Workload Implications Research Articles

Tiered escalation response systems in practice: A post hoc analysis examining the workload implications

ObjectiveMany rapid response systems now have multiple tiers of escalation in addition to the traditional single tier of a medical emergency team. Given that the benefit to patient outcomes of this change is unclear, we sought to investigate the workload implications of a multitiered system, including the impact of trigger modification. DesignThe study design incorporated a post hoc analysis using a matched case–control dataset. SettingThe study setting was an acute, adult tertiary referral hospital. ParticipantsCases that had an adverse event (cardiac arrest or unanticipated intensive care unit admission) or a rapid response team (RRT) call participated in the study. Controls were matched by age, gender, ward and time of year, and no adverse event or RRT call. Participants were admitted between May 2014 and April 2015. Main outcome measuresThe main outcome measure were the number of reviews, triggers, and modifications across three tiers of escalation; a nurse review, a multidisciplinary review (MDT—admitting medical team review), and an RRT call. ResultsThere were 321 cases and 321 controls. Overall, there were 1948 nurse triggers, of which 1431 (73.5%) were in cases and 517 (26.5%) in controls, 798 MDT triggers (660 [82.7%] in cases and 138 [17.3%] in controls), and 379 RRT triggers (351 [92.6%] in cases and 28 [7.4%] in controls). Per patient per 24 h, there were 3.03 nurse, 1.24 MDT, and 0.59 RRT triggers. Accounting for modifications, this reduced to 2.17, 0.88, and 0.42, respectively. The proportion of triggers that were modified, so as not to trigger a review, was similar across all the tiers, being 28.6% of nurse, 29.6% of MDT, and 28.2% of RRT triggers. Per patient per 24 h, there were 0.61 nurse reviews, 0.52 MDT reviews, and 0.08 RRT reviews. ConclusionsLower-tier triggers were more prevalent, and modifications were common. Modifications significantly mitigated the escalation workload across all tiers of a multitiered system.

Workload and workflow implications associated with the use of electronic clinical decision support tools used by health professionals in general practice: a scoping review

BackgroundElectronic clinical decision support tools (eCDS) are increasingly available to assist General Practitioners (GP) with the diagnosis and management of a range of health conditions. It is unclear whether the use of eCDS tools has an impact on GP workload. This scoping review aimed to identify the available evidence on the use of eCDS tools by health professionals in general practice in relation to their impact on workload and workflow.MethodsA scoping review was carried out using the Arksey and O’Malley methodological framework. The search strategy was developed iteratively, with three main aspects: general practice/primary care contexts, risk assessment/decision support tools, and workload-related factors. Three databases were searched in 2019, and updated in 2021, covering articles published since 2009: Medline (Ovid), HMIC (Ovid) and Web of Science (TR). Double screening was completed by two reviewers, and data extracted from included articles were analysed.ResultsThe search resulted in 5,594 references, leading to 95 full articles, referring to 87 studies, after screening. Of these, 36 studies were based in the USA, 21 in the UK and 11 in Australia. A further 18 originated from Canada or Europe, with the remaining studies conducted in New Zealand, South Africa and Malaysia. Studies examined the use of eCDS tools and reported some findings related to their impact on workload, including on consultation duration. Most studies were qualitative and exploratory in nature, reporting health professionals’ subjective perceptions of consultation duration as opposed to objectively-measured time spent using tools or consultation durations. Other workload-related findings included impacts on cognitive workload, “workflow” and dialogue with patients, and clinicians’ experience of “alert fatigue”.ConclusionsThe published literature on the impact of eCDS tools in general practice showed that limited efforts have focused on investigating the impact of such tools on workload and workflow. To gain an understanding of this area, further research, including quantitative measurement of consultation durations, would be useful to inform the future design and implementation of eCDS tools.

The United Kingdom's National Early Warning Score: should everyone use it? A narrative review.

