Non-routine Situations Research Articles

Front desk talk: discourse analysis of receptionist–patient interaction

GP receptionists are the first point of contact with the NHS for most patients and have an important role in facilitating access to healthcare services. There is evidence that they are often perceived as impersonal, insensitive, or officious. To analyse the communicative styles of GP receptionists when dealing with patients. Ethnographically situated discourse analysis of audio recordings. Three NHS GP surgeries in Scotland. Fine-grained transcription and stage-by-stage analysis of digital audio recordings of 283 encounters between receptionists and patients engaged in front desk business. Participants were 16 receptionists and 283 patients. Interaction between receptionists and patients consists mainly of verbal routines that are shaped by the administrative tasks completed through them. Receptionists adhere to these established patterns of use at all times, even when dealing with non-routine situations. Within the routine framework, receptionists communicate with patients using styles that display three dominant approaches: task centred, conventionally polite, and rapport building. Receptionists who adopt a task-centred approach use forms with minimal interpersonal content, while those who use conventionally polite forms or those associated with rapport building, give attention to establishing positive relationships with patients. There is no evidence that any stylistic approach is more efficient than another. There is, however, evidence that excessive adherence to routine verbal behaviour has an adverse impact on problem solving. Most receptionist discourse consists of the repetition of established verbal routines. Receptionists adopt verbal styles that are predominantly task centred, conventionally polite, or rapport building. Although all three styles enable the completion of reception work with similar levels of efficiency, task-centred styles may appear over-direct. The use of a routine approach when dealing with problematic situations can inhibit and delay their resolution.

Executive Function

In general, executive function can be thought of as the set of abilities required to effortfully guide behavior toward a goal, especially in nonroutine situations. Psychologists are interested in expanding the understanding of executive function because it is thought to be a key process in intelligent behavior, it is compromised in a variety of psychiatric and neurological disorders, it varies across the life span, and it affects performance in complicated environments, such as the cockpits of advanced aircraft. This article provides a brief introduction to the concept of executive function and discusses how it is assessed and the conditions under which it is compromised. A short overview of the diverse theoretical viewpoints regarding its psychological and biological underpinnings is also provided. The article concludes with a consideration of how a multilevel approach may provide a more integrated account of executive function than has been previously available.

Illuminating hospital discharge planning: staff nurse decision making

This qualitative study proposed to examine staff RN's decision making related to discharge planning and perceptions of their role. Themes resulting from interviews were “following the script” and “RN as coordinator.” The decision to consult a discharge planner occurred when the patient's situation did not follow the RN's expectations. Discharge planning for nonroutine situations was considered disruptive to the RN's workflow. The RN's role was limited to oversight when a discharge planner was involved. Understanding RNs' decision making in this key process provides valuable insights into differentiating routine from nonroutine patient situations and deploying appropriate resources in a timely fashion.

Understanding aviation English as a lingua franca

Researchers exploring the use of language use in radiotelephony communication have tended to focus on the limitations of the non-native English user and the threats which their limited control of English may pose for aviation safety (e.g. Atsushi, 2003, 2004). Hence the recent International Civil Aviation Organization (ICAO) policy places the onus on non-native users to bring their English to an appropriate standard. The present paper argues that there is a need for a broader perspective on this issue and supports this case with reference to two sources of data: a) episodes of radiotelephony discourse recorded in two air traffic control centres in Korea exemplifying non-routine, abnormal and emergency situations involving NS of English and NNS from different language backgrounds, b) focus group and individual interviews with selected Korean aviation personnel eliciting their interpretations of these episodes and of issues in aviation English more generally. Findings suggest that responsibilities for communication problems in aviation English are distributed across NS and NNS users, and may be partly due to the absence of shared assumptions about efficient and appropriate communication practices in an environment where English is a lingua franca (ELF). Implications are drawn for the communication training of all aviation personnel, regardless of language background.

