Staff Structure Research Articles

Innovations in staffing and service delivery structures and modalities in small institutions

AbstractSmall institutions are in a unique and perhaps necessary position to innovate as the field changes, resources falter, and the needs of the next generation of students and families become apparent and quite different from those supported by our historical structures and service modalities. This article examines the literature surrounding historical and innovative practices that higher education can explore to inform the future of student development practice. Additionally, the article explores new structural models and examines the efficacy of retaining the scaled down versions of the structures of large universities instead of creating new modalities that increase staff performance, provide better work/life harmony, create more efficient and effective services and functions, while increasing student engagement and connection.

Does staffing impact health and work conditions of staff in long-term care homes?: a scoping review

Abstract Background Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC? Methods A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years. Results Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness. Conclusions Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives. Key messages • With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce. • Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.

Social Workers' Experiences of Working With Support Workers in Services for Adults With Intellectual Disabilities in Hong Kong.

Services for adults with intellectual disabilities in Hong Kong have a hierarchical staffing structure. Professional social workers, who performed as mid-level employees, work with frontline support workers to deliver services to clients. This qualitative study explored social workers' experiences of working with support workers through in-depth interviews with 13 participants. The study revealed that social workers perceived a significant variation between themselves and support workers in terms of working motivation, values and attitudes towards clients with intellectual disabilities. Despite the hierarchical relationships, social workers and support workers share the power of service decision-making. Social workers used firm and gentle approaches to facilitate changes in practices to uphold service values. These findings were compared with Western literature on this topic, indicating similarities and differences. The organisations need to facilitate an effective collaboration between social workers and support workers to enhance the quality of services for adults with intellectual disabilities in Hong Kong.

Strategies to Improve Employee Engagement and HR Quality at M Educational Institution Jakarta

The development of education is no less important than the economic and social world. However, in recent years the workforce in the world of education has experienced significant turnover which has hampered the development of teaching. Therefore, it is necessary to analyze and discuss the level of employee engagement and the quality of human resource management using the example of the educational institution M Educational Institution Jakarta. This research was conducted by conducting interviews and distributing questionnaires to educational personnel as subjects. In this study, we identified the core concepts of employee engagement in educational institutions, designed an engagement questionnaire and a satisfaction questionnaire, and conducted a survey. Getting the results from this research, there are problems such as incomplete human resource development mechanism, high human resource mobility, serious exit of high-quality human resources, unbalanced faculty staffing structure, and incomplete performance evaluation and incentive mechanism. Analyzing the problems and their causes, it is necessary to propose constructive solutions and countermeasures, identify common problems in employee participation and human resource management in educational institutions, and improve strategy development and policy adjustment depending on the problems. The result of this research is that increasing employee engagement and the quality of human resources is very important. In the development of the M Educational Jakarta institution, it requires the implementation of a scientific and rational human resource management mechanism, with the concept of project management as a systematic implementation framework, which can also be a guide in managing HR in educational institutions, and ensuring the effectiveness of HR operations.

Associations of the staffing structure of intensive care units and high care units on in-hospital mortality among patients with sepsis: a cross-sectional study of Japanese nationwide claims data

ObjectiveThe objective was to analyse the associations of intensive care unit (ICU) and high care unit (HCU) organisational structure on in-hospital mortality among patients with sepsis in Japan’s acute care...

(1315) - International Survey: Ventricular Assist Device Program Staffing Structure and the Role of VAD Coordinator

(1315) - International Survey: Ventricular Assist Device Program Staffing Structure and the Role of VAD Coordinator

Digital economy policy and enterprise digital transformation: Evidence from innovation and structural effect

AbstractUsing a sample from 2010 to 2021 of listed companies in Shanghai and Shenzhen A‐shares, we explore the effect of digital economy policy (DEP) at city level on enterprise digital transformation (EDT). We find that DEP can promote EDT. And the outcome remains valid following a sequence of rigorous tests to assess its robustness and account for endogeneity. Further analysis indicates that DEP plays roles by internal innovation effect and external structural effect. Moreover, this positive effect will be stronger in enterprises in manufacturing and high‐tech industries and those with better staffing structure, higher enterprise productivity and value. Also, we find that the effect of DEP on enterprises varies in regions with different government subsidy, digital infrastructure level, and location.