This review critiques the benefits and drawbacks of the United Kingdom's National Early Warning Score (NEWS). Potential developments for the future are considered, as well as the role for NEWS in an emergency department (ED). The ability of NEWS to predict death within 24 h has been well validated in multiple clinical settings. It provides a common language for the assessment of clinical severity and can be used to trigger clinical interventions. However, it should not be used as the only metric for risk stratification as its ability to predict mortality beyond 24 h is not reliable and greatly influenced by other factors. The main drawbacks of NEWS are that measuring it requires trained professionals, it is time consuming and prone to calculation error. NEWS is recommended for use in acute UK hospitals, where it is linked to an escalation policy that reflects postgraduate experience; patients with lower NEWS are first assessed by a junior clinician and those with higher scores by more senior staff. This policy was based on expert opinion that did not consider workload implications. Nevertheless, its implementation has been shown to improve the efficient recording of vital signs. How and who should respond to different NEWS levels is uncertain and may vary according to the clinical setting and resources available. In the ED, simple triage scores which are quicker and easier to use may be more appropriate determinants of acuity. However, any alternative to NEWS should be easier and cheaper to use and provide evidence of outcome improvement.

PhD by Prospective Publication in Australian Business Schools: Provocations from a Collaborative Autoethnography

Aim/Purpose: The goal of this essay is to critically reflect on the emerging trend for PhDs by Prospective Publication (PbPP) in Australian Business Schools and to explore its appropriateness for fledgling academics. Background: The PbPP is a relatively new and increasingly popular alternative to traditional PhD by monograph (PbM). It is the idea that a doctorate can be completed by writing a series of papers that are published, or close to being published, as journal articles or book chapters. For students, it offers the chance to get a head-start on their publishing careers and helps them find their first academic jobs. For supervisors working in an academic environment increasingly characterized by ‘publish or perish’ dynamics, it guarantees meaningful rewards from doctoral supervision. However, despite the attractiveness of publishing during candidature, it is a very different way to complete a doctorate with many challenges for students, supervisors, and institutions. Methodology: We adopted critical collaborative autoethnography. Through this method, we reflect on our experience supervising and administrating PbPP students and integrate our reflections with the literature on PbPPs to highlight policy concerns and our position on them. Contribution: We argue that the primary goal of the PbPP is to produce students who can conduct research collaboratively after graduation, as opposed to people who can conduct independent research, although the two outcomes are not mutually exclusive. We also argue that assessment of PbPP should be significantly enhanced to determine the nature of the student’s contribution to the thesis, their understanding of research design, and their broader understanding of their subject. Finally, we argue that despite the attractiveness of PbPP, it can only be successfully attempted by students with elite levels of intellect, dedication, critical analytical skills, language skills, resilience, and patience and supervisors with expertise in the field of study, experience of publishing different types of paper, familiarity with the working of the journal publication process, and workload capacity. Findings: PbPP theses should be examined by viva voce. Viva voce examinations of PbPP theses should determine (1) the nature of the doctoral candidates’ contribution to the thesis, (2) whether it is sufficient for the award of a doctorate, (3) the contributions of the papers to advancing the field of research, and (4) the students’ understanding of the theory in their field. Viva voce examinations of PbPP theses should seek to discover the student’s ability to contribute to collaborative efforts of research teams. PbPP students should also sit an examination of their understanding of research philosophy, design, methodologies, and related topics. It should be externally set, administered, and marked by an independent examination board. PbPP candidates need to demonstrate excellent ‘research English’ language skills before commencing. Recommendations for Practitioners: PbPP candidates need excellent intellectual skills – as a rough guide, probably in the top quartile of doctoral candidates. PbPP candidates need to be resilient and able to cope with failure, criticism, and rejection. PbPP candidates need high levels of patience. PbPP candidates should be encouraged to produce their first manuscript early in their candidature. PbPP supervision requires supervisors with advanced levels of subject knowledge, research skills, and publishing outputs. PbPP supervision requires expertise across various forms of research and types of output. Due to the wide range of skills and experience, PbPP supervision is likely to require a team approach. Recommendation for Researchers: As the PbPP grows in popularity, it challenges educational researchers to explore this emerging phenomenon. Does it take a particular type of person to thrive through this process? Does it need supervisors with particular characteristics? How does the experience of PbPP supervisors differ to the experience of PbM supervisors? Do PbPP graduates differ in their abilities to PbM graduates? Impact on Society: People graduating with PhDs typically enter influential and important jobs in society. It is vital that they have the knowledge, skills, and abilities that the qualification confers. In Australia, the PbPP challenges this credibility due to issues of co-authorship, selective study, and shallow assessment. These matters need to be understood and rectified to prevent a loss of credibility in Australia’s Higher Education institutions and its graduates. Future Research: Are there any differences in the knowledge, skills, and abilities of PbPP and PbM graduates? Studies are needed of the characteristics prospective PbPP students need to be successful taking this doctoral route. How does the nature of supervision differ between PbPP and PbM? What is the impact on the skills and abilities supervisors need and the implications for workload? What jobs do PbPP graduates go into and does this differ to PbM graduates? What resistance will the proposals made in this essay meet?