Understanding Aviation english as a Lingua Franca

Researchers exploring the use of language use in radiotelephony communication have tended to focus on the limitations of the non-native English user and the threats which their limited control of English may pose for aviation safety (e.g. Atsushi, 2003, 2004). Hence the recent International Civil Aviation Organization (ICAO) policy places the onus on non-native users to bring their English to an appropriate standard. The present paper argues that there is a need for a broader perspective on this issue and supports this case with reference to two sources of data: a) episodes of radiotelephony discourse recorded in two air traffic control centres in Korea exemplifying non-routine, abnormal and emergency situations involving NS of English and NNS from different language backgrounds, b) focus group and individual interviews with selected Korean aviation personnel eliciting their interpretations of these episodes and of issues in aviation English more generally. Findings suggest that responsibilities for communication problems in aviation English are distributed across NS and NNS users, and may be partly due to the absence of shared assumptions about efficient and appropriate communication practices in an environment where English is a lingua franca (ELF). Implications are drawn for the communication training of all aviation personnel, regardless of language background.

Impossible requests: L2 users' sociopragmatic and pragmalinguistic choices in L1 acts of refusal

The study compares pragmalinguistic knowledge of the L1 in non-routine situations in L2 users and L2 learners, aiming to see to what extent pragmalinguistic behaviours in the L1 are influenced by exposure to the L2. The first part of the paper discusses the nature of bilingual language knowledge and transfer in multicompetence. In the experiment, refusals to untypical requests were elicited by means of a discourse completion test (DCT). The L2 users in this study appear to be “more native than the native speaker” (Cook, Iarossi, Stellakis, & Tokumaru 2003) in their choice of semantic formulas, as compared to monolingual speakers of their L1. Since pragmatic transfer is ruled out by the baseline data from native speakers of English, an alternative explanation is proposed, based on the L2 users’ increased sensitivity to interactional demands (Genesee, Tucker & Lambert 1975), more varied experience at social interaction and changed perception of their L1.

Lobe frontal, fonctions exécutives et controle cognitif

The approach of executive functions began with the early description of behavioural disorders induced by frontal damage. The development of neuropsychology has led to the description of a large variety of cognitive disorders. The interpretation in cognitive terms of these disorders has emphasized the critical impairment of executive functions which are involved in non-routine situations. The role of working memory, initially suggested by animal studies, has also largely influenced theoretical approaches. Numerous studies have been interpreted within the theoretical frameworks developed by Shallice and by Baddeley. A large amount of studies have allowed the specification of control processes (initiation, inhibition…). Recent studies are beginning to investigate cognitive disorders underlying behavioural changes such as deficits of emotional, social and metacognitive processes. In addition these studies seriously question the assumption of a unique central control system. These studies have deeply influenced the clinical approach, the assessment and the diagnosis of executive syndrome. For clinical practice, these data lead to favour specific assessment of some key behavioural and cognitive deficits based on a battery of tests and structured interview of an informant.

Audit Committee Effectiveness: Informal Processes and Behavioural Effects

Purpose of this paper - This paper seeks to investigate the conditions and processes affecting the operation and potential effectiveness of audit committees, with particular focus on the interaction between the audit committee, individuals from financial reporting and internal audit functions and the external auditors. Design/methodology/approach - A case study approach is employed, based on direct engagement with participants in audit committee activities, including the audit committee chair, external auditors, internal auditors, and senior management. Findings - We find that informal networks between audit committee participants condition the impact of the audit committee and that the most significant effects of the audit committee on governance outcomes occur outside the formal structures and processes. An audit committee has pervasive behavioural effects within the organization and may be used as a threat, an ally and an arbiter in bringing solutions to issues and conflicts. Audit committees are used in organizational politics, communication processes and power plays and also affect interpretations of events and cultural values. Research limitations/implications - Further research on audit committee and governance processes is needed to develop better understanding of effectiveness. Longitudinal studies, focusing on the organizational and institutional context of audit committee operations, can examine how historical events in an organization and significant changes in the regulatory environment affect current structures and processes. Originality/value - The case analysis highlights a number of significant factors which are not fully recognised either in theorizing the governance role of audit committees or in the development of policy and regulations concerning audit committees but which impinge on their governance contribution. They include (i) the importance of informal processes around the audit committee; (ii) its influence on power relations between organizational participants; (iii) the relevance of the historical development of governance in an organization; (iv) and the possibility that the audit committee's impact on governance may be greatest in non-routine situations.

