Staff Policy Research Articles

Mixing It Up: Operational Impact of Hospitalist Caseload and Case-Mix

Hospitalists are medical doctors that specialize in the care of hospitalized patients, a role that until recently belonged to primary care physicians. We develop an operational model of hospitalist-patient interactions with rounding and responding service modes, optimizing hospitalist caseload and case-mix to achieve the maximal reduction in patient length of stay (LOS). We show that hospitalists are effective at reducing LOS for patients with complex conditions, corroborating intuitive reasoning. However, the optimal hospitalist case-mix also includes “simple” patients with few interventions and short LOS, as they can effectively reduce discharge delays. This actionable insight is particularly salient for small community hospitals with simple, short-stay patients, where hospitalists may be undervalued due to the prevailing belief that they are primarily effective for complex patients. We conduct a comparative case study of a small community hospital and a large academic hospital, drawing a stark contrast between the two in terms of ideal caseload and patient coverage. Despite the fact that the academic hospital treats higher complexity patients, hospitalists at the community hospital should actually have a lower caseload than hospitalists at the academic hospital due to shorter stays in the community hospital. We find that both hospitals are understaffed but for different reasons: the academic hospital needs to staff more hospitalists to reduce the current caseload of its hospitalists, whereas the community hospital needs to staff more hospitalists to expand its hospitalist coverage to more patients. We estimate that these hospitals can save on average $1.5 million annually by implementing the optimal staffing policies. This paper was accepted by Stefan Scholtes, healthcare management. Funding: This work was supported by a PSC-CUNY Award, jointly funded by The Professional Staff Congress and The City University of New York. Supplemental Material: The e-companion and data files are available at https://doi.org/10.1287/mnsc.2022.4342 .

Safeguarding adults at risk of abuse: identifying educational gaps amongst hospital staff to guide training.

BackgroundSafeguarding refers to the protection of health and wellbeing and enabling “life free from harm, abuse and neglect” (Safeguarding People 2019). In Ireland, the Health Service Executive (HSE) drafted a revised 2019 policy to replace the original policy on safeguarding adults at risk of abuse. A Safeguarding Committee was founded in Beaumont Hospital, Dublin to prepare for policy implementation and staff training.AimsTo establish staff awareness and understanding of safeguarding to guide training and policy implementation.MethodCross-sectional study of 223 hospital staff using a 10-question paper survey.ResultsSuboptimal awareness of the revised HSE policy, reporting structures and confidence levels amongst staff. In-person and online training identified as the most popular methods of learning.ConclusionsKnowledge and confidence gaps can be addressed in future training. Identifying education gaps will help guide training and policy implementation.Supplementary informationThe online version contains supplementary material available at 10.1007/s11845-022-02965-4.

Residential homes for children in Ghana: Compliance with standards, quality of care, and case management

Accurate data on the extent to which residential homes for children in Ghana are in compliance with national standards for quality of care and case management are lacking. To begin to address this gap, a census of residential homes and an enumeration of the child population were undertaken in 2019, followed by a survey on a representative sample of children living in such homes. Data were gathered on the types and characteristics of all 139 residential homes operating in the country at the time and the demographic profiles and well-being of children living in such facilities. The purpose of this article is to provide information on the residential care facilities that operate in Ghana in terms of their licensing status, staffing, child safeguarding, and protection policies, as well as the safety and suitability of the premises. The article also describes the demographic profiles of the children who live in such facilities and provides an overview of the care they received and their well-being. The paper concludes with a discussion of the implications of the findings within the national context and policies on children in residential care in order to demonstrate how results are being used to inform care reform efforts and systems strengthening in Ghana.