Effect of Hard Skill, Workload and Technology on Job Satisfaction and Work Productivity At Pt. Delta Jaya Mas Gresik

This study aims to determine the implications of hard skills, workload, and product technology on job satisfaction and their impact on employee productivity at PT. Delta Jaya Mas Gresik. The population used in this study was 45 people, all production employees at PT. Delta Jaya Mas. The sampling technique used was purposive sampling. Samples were taken from all employees working in the production division with the criteria of having status as permanent employees at PT. Delta Jaya Mas numbered 45 respondents. The research method used is a quantitative research method; the techniques used include path analysis and mediation sobel test. The test results show that: Hard skills have a significant effect on employee job satisfaction at PT. Delta Jaya Mas Gresik. Workload has a significant effect on employee job satisfaction at PT. Delta Jaya Mas Gresik. Production technology has a significant effect on employee job satisfaction at PT. Delta Jaya Mas Gresik. Hard skills have a significant effect on employee work productivity at PT. Delta Jaya Mas Gresik. Workload has no significant effect on employee work productivity at PT. Delta Jaya Mas Gresik. Production technology has a significant effect on employee work productivity at PT. Delta Jaya Mas Gresik. Job satisfaction has a significant effect on employee work productivity at PT. Delta Jaya Mas Gresik

Effect of implementing the NEWS2 escalation protocol in a large acute NHS trust: a retrospective cohort analysis of mortality, workload and ability of early warning score to predict death within 24 hours

ObjectivesTo describe the inpatient population, establish patterns in admission and mortality over a 4-year period in different cohorts and assess the prognostic ability and workload implications of introducing the National...

Supporting students from equity groups: experiences of staff and considerations for institutions

ABSTRACT In light of widening participation initiatives internationally, including those in Australia, much has been written about equity policies in education. There is a growing body of research related to the outcomes of such policies and the experiences of non-traditional students, including those from low socio-economic status (LSES) backgrounds and students who are First Generation and/or First in Family, as well as other equity groups. This paper presents data related to a less researched effect of widening participation: the experiences of and impact on academic staff and those providing support services to students. We focus particularly on students from LSES backgrounds. Qualitative data were collected through focus groups with academic and student support staff in a large regional Australian university, with several themes emerging. In this paper, we investigate staff experiences related to diversity in student cohorts, drawing on Bourdieu’s concept of capital. Results show that the academics are supportive of LSES students and sensitive to the range of student backgrounds in their courses, including differences in cultural capital and students experiencing extreme hardship, but the support provided is affected by staff gender. It is evident that staff endeavour pedagogically and pastorally to support students, often at personal cost. There are workload and welfare implications evident for staff, institutions and funding.

Implications Of Workload And Work Environment Among Expatriate Healthcare Workers In Saudi Arabia: Narrative Review

This narrative review explores the challenges faced by expatriate healthcare workers in Saudi Arabia, focusing on workload, work environment, and their impact on well-being and job satisfaction. Berry’s acculturation theory provides the theoretical framework, examining how expatriate healthcare workers adapt to the cultural norms and healthcare practices in the sociocultural setup of Saudi Arabia. The examined literature evidence shows that the expatriate healthcare workers face a plethora of challenges regarding workload and work environment, including high workload, long working hours, inadequate staffing, improper recruitment practices, cultural differences, poor living conditions and social support. This review further noted that proper coping mechanisms and support systems should be availed to the expatriate health workers, including professional support, language training, and improved working conditions.

Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study.

BackgroundMost studies of long COVID (symptoms of COVID-19 infection beyond 4 weeks) have focused on people hospitalized in their initial illness. Long COVID is thought to be underrecorded in UK primary care electronic records.ObjectiveWe sought to determine which symptoms people present to primary care after COVID-19 infection and whether presentation differs in people who were not hospitalized, as well as post–long COVID mortality rates.MethodsWe used routine data from the nationally representative primary care sentinel cohort of the Oxford–Royal College of General Practitioners Research and Surveillance Centre (N=7,396,702), applying a predefined long COVID phenotype and grouped by whether the index infection occurred in hospital or in the community. We included COVID-19 infection cases from March 1, 2020, to April 1, 2021. We conducted a before-and-after analysis of long COVID symptoms prespecified by the Office of National Statistics, comparing symptoms presented between 1 and 6 months after the index infection matched with the same months 1 year previously. We conducted logistic regression analysis, quoting odds ratios (ORs) with 95% CIs.ResultsIn total, 5.63% (416,505/7,396,702) and 1.83% (7623/416,505) of the patients had received a coded diagnosis of COVID-19 infection and diagnosis of, or referral for, long COVID, respectively. People with diagnosis or referral of long COVID had higher odds of presenting the prespecified symptoms after versus before COVID-19 infection (OR 2.66, 95% CI 2.46-2.88, for those with index community infection and OR 2.42, 95% CI 2.03-2.89, for those hospitalized). After an index community infection, patients were more likely to present with nonspecific symptoms (OR 3.44, 95% CI 3.00-3.95; P<.001) compared with after a hospital admission (OR 2.09, 95% CI 1.56-2.80; P<.001). Mental health sequelae were more strongly associated with index hospital infections (OR 2.21, 95% CI 1.64-2.96) than with index community infections (OR 1.36, 95% CI 1.21-1.53; P<.001). People presenting to primary care after hospital infection were more likely to be men (OR 1.43, 95% CI 1.25-1.64; P<.001), more socioeconomically deprived (OR 1.42, 95% CI 1.24-1.63; P<.001), and with higher multimorbidity scores (OR 1.41, 95% CI 1.26-1.57; P<.001) than those presenting after an index community infection. All-cause mortality in people with long COVID was associated with increasing age, male sex (OR 3.32, 95% CI 1.34-9.24; P=.01), and higher multimorbidity score (OR 2.11, 95% CI 1.34-3.29; P<.001). Vaccination was associated with reduced odds of mortality (OR 0.10, 95% CI 0.03-0.35; P<.001).ConclusionsThe low percentage of people recorded as having long COVID after COVID-19 infection reflects either low prevalence or underrecording. The characteristics and comorbidities of those presenting with long COVID after a community infection are different from those hospitalized. This study provides insights into the presentation of long COVID in primary care and implications for workload.

Impact of the COVID-19 pandemic on emergency hospital cancer admissions in a UK region

BackgroundThe pandemic disrupted society and health services through lockdowns and resource reallocation to care for COVID-19 patients. Reductions in numbers of cancer patients having surgery, being diagnosed pathologically or via 2-week wait, and screening programs pauses have been described. The effect on emergency presentation, which represents an acute episode with poor outcomes, has not been investigated. This study explored the pandemic’s impact on emergency hospital admissions for cancer patients in a UK region.MethodsHospital discharge data for cancer patients in Northern Ireland, which included route to admission, were analysed for the pandemic era in 2020 compared to averages for March to December 2017–2019, focusing on volume and route of emergency admissions by demography and tumour site.FindingsCompared with the pre-pandemic era, the number of cancer emergency admissions fell by 12·3% in 2020. Emergency admissions for cancer were significantly reduced when COVID-19 levels were highest (− 18·5% in April and − 16.8% in October). Females (− 15·8%), urban residents (− 13·2%), and age groups 0 to 49 and 65–74 years old (− 17%) experienced the largest decreases as did those with haematological (− 14·7%), brain and CNS (− 27·9%), and lung cancers(− 14·3%). Significant reductions in referrals from outpatient departments (− 51%) and primary care (− 43%) (p < 0·001) were counterbalanced by admissions from other routes including confirmed or suspected COVID-19 infection (increase 83·6%).InterpretationReductions in emergency admissions, and pathologically diagnosed cancers, as reported by the Northern Ireland Cancer Registry (NICR), indicate undiagnosed patients in the community which has implications for future workloads and survival. Data suggest undiagnosed cases may be higher for haematological, brain and CNS, and lung cancers and among females. Efforts should be made to encourage people with symptoms to present for diagnosis or reassurance.FundingThe NICR is funded by the Public Health Agency of Northern Ireland. This work was supported by Macmillan Cancer Support and uses data collected by health services as part of their care and support functions.