The challenge of explaining why quality improvement has not done better

Success has many fathers, but failure is an orphan. (John F. Kennedy) It is always easier to suggest reasons why something failed than succeeded. The frequently expressed concerns about quality of health care make it a fitting topic for examination [1–3]. Many preach the doctrine of continuous improvement, arguing that the system is at fault not the individual [4–7]. Whereas some bemoan the lack of a business case for quality in health care [8], others propose creating environments that will encourage and reward better quality [9–11]. There is a litany of problems in introducing quality improvement in health care [12–15]. Report cards and pay for performance can certainly yield perverse results [16]. The analysis by T. Katz-Navon et al . in this issue puts forth three reasons why efforts to improve quality have not gone as well as might be hoped: (i) They challenge the frequently used “clinicians as pilots” metaphor. (ii) They raise the risk of sending mixed messages to clinicians. (iii) They cite the need for organizations to be willing to disclose their errors as the basis for improving. The authors suggest that the physician pilot analogy does not hold because physicians too frequently face non-routine situations, which are complex and varied. Moreover, physicians have more autonomy than pilots. The rejection of this comparison is all the more surprising because at least some of the authors began their work in systems developing information systems for fighter pilots. The pilot analogy is compelling for many because both professions make decisions that could affect lives and both are highly trained. Both rely on complex information systems to make decisions that must combine information with instinct. To see how well the analogy holds, the question …

A Method for Constructing a Reference Image Database to Assist with Design Process. Application to the Wooden Architecture Domain

Designing architectural projects requires the introduction of references, because design is an activity oriented towards a result which does not yet exist. If we summarise the current categories used in Artificial Intelligence to characterise the different forms of reasoning, we are able to consider that design is more the concern of the induction or the abduction mechanism than the deduction mechanism. Moreover, the main characteristic of the designer's activity is to work towards non-routine situations with the use of many references. In this paper we will present method principles to construct a reference image database. These references will enable the designer to further in solving the design problem. To illustrate these reference usage, we choose photographic images belonging to the wooden construction domain We also present at the end of the paper an experiment which aims to evaluate the real help that this reference image database can bring to designers during their creation task.

Effects of Adaptive Behaviors and Shared Mental Models on Control Crew Performance

Control crews are highly trained teams responsible for monitoring complex systems, performing routine procedures, and quickly responding to nonroutine situations. Previous literature suggests that higher-performing control crews engage in adaptive behavior during high-workload or crisis situations. Other work suggests that higher-performing crews use periods of lower workloads to prepare for future problems. To understand which behaviors performed during which situations better differentiate lower- from higher-performing crews, we conducted a study of 14 nuclear power plant control room crews and examined adaptive behaviors and shared mental model development in the crews as they faced monitoring, routine, and nonroutine situations. Our results suggest that few differences in adaptive behaviors exist between higher- and lower-performing crews during monitoring or routine situations, but that information collection and shared mental model development activities, and intracrew processes used during model development, differ significantly between lower- and higher-performing control crews during nonroutine situations.

Project review and learning in the construction industry: Embedding a problem structuring method within a partnership context

Problem Structuring Methods have most commonly been employed in one-off interventions to address non-routine problem situations. This paper argues that problem structuring methods are by their nature also appropriate for routine use within multi-organizational partnerships as a means of supporting inter-organizational learning. An experience of the use of a problem structuring methods approach in this mode is reported, within a UK construction industry partnership context. The approach which was developed has been called the Cross Organizational Learning Approach (COLA). COLA uses Strategic Choice-based workshops to identify and review critical incidents and project successes, in order to generate a limited set of key actions to feed back both to project partners and to future joint projects. The paper describes and discusses the process of developing and using this approach, with particular concentration on the apparent success in embedding it as a continuing business practice.