Implementing tobacco-free policy in residential substance use disorders treatment: Practice changes among staff

IntroductionImplementing tobacco-free policies in substance use disorders (SUD) treatment may reduce tobacco-related, health disparities. This study examined adoption of tobacco-related policy and practices in six residential programs participating in a California-sponsored, 18-month, tobacco-free policy intervention. MethodsDirectors (N=6) completed surveys of tobacco-related policies before and after the intervention. Staff completed cross-sectional surveys assessing tobacco-related training, beliefs, practices, workplace smoking policy, tobacco cessation program services, and smoking status pre- (n=135) and post-intervention (n=144). ResultsDirector surveys indicated no programs had tobacco-free grounds, one provided tobacco-related staff training, and two provided nicotine replacement therapy (NRT) pre-intervention. At post-intervention, 5 programs had implemented tobacco-free grounds, 6 provided tobacco cessation training, and 3 provided NRT. Across all programs, staff were more likely to report smoke-free workplaces (AOR = 5.76, 95% CI1.14,29.18) post- versus pre-intervention. Staff positive beliefs towards addressing tobacco use were higher post-intervention (p<0.001). Odds of clinical staff reporting tobacco-related training participation (AOR = 19.63, 95% CI14.21,27.13) and program-level provision of NRT (AOR = 4.01, 95% CI 1.54, 10.43) increased post- versus pre-intervention. Clinical staff reporting they provided tobacco cessation services were also higher post-intervention (p= 0.045). There were no changes in smoking prevalence or quit intention among smoking staff. ConclusionA tobacco-free policy intervention in SUD treatment was associated with implementation of tobacco-free grounds, tobacco-related training among staff, more positive staff beliefs towards and delivery of tobacco cessation services to clients. The model may be improved with greater emphasis on staff policy awareness, facilitating availability of NRT, and reducing staff smoking.

Dynamism in policy-affiliated transition intermediaries

Transition intermediaries are actors that support socio-technical transition processes by bridging structural deficiencies in a transitioning domain. Previous research has identified what roles transition intermediaries perform and how. However, while transitioning domains are by definition in a state of change, the dynamics of transition intermediaries have hardly been studied. Therefore, we explore what mechanisms are driving change in transition-supportive roles of intermediaries, and what kind of conditions enable an intermediary to be dynamically adaptive in supporting a transitioning domain. These questions are addressed in a longitudinal case study of a major European intermediary in sustainable energy. We find this intermediary changed its transition support activities as a result of the frontline staff continually exploring the needs of transition stakeholders and designing new value offerings in response. These role dynamics are enabled by a structure where the policy principal delegates the choice of support activity and external accountability to the intermediary, which organizes itself in a customer-oriented manner. As such, we conclude that the dynamics in intermediaries’ transition activities arise from the interplay between policy mandate, organizational structure/design and staff agency.

Stepping in and up to meet community needs: How community-based college access and success programs responded to COVID-19.

The current study uplifts the efforts of community‐based college access and success programs (CAS) to support the college preparation, matriculation, and persistence of underserved students during COVID‐19. Fifty‐eight CAS across the United States completed an online survey that gathered information about organizational demographics, COVID‐19 challenges, responses to challenges, and communication with constituents and funding needs during COVID‐19. Results suggested CAS faced multiple challenges due to COVID‐19 that affected the organization, staff, and constituents. Results also revealed organizations of varying sizes, locations, and demographics responded to challenges by revising existing programming for students, creating new programming for students and caretakers, and updating staff policies to meet ongoing and emergent needs despite limited resources. CAS are essential service providers for students who are under‐ and mis‐served in formal education systems. Recommendations are provided for how such organizations can be invested in and better prepared for future disruptions.

Japanese school administrators\u2019 experiences after the implementation of the Top Global University Project language policy

As a result of globalisation, many higher education institutions in Japan have made changes to their curriculum and administrative system to attract international students. The Japanese government has also carried out different policies to support universities across the country and accelerate their internationalisation process. The study focuses on the implementation of the 2014 Top Global University Project (TGUP) in 37 Japanese higher education institutions. School administrators were interviewed in relation to their experiences with policy implementation. After coding and analysing the interview data, three themes were selected for discussion a) the financial burden; b) the English policy for staff; and c) policy transmission within an institution. Bernstein’s notion of the pedagogic device was employed to analyse school administrators’ discourses concerning the policy. Findings revealed how the process of implementation has taken place and the issues affecting its proper execution. The study concludes that top-down relations of power and control, hierarchies, people’s ideologies, and management culture affect and delay the internationalisation process of higher education.