Learning on the periphery: A pilot study of an undergraduate nursing student communities of practice model

Objective: Nursing shortages have led to an increased student nurse education and a greater need for work integrated learning among limited health services. A Communities of Practice student placement model was developed to address this deficit, while facilitating greater peer-to-peer learning, and incidental, yet essential, support and learning between junior and senior students. An exploratory study was undertaken to examine the experiences of key stakeholders, students and clinical staff regarding the Communities of Practice model.Methods: After implementation interviews were conducted with six (n = 6) students and three (n = 3) nursing staff, two (n = 2) nurse managers, and one (n = 1) clinical educator. Interviews examined the benefits and challenges of the new model, while further guiding its refinement. Interview data were analysed thematically.Results: The Communities of Practice student placement model, although met with initial hesitancy, was indicated to be a positive learning experience for all participants. Specifically, five key themes emerged, including increased support for junior students, extended learning among senior students, unexpected discoveries for staff and students, workload decision-making and implications for staff, followed by the need for adaptability and further insights to modify the model.Conclusions: The study demonstrated the capacity to increase student placement numbers, while effectively increasing the level of support, mentorship, and learning among students, and assisting nurses in their roles. Overall, the model has also been suggested to offer the near-peer support desperately needed for junior students, while at the same time, offering more senior students the foundation upon which to develop their leadership skills.

Feasibility and Safety of Ambulatory Surgery as the Next Management Paradigm in Colorectal Resection Surgery.

Current clinical dogma favors universal inpatient admission after colorectal resection particularly in the presence of an anastomosis. We evaluate the feasibility and safety of ambulatory surgery in carefully selected patients undergoing colorectal resection/anastomosis. Between October 2020 and October 2021, all patients undergoing colorectal resection/anastomosis meeting specific criteria {no major comorbidity [American Society of Anesthesiologist (ASA) <4], not on therapeutic anticoagulation, compliant patient/family} were counseled preoperatively for ambulatory surgery (discharge <24h postsurgery). Complicated surgery (ileoanal pouch, enterocutaneous fistula repair, reoperative pelvic surgery, multiple resections) and/or ostomy creation (loop/end ileostomy, Hartmann's, abdominoperineal resection) were exclusions. Discharge was at 6 to 8 hours postoperatively if all predetermined factors (no ostomy teaching needed, ambulating comfortably, tolerating diet, stable vitals, and blood-work) were met and patients were willing, or was postponed to the next day at patient request. All discharged patients received phone checks the next day with the option also given for voluntary readmission if inpatient care was preferred by patient. Patients discharged <24 hours postop (AmbC) were compared to those staying on as inpatients admitted (InpC) and also to a comparable historical (October 2019-October 2020) group when ambulatory surgery was not offered (HistC). Of 184 abdominal colorectal surgery patients, 97 had complicated colorectal resection and/or ostomy. Of the remaining 87, 29 (33.3%) were discharged <24 hours postoperatively [7 (24%) patients at 8h]. Of these 29 AmbC patients, 4 were readmitted <30 days (ileus: 1, rectal bleeding: 2, nausea/vomiting: 1), 1 readmission was on first postdischarge day, none were voluntary post phone-check. AmbC and InpC (n=58) had similar age, sex, race, body mass index, and comorbidity. InpC had greater estimated blood loss (109 vs 34mL, P <0.001) while length of stay was expectedly significantly longer (109 vs 17 hours, P <0.001). There was no mortality in either group. AmbC and InpC had similar readmission, reoperation, anastomotic leak, ileus, and surgical site infection. Mean length of stay for HistC was 83 hours. AmbC and HistC had similar age, sex, race, body mass index, and ASA class. Complications including readmission, reoperation, anastomotic leak, ileus, and surgical site infection were also similar for AmbC and HistC. With careful patient selection, preoperative education, perioperative management, and postoperative follow-up, ambulatory surgery is feasible in up to a third of patients undergoing colorectal resection/anastomosis and can be performed with comparable safety to the time-honored practice of routine inpatient hospitalization. Refinements in inclusion/exclusion criteria and postoperative outpatient follow-up will allow a paradigm shift in how such patients are managed, which has huge implications for patient experience, care-giver workload and health care finances.