Adaptive Expertise during Simulated Flight

The present research examined pilot ability to perform simulated flight maneuvers in routine and nonroutine instrument flight situations as a function of expertise. Twenty-one pilots were asked to fly nine simulated instrument flight maneuvers using a modified version of Microsoft Flight Simulator©. Each of the flight maneuvers involved performing routine control movements on up to three axes (airspeed, altitude, and/or heading). For the first seven trials, all instruments operated properly. During the final two trials, the attitude indicator experienced a partial vacuum failure that was either announced or unannounced. Pilot control movements, eye fixations, and flight status were recorded. Percent goal completion within specified bounds (commercial pilot standards) was calculated for each trial. Eye fixations were not analyzed. The results indicated an overall expertise effect for routine flight. However, during unannounced failure, expert performance dropped to novice levels. The results are discussed in terms of training and routine versus adaptive expertise.

Paramedic Practice – Knowledge Invested in Action

The ability of expert practitioners to make sound judgments when faced with non-routine situations calls on a form of tacit knowing that has been loosely branded as ‘intuition’, a ‘sixth sense’, or ‘gut feeling’. The development of tacit knowledge is associated with nonformal learning that occurs in the context of the workplace; however, the elusive nature of this phenomenon has served to hamper research efforts. The focus has therefore shifted away from tacit knowledge toward the more observable concept of ‘judgment’. Paramedics are called to make clinical judgments as part of their everyday practice, often unaware of the basis behind these judgments. This case study examines the source of knowledge drawn on by experienced paramedics when making judgments, especially when faced with situations they have not previously encountered, and proposes how new knowledge and meaning is constructed through such involvements. A better understanding of the relationship between knowing and judgment, and how they are developed, will have future implications for the provision of ongoing education and training programs for paramedics.

Core Networks and Tie Activation: What Kinds of Routine Networks Allocate Resources in Nonroutine Situations?

Social resources research has linked activated ties to outcomes—but not to the core networks from which the ties came. This study shifts the focus to the question of how networks allocate resources. The activation of core network ties is analyzed in a nonroutine situation—a hurricane—to determine how core network structure affects the degree to which individuals activate core network ties to gain one type of social resource—informal support. Results show that the structures of individuals’ core networks affect the degree to which individuals activate ties from those networks to gain informal support. Individuals embedded in higher-density core networks (i.e., alters are connected to one another), core networks with more gender diversity (i.e., a mix of men and women), and networks that contain higher proportions of men, kin, and younger individuals, activated core network ties for informal support to a greater degree than did individuals embedded in core networks lacking these characteristics. The conclusions consider the study's implications for understanding resource activation in the contexts of social support and job searches.

Core Networks and Tie Activation: What Kinds of Routine Networks Allocate Resources in Nonroutine Situations?

Social resources research has linked activated ties to outcomes-but not to the core networks from which the ties came. This study shifts the focus to the question of how networks allocate resources. The activation of core network ties is analyzed in a nonroutine situation-a hurricane-to determine how core network structure affects the degree to which individuals activate core network ties to gain one type of social resource-informal support. Results show that the structures of individuals' core networks affect the degree to which individuals activate ties from those networks to gain informal support. Individuals embedded in higher-density core networks (i.e., alters are connected to one another), core networks with more gender diversity (i.e., a mix of men and women), and networks that contain higher proportions of men, kin, and younger individuals, activated core network ties for informal support to a greater degree than did individuals embedded in core networks lacking these characteristics. The conclusions consider the study's implications for understanding resource activation in the contexts of social support and job searches.