Adequacy of Inquiry About, Documentation of, and Treatment of Trauma and Adversities: A Study of Mental Health Professionals in England.

This study aimed to ascertain how often staff in community mental health services (CMHSs) in England ask about adverse experiences in childhood and adulthood, including abuse and neglect, how often those experiences are known about and documented by staff, and how staff respond when such experiences are known about and documented. The files of 400 people using four CMHSs in England were reviewed. Only 13% of clinical records contained documentation of any adverse experiences. One percent showed clear evidence that clients had been asked about adversities. People with psychosis diagnoses were less likely to have adverse experiences documented in their file. Rates of responses to adversities of which staff were aware were high, with 90% of records indicating some appropriate support following disclosure. Future research endeavours are recommended, including on reasons for not routinely asking and on type of training needed. Recommendations are made in relation to policy change, staff training and guidelines to improve routine enquiry about adversities. Ultimately, a move to 'trauma-informed' services, already underway in some areas, is required for all mental health services.

In search of didactics in school-age educare centres: To conceptualise what exists, but has not yet been found

The purpose of this paper is to focus on approaches that could build a didactic framework for School-Age Educare Centres (SAECs). As a theoretical basis and a research field, didactics exists within many disciplines (e.g., education in natural sciences and preschool). This is not the case within the SAEC. While a lot of research has been devoted to subject didactics, there is a lack of research on didactics in SAECs, and the marginal research that exists shows a fragmented picture of what it could consist of. However, researchers in the field agree that didactics in SAECs is something else than subject didactics and differs from general didactics. Our aim in this paper is to suggest and discuss how a didactic framework in SAECs could be conceptualized with an intention in the near future to find the specific didactics that distinguishes the work in SAECs. The proposed design involves theory building/testing with a bottom-up perspective and various data collection methods. Because building a didactic theory for SAECs is the intention, the research process will take informed grounded theory (GT) as its methodological starting point. The empirical material will be related to the two dominant didactic frameworks: the German and the Anglo-Saxon. This framework will also be critically reviewed in relation to the activities in SAECs. The results will contribute important knowledge to the development of a relevant and useful didactic theory for SAECs. The practical implications are directly relevant to every stakeholder affected by the SAECs’ activities: policy actors, staff, students, and researchers. In the long term, we will be able to find a legitimate platform for didactics in SAECs, which will have concrete importance for professionals and researchers in particular. The purpose of this paper is to focus on approaches that could build a didactic framework for School-Age Educare Centres (SAECs). As a theoretical basis and a research field, didactics exists within many disciplines (e.g., education in natural sciences and preschool). This is not the case within the SAEC. While a lot of research has been devoted to subject didactics, there is a lack of research on didactics in SAECs, and the marginal research that exists shows a fragmented picture of what it could consist of. However, researchers in the field agree that didactics in SAECs is something else than subject didactics and differs from general didactics. Our aim in this paper is to suggest and discuss how a didactic framework in SAECs could be conceptualized with an intention in the near future to find the specific didactics that distinguishes the work in SAECs. The proposed design involves theory building/testing with a bottom-up perspective and various data collection methods. Because building a didactic theory for SAECs is the intention, the research process will take informed grounded theory (GT) as its methodological starting point. The empirical material will be related to the two dominant didactic frameworks: the German and the Anglo-Saxon. This framework will also be critically reviewed in relation to the activities in SAECs. The results will contribute important knowledge to the development of a relevant and useful didactic theory for SAECs. The practical implications are directly relevant to every stakeholder affected by the SAECs’ activities: policy actors, staff, students, and researchers. In the long term, we will be able to find a legitimate platform for didactics in SAECs, which will have concrete importance for professionals and researchers in particular.