A text-mining tool generated title-abstract screening workload savings: performance evaluation versus single-human screening

Background and ObjectivesText-mining tool, Abstrackr, may potentially reduce the workload burden of title and abstract screening (Stage 1), using screening prioritization and truncation. This study aimed to evaluate the performance of Abstrackr's text-mining functions (‘Abstrackr-assisted screening’; screening undertaken by a single-human screener and Abstrackr) vs. Single-human screening. MethodsA systematic review of treatments for relapsed/refractory diffuse large B cell lymphoma (n = 7,723) was used. Citations, uploaded to Abstrackr, were screened by a human screener until a pre-specified maximum prediction score of 0.39540 was reached. Abstrackr's predictions were compared with the judgments of a second, human screener (who screened all citations in Covidence). The performance metrics were sensitivity, specificity, precision, false negative rate, proportion of relevant citations missed, workload savings, and time savings. ResultsAbstrackr reduced Stage 1 workload by 67% (5.4 days), when compared with Single-human screening. Sensitivity was high (91%). The false negative rate at Stage 1 was 9%; however, none of those citations were included following full-text screening. The high proportion of false positives (n = 2,001) resulted in low specificity (72%) and precision (15.5%). ConclusionAbstrackr-assisted screening provided Stage 1 workload savings that did not come at the expense of omitting relevant citations. However, Abstrackr overestimated citation relevance, which may have negative workload implications at full-text screening.

Implications of resource constraints and high workload on speaking up about threats to patient safety: a qualitative study of surgical teams in Ghana

BackgroundAlthough under-resourcing of healthcare facilities and high workload is known to undermine patient safety, there is a dearth of evidence about how these factors affect employee voice and silence about...

Understanding Stakeholder Views Regarding the Design of an Intervention Trial to Reduce Anticholinergic Burden: A Qualitative Study.

Background: Anticholinergic burden (ACB), is defined as the cumulative effect of anticholinergic medication which are widely prescribed to older adults despite increasing ACB being associated with adverse effects such as: falls, dementia and increased mortality. This research explores the views of health care professionals (HCPs) and patients on a planned trial to reduce ACB by stopping or switching anticholinergic medications. The objectives were to explore the views of key stakeholders (patients, the public, and HCPs) regarding the potential acceptability, design and conduct of an ACB reduction trial. Materials and Methods: We conducted qualitative interviews and focus groups with 25 HCPs involved in prescribing medication with anticholinergic properties and with 22 members of the public and patients who were prescribed with the medication. Topic guides for the interviews and focus groups explored aspects of feasibility including: 1) views of a trial of de-prescribing/medication switching; 2) how to best communicate information about such a trial; 3) views on who would be best placed and preferred to undertake such medication changes, e.g., pharmacists or General Practitioners (GPs)? 4) perceived barriers and facilitators to trial participation and the smooth conduct of such a trial; 5) HCP views on the future implementability of this approach to reducing ACB and 6) patients’ willingness to be contacted for participation in a future trial. Qualitative data analysis was underpinned by Normalization Process Theory. Results: The public, patients and HCPs were supportive of an ACB reduction trial. There was consensus among the different groups that key points to consider with such a trial included: 1) ensuring patient engagement throughout to enable concerns/potential pitfalls to be addressed from the beginning; 2) ensuring clear communication to minimise potential misconceptions about the reasons for ACB reduction; and 3) provision of access to a point of contact for patients throughout the life of a trial to address concerns; The HCPs in particular suggested two more key points: 4) minimise the workload implications of any trial; and 5) pharmacists may be best placed to carry out ACB reviews, though overall responsibility for patient medication should remain with GPs. Conclusion: Patients, the public and HCPs are supportive of trials to reduce ACB. Good communication and patient engagement during design and delivery of a trial are essential as well as safety netting and minimising workload.