Experiences, Benefits, and Challenges of Virtual Teamwork for Public Libraries in the US Midwest during the COVID-19 Pandemic

Experiences, Benefits, and Challenges of Virtual Teamwork for Public Libraries in the US Midwest during the COVID-19 Pandemic

Revisiting the concept of highly skilled professionals: an analysis of support staff in Finnish universities

Changes in university staffing structures, the professionalisation of support staff and their increasing role in universities have been studied with varying perspectives and methods over the last two decades. The discussion has recently been enriched by the research conducted in different national settings. This paper contributes to the international debate and elaborates on the theme through two aims. The first is to investigate the emergence of a specific qualified professional group and its characteristics by analysing personnel data from Finnish universities. Second, the article seeks to indicate recent developments in the number and composition of professional staff in Finnish universities. The study is based on national official statistics on university personnel, some of which are previously unpublished, and on personnel data collected from all Finnish universities using an analytical framework built for this study. The results provide a comprehensive picture of the changing structure of the university workforce and a new insight into a previously studied occupational group through a lens of Finnish university system. The decline in the number of professional staff and the emergence of new kind of professionals in Finland reflect changes witnessed elsewhere, especially in Europe. Highly skilled professionals work in roles with specific knowledge, competences and responsibilities, which points out the differentiation of functions in the university system. This knowledge will support efforts to develop the university organisation by building on the competence of all staff.

A university in Buxton - a place of extinguished chances or a promise delayed?

The University of Derby opened a new university campus in Buxton in 2000. The aim was to produce a socially desirable outcome - better prospects for jobs and lives, and more freedom through learning. The university would help people overcome limits on their lives by openly examining them: the true purpose of education. It represented a challenge to the neoliberal idea that the vitally important social and economic function of learning could be left to market forces. Like many former industrial centres, the town needed to re-invent itself and find creative ways to adapt to the new economic realities. Buxton was different from almost anywhere else in the UK because it offered further and higher education on a single campus, with a unified staffing structure and a single academic management. It offered vocational degrees such as Tourism and Hospitality, Outdoor Pursuits and further education teacher training. In November 2019, however, it was announced that all HE courses at the campus would be closed. The story of this abrupt volte face raises many questions about the way higher education is run in the UK today. The decision was made as if the central university was a business with different cost centres. The article explores the background to this story: it covers wider issues such the chaotic marketisation of higher education, which appeared to offer choice but in fact was managed in such a way as to privileged existing elite institutions; the rules of a numbers game that favoured approaches based on conservatism and corporate uniformity, so that campuses are no longer able to reflect the diversity of our communities; the running of universities as businesses, so that educational concerns are excluded from decision–making; the centralisation of control by those who restrict to themselves the ability to collect and analyse the metrics which are used to legitimise and justify decisions; and the arbitrary power of Vice Chancellors. Ultimately, the closure was the result of a management system that was no longer commensurate with the university's stated commitment to the opening up of higher education to a wider range of people.

Framing, classification, and conceptual linkages: What can interdisciplinary practice in small secondary schools contribute to the curriculum conversation?

AbstractThis article reports on the design of interdisciplinary units in five International Baccalaureate schools in Norway and Denmark, each with fewer than 100 students in their Middle Years Programme. The mixed methods study describes subject combinations and time frames of 37 enacted units and 111 hypothetical interdisciplinary units, and the qualitative perspectives of nine teachers, representative of the curriculum frameworks' eight subject groups, on the contribution of these school‐based units to student learning. In the special context of schools with logistically simple staffing structures, interdisciplinary units were consistently conceived and enacted as substantial units, typically implemented over 8 weeks. Subjects were usually paired using a common Key Concept and differentiated by Related Concepts. Although framing and classification were considerations in interdisciplinary planning, the quantitative data found nearly every pairing of the subject groups was feasible. Interdisciplinary units were consistently valued by teachers for helping students connect disciplinary knowledge and developing metacognitive skills that supported their future learning, and for enriching teachers' own pedagogical practice. As a pragmatic, sustainable approach that resolves the tensions posed by assessment of disciplinary and interdisciplinary perspectives, the strategies reported in this study suggest a ‘middle way’ for countering the disciplinary fragmentation associated with junior secondary education.

Analisis Desain Kelembagaan Pengadaan Pegawai Pemerintah dengan Perjanjian Kerja (PPPK) Guru di Kabupaten Lumajang

The momentum formation of a new status in the staffing structure in Indonesia raises pro and contra, especially for the teaching profession. This is not surprising because it is accompanied by the discourse of eliminating the existence of honorary workers in November 2023. Even though until now the number of honorary workers has dominated compared to the ASN. This study aims to analyze the procurement of PPPK teachers carried out in Lumajang regency using the Institutional Analysis and Development (IAD) point of view. In this case it will be seen how the agenda is designed to attract as many teachers as possible. Methode Using a case study qualitative research method with data collection techniques through interviews and documentation. The results of the study show that PPPK procurement in Lumajang is running quite well. Succesfully implementing a Merit System so that the selected teachers are truly highly qualified and competent in their fields. It can be concluded the procurement of PPPK teachers has a structured and more objective implementation plan. However, there are still some things that needed improvement such as available formations and affirmation policies.