Analysing the staff supply of a dairy enterprise in the Samara region

The key objective of any enterprise's staff policy is to form a system of providing managers, specialists and workers of mass professions who can solve tasks of future development at a high professional level. The volume and timeliness of all work, the efficient use of fixed assets and, as a result, the volume of production, its cost, profit and several other economic indicators depend on the availability of labour resources and the efficiency of their use. The most important social and labour indicators in enterprises are ensuring full employment of labour resources and high labour productivity, creating good working conditions for staff and increasing wages, achieving proper economic growth and quality of life for workers. Labour has a major role to play in realizing these economic objectives. The article analyses the indicators characterizing the level of labour supply of the enterprise, their qualitative composition and the level of labour productivity.

Categorical framework for implementation of industry 4.0 techniques in medium-scale bearing manufacturing industries

In the current industrial scenario, the concept of a smart factory has evolved intending to manufacture the products to meet international standards in the age of cutthroat competition. To enhance the quality of a product, technological up-gradation and intervention have become the need of the hour in manufacturing industries. Excellent product quality in turn guarantees customer satisfaction. The present research paper aims to build a roadmap and key plan of technology intervention by implementing Industry 4.0 techniques in a medium-scale bearing manufacturing industry. The thrust areas of the paper are working on a strategy while implanting industry 4.0 techniques in the industry, various challenges to be faced while implementing the smart factory concept. the technological gap between traditional manufacturing and Industry 4.0, the components of industry 4.0 like Cyber-Physical Systems, the Internet of things, advanced robotics, advanced sensors, artificial intelligence, and cloud computing. The paper also throws light on various Industry 4.0 techniques that can be applied in different departments of the medium-scale bearing manufacturing industry to improve the quality of a product and customer satisfaction. The paper also discusses the pre-requisites for implementing the concept of Industry 4.0, namely, team work policy and trained technical staff, and elucidates how implementing Industry 4.0 improves productivity and overall plant effectiveness.

Leadership in education as the principal direction of educational policy

The article is devoted to the analysis of theoretical and practical aspects of educational leadership. It is noted that leadership is a model of management of an educational organization that stimulates the innovative behaviour of teachers, ensures the use of innovations at all levels of the organization. It should create the practice of corporate management in order to support the innovative behaviour of teachers at educational institutions of various types. It is shown by the author that one of the principal directions of the state educational policy is leadership in education as a way of effective staff management in the education management system. Various approaches to the definition of educational policy are proposed, where common indicators are: the organized and purposeful activity of the state; the complex system of measures of state institutions; the key subject of educational policy in society is the state; the education system is a leading institution of a democratic society. The priority areas of educational policy are highlighted: ensuring state guarantees of access to quality education; creation of conditions for improving the quality of general and vocational education; formation of effective economic relations in the education system; enrolling highly qualified specialists to the system of education, their support by the state and society; management of education development based on the distribution of responsibility between the subjects of the educational policy. The emphasis is placed on the technique of managing a structural unit at an educational institution (a set of operations, processes and procedures of managerial activity that are performed formally, based on rules and instructions). It has been proven that the training of managers in the main aspects of staff policy in the field of education, the involvement in training programs and advanced training in matters of staff management, contribute to the formation of scientifically based work with scientific and pedagogical staff, which ensures the effective organization of the educational process

A strict mask policy for hospital staff effectively prevents nosocomial influenza infections and mortality: monocentric data from five consecutive influenza seasons

