being expressed . as to the validity of the concept of primary genetic control over intellectual performances (Ferguson, 1956). This early expression of doubt heralded a controversy that had yet to begin in earnest, a controversy that is still raging many years later. Respected behavioral scientists (e.g., Burt, 1940; Herrnstein, 1973; Jensen, 1969, 1973; Spearman, 1927) had long argued that psychometrically measured lack of intellectual capacity, and the associated cognitive deficits usually seen or inferred, were in the main a biological given. However, there is a dawning suspicion?even among geneticists?that many people who fail to show cognitive or intellectual ability may not be irrevocably disabled but, rather, may be displaying the results of an unsuitable or unfortunate developmental process (Dobzhansky, 1973; McClearn, 1964, 1970; Vale & Vale, 1969). A growing number of authors have begun to point to performances in those people designated to be intellectually or mentally deficient that do not square with the common concep tion of the types of problems such people should (or should not) be able to solve (Bernstein, 1960, 1961; Clarke & Clarke, 1973; de Bono, 1970, 1973, 1976; Dunn, 1968; Feuerstein, 1970, 1979; Feuerstein & Richelle, 1963; Riessman, 1962; Robinson & Robin son, 1970; Rowher & Ammon, 1971; Sarason & Doris, 1969; Schwebel, 1967, 1968; Vygotsky, 1962). Thus, it can be fairly stated that the experts still disagree as to the extent to which intellectual capacity (or thinking or problem-solving ability) is biologically determined and, therefore, they disagree regarding the extent to which cognitive functioning may be positively or negatively influenced by one's environment. Of late, those favoring the importance of en vironmental influences, and the related possibility of reversing poor cognitive development, have been somewhat more vocal. Several have put forth pro grams for improving the thinking skills and, ulti mately, the intellectual capacity of those who are often regarded as irreversibly slow learners and thinkers (de Bono, 1970, 1973, 1976; Feuerstein, 1980; Weber, 1974). While there are many points of theoretical agreement and some similarities in methodology among these authors, Feuerstein and his colleagues ap pear to have developed the broadest, most theoretical and practically developed system of intervention in order to improve cognitive functioning when it has not developed well on a natural basis. Feuerstein's system includes theoretical analysis, a broad range of remedial materials and techniques, and a definite method for training front-line teaching and support personnel. Feuerstein argues that slow thinking and learning, and subsequently retarded performance, arise because of the failure of nurturing adults to provide adequate mediated learning experience during the crucial years of development (Feuerstein, 1979, 1980; Feuer stein & Rand, 1974). This argument is presented predominantly on the basis of work done with Address correspondence to Mary Waksman, Faculty of Education, University of Toronto, 371 Bloor St., West, Toronto, Ontario, Canada M5S 2R7. This content downloaded from 207.46.13.113 on Thu, 06 Oct 2016 04:25:26 UTC All use subject to http://about.jstor.org/terms

Fostering Friendliness in a Fast Food Franchise

As a result of upper level management interest in improving customer service in a fast foods restaurant, a behavioral program was designed to measure and improve one aspect of service, the friendliness of front-line personnel (N = 11). Friendliness was defined behaviorally and measured using an interval recording system. A multiple-baseline design across areas within the restaurant was employed. During the program, desired behaviors were defined and rehearsed, cues were provided (e.g., after greeting customers), and the behaviors were followed by consequences that came from the manager (e.g., recognition), customers (c.g., smiling back), and the employees themselves (e.g., checkmarks). The interventions were successful in one area and partially successful in another. Suggestions are made for future research on the subject of customer service.