Assessing the Accuracy of Director of Clinical Education Roles/Responsibilities Taxonomy and Matrix: A Delphi Study

Introduction. There is not a taxonomy that has been fully vetted for traditional positions in physical therapy programs and it is not known what efficiencies could be afforded by employing a taxonomy and matrix for the Director of Clinical Education (DCE) position, specifically. This study provides a pathway to greater understanding of the DCE competing roles and responsibilities both as a traditional faculty member and those that pertain specifically to the DCE through determining the accuracy of the DCE Taxonomy and Matrix. The study addressed the following questions: (1) Within the Taxonomy, do each of the levels' responsibilities and sample tasks accurately match the levels’ definition, as duties performed by a DCE at that level? (2) Within the Matrix, do the characteristics serve as a common descriptor across all taxonomy levels? and (3) Within the Matrix, do each of the characteristics and ranges align with the Taxonomy levels? We hypothesized that the DCE Taxonomy and Matrix would require minor revisions to refine the tools to confirm accurate descriptions of the DCE roles and responsibilities. Directors of Clinical Education have an integral role with multiple responsibilities to fulfill as a bridge between the clinic and the academy as well as performing the traditional duties of a faculty member. Work completed by McCallum et al provided a foundational understanding of the DCE's work. Engelhard et al expanded on the foundational DCE study using Watts Taxonomy as a basis to develop the DCE Roles and Responsibilities Taxonomy and Matrix. Subjects. Through purposive sampling, 86 faculty, including DCEs, ADCEs (Associate Directors of Clinical Education), and Program Directors, participated in the study. Methods. This Delphi, mixed methods study used 2 web-based survey rounds to achieve consensus, defined agreement as ≥80% of respondents. Round 1 sought agreement for DCE roles, responsibilities, and sample tasks in the Taxonomy. Matrix agreement was sought for each of the 4 characteristics. Round 2 involved refinement of the Taxonomy to improve clarity. Results. The Matrix achieved consensus after Round 1. Consensus was achieved at the conclusion of the Round 2 for the Taxonomy, which resulted in a concise description of the categories of Processor, Coordinator, and Director level roles and responsibilities. Discussion and Conclusion. Findings suggest a clear and concise classification of work-related elements that can contribute to success in the DCE position and ultimately the physical therapy program. As the profession goes forward, understanding of the impact of where we spend time in our programs must occur as we balance student matriculation and success with organizational knowledge of key program positions. By establishing the accuracy of the DCE Taxonomy and Matrix, insights to workload implications are gained.

When emergencies and disasters collide: Lessons from the response to the Magna, Utah earthquake during the COVID-19 pandemic.

The following article addresses the complexities of responding to the Magna, Utah earthquake under conditions of the global corona virus disease (COVID-19) pandemic. The article begins with a brief mention of the literature on complex disasters along with the research methods employed for the study. Contextual information about COVID-19 and the Magna earthquake are then provided along with general issues that had to be addressed in the public health emergency and after the seismic hazard occurred. The following two sections identify how COVID-19 benefited the response to the earthquake as well as how the virus complicated operations after the tremor. The article then discusses major lessons of this research and provides recommendations for future study and practice. Overall, this research reveals that the responses to these two simultaneous events witnessed successes as well as significant challenges. The appearance of COVID-19 may have limited injuries or the loss of life during the Magna earthquake, and it also enabled an early activation of the emergency operations center (EOC). However, COVID-19 presented unique challenges for evacuation, sheltering, and damage assessment functions. The pandemic also altered the nature of EOC operations, created the need for a virtual response, and had distinct implications for financial accounting and personnel workload.