Avoidant personality in social phobia and panic–agoraphobic disorder: a comparison

Background: Avoidant personality disorder (APD) is generally believed to be related to social phobia (SP), especially to generalized subtype. However, it has also been reported to be prevalent in panic disorder–agoraphobia (PDA). In the present investigation, we wished to explore whether APD in each of these disorders has discriminatory features. Method: We studied 71 SP and 119 PDA patients with state-of-the-art clinical instruments based on DSM-III-R. Results: The pattern of social avoidance in SP was more pervasive: it was characterized by a higher level of interpersonal sensitivity and greater severity, associated with psychopathology as well as a higher rate of Axis I comorbidity. By contrast, avoidance of non-routine situations characterized APD occurring in the setting of PDA. Limitations: Differences in inclusion criteria and comorbidity rates, as well as overlap between different operational disorders, may have influenced our findings. Conclusion: ADP is operationally broad, and ‘avoidant’ as a specifier of a personality type is insufficiently precise. ADP captures avoidant traits — which appear secondary to a core dimension such as interpersonal sensitivity — but is basically a heterogeneous condition influenced by the nature of comorbid Axis I disorders.

How much does it cost? How much can be saved?

How much does it cost? How much can be saved?

The Development of Fifth-Grade Children's Problem-Posing Abilities

This one-year study involved designing and implementing a problem-posing program for fifth-grade children. A framework developed for the study encompassed three main components: (a) children's recognition and utilisation of problem structures, (b) their perceptions of, and preferences for, different problem types, and (c) their development of diverse mathematical thinking. One of the aims of the study was to investigate the extent to which children's number sense and novel problem-solving skills govern their problem-posing abilities in routine and nonroutine situations. To this end, children who displayed different patterns of achievement in these two domains were selected to participate in the 10-week activity program. Problem-posing interviews with each child were conducted prior to, and after the program, with the progress of individual children tracked during the course of the program. Overall, the children who participated in the program appeared to show substantial developments in each of the program components, in contrast to those who did not participate.

Mental planning and anticipatory processes with acute and chronic frontal lobe lesions: A comparison of maze performance in routine and non-routine situations

A series of computerized mazes were masked during presentation allowing only partial view of their structure. Patients suffering from acute or chronic unilateral frontal (medial, lateral) or retrorolandic (temporal, parietal) lesions and non-brain-damaged controls were required to pass through the mazes repeatedly, until they solved them without reaching a dead end. Because the mazes could not be viewed in their entirety at any one time, the subjects were forced to mentally generate and apply a plan of the maze. The first (“non-routine” situation), the second and the last (“routine” situation) trials of the mazes were analysed separately. The prefrontal cortex is supposed to subserve important functions in the planning of behaviour in unfamiliar, non-routine situations. S HALLICE ( Phil. Trans. R. Soc. Lond. 298, 199–209, 1982; From Neuropsychology to Mental Structure, Cambridge University Press, Cambridge, 1988) therefore postulated that the behaviour of patients with frontal lobe lesions should not be disturbed in routine situations, but rather these patients should exhibit difficulties in dealing with new and unfamiliar situations. In the present investigation, patients with acute and chronic frontomedial lesions exhibited deficits in generating mental plans. Patients with acute frontomedial lesions made a larger number of errors in their second trials and subsequently required more trials to reach task criterium. Patients with chronic frontomedial lesions showed more frequent rule-breaking behaviour in their second trials. The analysis of maze performance in the first trial and that trial in which task criterion was achieved, showed that frontal lobe patients were impaired in neither routine nor non-routine situations. The observed results suggest a modification concerning Shallice's assumptions. Patients with frontomedial lesions are not generally incapable of dealing with non-routine situations. But they seem to be slower than patients with retrorolandic lesions and controls in profiting from experiences made in an unfamiliar, non-routine situation represented by the first explorations of new maze problems. This deficit can possibly be explained by the observation that anticipatory processes or the formation of expectations about possibly correct decisions in non-routine situations were altered in acute and chronic frontomedial patients. When these patients reached a maze intersection for the first time and therefore had no information about the continuation of the correct path, they showed significantly different intuitive directional decisions when compared to controls.