Influenza infections acquired in hospital show increased mortality, especially in elderly patients with risk factors. Nevertheless, vaccination rates are low among both high-risk patients and healthcare workers (HCWs). To more effectively prevent influenza infections in the hospital during the influenza season, a strict mouth-nose protection (MNP) requirement was introduced for all staff throughout the shift on the affected wards as an intervention and its effect on nosocomial infection rates was studied. The present data were obtained in a retrospective, monocentric analysis over a period of four consecutive influenza seasons from 2015 to 2019. MNP for all staff during the whole shift as an intervention was introduced in 2017 and for the following seasons if at least three influenza patients were in the ward at the same time. Data from hospitalized influenza patients before and after intervention were compared with regard to nosocomial incidences and mortality. In the years with strict mandatory MNP (2017-2019), the nosocomial influenza incidence fell nearly 50% (odds ratio: 0.40; 95% confidence interval: 0.28-0.56; P < 0.001) accompanied by a significant reduction in nosocomial mortality by 85% (0.15; 0.02-0.70; P= 0.007). The infectious pressure indicated by influenza incidences and patient-days at risk were comparable before and after intervention, as was the low rate of vaccine uptake by nurses. Mandatory MNP for HCWs effectively protects patients from nosocomial influenza infections and mortality.

Trends in Delirium Rate Across 14 Hospitals During the COVID-19 Pandemic: A Comparative Study.

During the COVID-19 pandemic, strategies to prevent delirium in the hospital were limited due to restrictions in staff and visitor policies. Thus, we suspected the delirium rate may increase during the pandemic. This study aimed to investigate the trends in delirium rate over past 2-years and compare this trend prior-to-and-during the COVID-19 pandemic in hospitalized older adults. Data was retrospectively obtained from the Acute-Care-for-Elders Tracker snapshot, an electronic health record tool to identify the presence of delirium within 48hrs of hospitalization for patients ≥65 years. Periods of interests were 3/2019-6/2019 (pre-COVID) and 3/2020-6/2020 (during-COVID). A weighted rate was calculated for each month by combining data from all hospitals for the total number of inpatients ≥65 years. The overall trend in the delirium rate was assessed with simple linear regression models and an ANCOVA. A χ2 and a Wilcoxon-Signed-Rank-Test were utilized to test for differences in the overall delirium rate between two time periods. Overall median delirium rate was 6.8% in 70,562 encounters of 42,878 patients (mean age= 78 years; mean length-of-stay= 6.5 days). The median delirium rate increased by 2.1% (6.6%to8.6%), for pre-COVID vs. during-COVID, respectively (Z=-3.044,p<0.001). There were no significant differences between actual and projected weighted delirium rates (p=0.18). However, the weighted delirium rate—for both the actual and projected trend lines—demonstrated significant changes over time (p<0.001).The trend in delirium rate increased over the study time period regardless of the pandemic. Further analyses with longer time-frame are crucial to understand the consequences of the pandemic on delirium rate.

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities

Advancing food democracy: The potential and limits of food policy positions in local government

For several decades, food policy councils (FPCs) have led the effort to place food on local govern­ment policy agendas. While FPCs are making pro­gress in supporting local food systems, they also face institutional and organizational challenges. In recent years, a handful of cities and counties have endeavored to further food system reform with the establishment of full-time government staff posi­tions focused on food policy. As of spring 2020, there were 19 confirmed food policy positions housed in local governments across the United States. While there is considerable literature on FPCs, little research has been published regarding food policy staffing in local governments. Accordingly, this study uses original in-depth inter­views with 11 individuals in municipal or county food policy positions to understand the purpose and function of governmental food policy staff positions and their impact on local food systems. Our findings suggest that these positions help to coordinate and nurture local food programs and policies and have the potential to facilitate mean­ingful participation of individuals and groups in the community in food system reform. We discuss the potential benefits and challenges for governmental food policy positions to support food democracy, and provide the following recom­mendations for communities interested in estab­lishing or strengthening similar positions: (1) iden­tify and coordinate existing opportunities and assets, (2) foster and maintain leadership support, (3) root the work in community, (4) connect with other food policy professionals, and (5) develop a food system vision.