Principals’ perceptions of school autonomy and educational leadership

This paper examines principals’ perceptions of school autonomy and leadership as part of a 3-year research project looking at the implications of school autonomy on social justice across four states of Australia (Victoria, New South Wales, Western Australia and Queensland). Drawing on interviews with principals and representatives from principal stakeholder organisations in these four state jurisdictions, the paper identifies a number of key issues for school principals and the implications for understandings and practices of educational leadership. These include varied understandings of autonomy, practices of leadership and implications for health, workload and well-being. The paper argues that while principals have mixed perceptions of school autonomy policies, there has been a narrowing of leadership experiences by principals in the form of managerialism and compliance. Furthermore, principals continue to experience high levels of workload, and some principals, depending on career stage and experience level, feel better able to work within and sometimes against these policies in their schools and communities. These practices are sometimes felt to be despite the system and not due to school autonomy policies themselves. The implication of these findings is that principals are inequitably able to respond to and implement school autonomy policies, an issue often glossed over in educational leadership research.

Understanding aviation operators’ variability in advanced systems

Purpose This study aims to identify variability in aviation operators in order to gain greater understanding of the changes in aviation professional groups. Research has commonly addressed human factors and automation in broad categories according to a group’s function (e.g., pilots, air traffic controllers [ATCOs], engineers). Accordingly, pilots and Air Traffic Controls (ATCOs) have been treated as homogeneous groups with a set of characteristics. Currently, critical themes of human performance in light of systems’ developments place the emphasis on quality training for improved situational awareness (SA), decision-making and cognitive load. Design/methodology/approach As key solutions centre on the increased understanding and preparedness of operators through quality training, the authors deploy an iterative mixed methodology to reveal generational changes of pilots and ATCOs. In total, 46 participants were included in the qualitative instrument and 70 in the quantitative one. Preceding their triangulation, the qualitative data were analysed using NVivo and the quantitative analysis was aided through descriptive statistics. Findings The results show that there is a generational gap between old and new generations of operators. Although positive views on advanced systems are being expressed, concerns about cognitive capabilities in the new systems, training and skills gaps, workload and role implications are presented. Practical implications The practical implications of this study extend to different profiles of operators that collaborate either directly or indirectly and that are critical to aviation safety. Specific implications are targeted on automation complacency, bias and managing information load, and training aspects where quality training can be aided by better understanding the occupational transitions under advanced systems. Originality/value In this paper, the authors aimed to understand the changing nature of the operators’ profession within the advanced technological context, and the perceptions and performance-shaping factors of pilots and ATCOs to define the generational changes.

Married Adults Coresiding with Older Parents: Implications for Paid Work and Domestic Workloads

The rise of life expectancy throughout the developed world has meant that older adults play an increasingly important role in their grown-up children’s lives. We evaluate whether the intergenerational solidarity theory is useful for understanding the intergenerational transfers of time in Japan given the relatively generous welfare provision for the older adults and the fall in intergenerational coresidence. We apply seemingly unrelated regression models to data of the 2006 Japanese Survey on Time Use and Leisure Activities (Statistics Bureau Japan, 2006) to investigate how coresidence patterns are associated with paid and unpaid work time of adult married children. The sample contains 23,226 married couples where both husband and wife are aged 20 to 59. We find evidence of intergenerational solidarity in coresident households. We also find that “doing gender” is layered through intergenerational exchanges of support between married working-age children and their older parents. Working-age women’s time use patterns are associated with coresidence arrangements and care needs of their older relatives to a much greater extent than working-age men’s. The observed patterns are consistent with healthy older women supporting their daughters’ careers in exchange for care when they need help themselves. For working-age men, the patterns are not very pronounced. Notably, working-age husbands without children appear to be more responsive to their older the parents’ care needs, suggesting that fatherhood may be associated with solidifying gendered role performance within Japanese couples.