Exploring Camp Policies and Leadership Opinions on Digital Media Use in Camps

While summer camps provide children a unique experience away from home, this environment may lead to increased and unsupervised use of digital media. Camps’ policies and leaderships’ views on digital media consumption in camps are currently unknown. To elucidate current trends, we partnered with CampDoc.com to survey a national sample of camp leadership about digital media policies and practices. A single response was selected from each camp and analyzed using descriptive statistics. Free text responses reflecting on positive and negative experiences with digital media were assessed using thematic analysis. We received 722 responses from 363 of the 950 camps within the Camp Doc network. Respondents represented camps in 45 states in the United States. Internet and cell service were available in 22.3% and 34.7% of camps, respectively. Approximately 60% of camps reported a digital media policy for campers and staff. Most policies (67.9%) did not allow use of digital media devices. Camp leadership reported that smartphones (51.3%) and social media apps (42.2%) were most difficult to restrict. Qualitative themes focused on the benefits of digital media for creativity and connection, but also the interruption of camp experiences. Camp personnel described positive media uses aligned with American Academy of Pediatrics media guidelines, for teaching creativity, acquiring new skills, and understanding the value of unplugging for creating social connections. Although most camps have policies restricting digital media use, complete restriction may be difficult.

Comparative Analysis of Regional Elite of The Communist Party and «Just Russia»: Social Characteristics and Channels of Recruitment

The article presents a comparative analysis of the socio-demographic characteristics and recruitment channels of the regional political elite of CPRF and «Fair Russia». The study uses heads of regional party branches as a political elite group that holds key positions in party structure and selects candidates for all levels of elections. The empirical data includes 170 representatives of the party elite. The analysis showed differences in the age structure of the party elite. The largest demographic group of the Communist Party is people over 60 years old, in «Just Russia» the same group is between the ages of 40 and 50. During the last years, CPRF begun management reform and system renewal of staff policy by young party leaders, in contrast to «Just Russia» where the system of elite recruitment is rather random. The representation of women in the elite of both parties is insignificant and amounts to 9% in the Communist Party and 11% in the «Just Russia». The study traces an increase in the share of professional lawyers among the younger generation (25-40 years old) of regional elite in both parties. Finally, we have identified significant differences in the key recruitment channels of elite groups. About 50 per cent of persons from CPRF were appointed to the elite position because of their long and active party work. In «Just Russia», the key recruitment channel is large and medium-sized regional business.

Dialectical Analysis of Global Staffing Policy

Global staffing is an essential aspect of human resource management in multinational corporations (MNC) (Collings &amp; Scullion, 2009). As the positioning of multinational organizations gradually becomes global, multinational companies must cultivate suitable global personnel. Flexible and adequate staffing and management skills can give transnational corporations a particular competitive advantage in global operations (Collings &amp; Scullion, 2009). Understanding the background of the local market and gaining and sharing tacit knowledge in jobs around the world are all necessary professional skills for the multinational company (Harvey et al., 1999). However, human resources management departments also face more significant challenges as the multinational company expands its business globally. Learning how to effectively respond to the staffing problems of multinational companies in the course of operation reflects the company's operating capabilities. This article will first define and elaborate the global staffing policy, while the factors that will make the system more effective will be introduced. Secondly, the current problems and challenges faced by multinational companies will be listed, followed by corresponding measures. Finally, other recommendations will be provided in some areas for the human resources of multinational companies.

Looking Back: Reviewing the Challenges of Policy Development During the COVID-19 Pandemic for a TNE Partnership in Higher Education

This paper takes a retrospective view of the year 2020, with a focus on how Higher Education policy development was undertaken on a Transnational Education (TNE) program between the University of Glasgow (UofG) and the University of Electronics, Science and Technology in Chengdu (UESTC), China in response to the COVID-19 pandemic. It explores the approach to policy development under normal circumstances, contrasting this with the approach taken during the emergence of the epidemic and how the unfolding situation impacted on those policies. It demonstrates how the application of management tools for scenario planning and crisis management can be used effectively to develop a clear and prescriptive policy for staff. It also demonstrates how the use of such tools, combined with careful analysis and planning, can minimize disruption to student learning, teaching, and assessment. The paper then goes on to explain the creation and implementation of policies addressing three main areas: learning and teaching, Final Year Projects, and assessment. Finally, it reflects on the student and staff perspectives on the policies, considering how this information might be used to enhance the policy development process in future.