Practice patterns in extracorporeal life support in tertiary cardiac intensive care units in north america: a survey-based analysis from the critical care cardiology trials network

Abstract Funding Acknowledgements Type of funding sources: None. Background The use of veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has significantly increased in the last decade. However, there is substantial variability in practice patterns between institutions. To date, the optimal ECMO program model is unclear and possible differences between ECMO centers in staffing, organization and team structure have been poorly characterized. Purpose Our aim was to describe contemporary practices of care for patients undergoing ECMO in tertiary cardiac centers in North America. Methods An 11-question anonymous survey was sent to all participating sites in the Critical Care Cardiology Trials Network (CCCTN), a prospective registry of advanced cardiac intensive care units (CICUs) in North America, coordinated by the TIMI Study Group. The survey evaluated ECMO staffing models, decision-making processes, cannulation and longitudinal care. Results The response rate was 100% (39/39) across CCCTN centers. The decision to proceed with VA ECMO was made as a team in 79% of the cases and in 58.3% of the VV ECMO cases, rather than by an individual specialty. An ECMO consult service was used in 67% of the centers, and integrated with the cardiogenic shock team in 58%. The most common specialty participating in the ECMO service was cardiothoracic surgery (CTS) (73.1%), followed by heart failure specialists (38.5%), with critical care cardiology (CCC) in only 23.1% of the centers (Figure 1A). In the majority of centers, VA ECMO cannulation was performed by CTS alone (46.2%), Interventional cardiology (IC) and CTS (38.5%), and IC alone (7.7%, Figure 1B). Cannulation for VA ECMO was not performed by intensivists at any center. VV ECMO cannulations were performed by CTS in 51.3%, intensivists in 17.9% and IC in 2.6% of the centers. VA ECMO patients were admitted to the cardiovascular surgical intensive care unit in 64.1% of centers, with 20.5 % admitted to the CICU (Figure 1C). VV ECMO patients were admitted to the cardiovascular surgical intensive care unit in 36.8% of sites, and the medical intensive care unit in 34.2%. The most common ECMO specialist model was having a perfusionist at the bedside, followed by nurse specialist (Figure 1D). Specialty services consulted within 24-48 hours of cannulation included physical therapy in 48.7%, palliative care in 30.8%, and bioethics in only 2.6% of centers. Simulation-based ECMO training is performed in 59% of the centers. Half (51.3%) of the centers perform ECPR, while 17.9% reported plans of developing a program. Conclusions Although there is significant variability in ECMO cannulation, location of care, staffing practices in advanced CICUs in North America, a multidisciplinary team approach is common in ECMO centers, with early involvement of physical therapy and palliative care specialists. Further research to establish the optimal model for ECMO programs is of high importance.

Quantifying Housekeeping Challenge and Conservation Need

This simple model, developed by conservators, assists in the challenge of making preventive conservation, housekeeping, and care of historic interiors and collections, physically and economically sustainable, in historic houses welcoming increasing volumes of visitors (a primary source of dust). It introduces objectivity into conservation advice and management decisions: how many collections care staff should each historic house ideally employ, and how large an annual budget is required to fund the non-wage costs of routine preventive and interventive conservation? Are staffing structures rational and consistent, and tailored to the individual and developing circumstances of multiple properties? Eight qualitative and quantitative criteria are each given a score from 1–4 in relation to their data ranges. The total scores for each property are converted to percentages, correlated with staffing structures, and used to estimate the requirements for daily, weekly and annual housekeeping and conservation cleaning. Selected data are used to measure housekeeping performance against weekly targets, and to rationalize the distribution of financial resources for preventive conservation and maintenance. The model can be adapted for use in any museum or heritage building which needs to assess and quantify the routine care of interiors and collections on open display to visitors.

449 Multidisciplinary deprescribing review for frail older adults in long-term care: Development of a theory informed implementation strategy using a Delphi survey and Roundtable discussion with stakeholders

Abstract Introduction Deprescribing, the systematic process of stopping or altering inappropriate medicines, has been suggested as a safe, effective and appropriate process to optimise prescribing for older adults (1). There is still a lack of understanding of how best to implement sustainable deprescribing in long-term care (LTC). Aim Design a theory-driven implementation strategy, based on consensus from healthcare professionals (HCPs), to facilitate their engagement with deprescribing for frail older adults in LTC. Methods This study consisted of three phases and was designed in conjunction with HCPs working in LTC. Firstly, barriers and enablers to deprescribing in LTC previously identified by the research team were mapped to behaviour change techniques (BCTs) (2). Secondly, a Delphi survey of HCPs (General Practitioners (GPs), Pharmacists, nurses, geriatricians and psychiatrists of old age) was conducted to select feasible BCTs to support deprescribing. HCPs were purposively sampled and recruited via email, divided into HCPs working in Ireland and internationally. Experts were identified from existing professional relationships, engagement with LTC or deprescribing research. Using the results from the Delphi process, the literature on deprescribing interventions and research team knowledge, the BCTs which could form components of an intervention in LTC were shortlisted based on was acceptability, effectiveness, affordability, safety and equity (APEASE). Finally, a roundtable discussion was held with a purposeful, convenience sample of GPs, Pharmacists and nurses working in LTC in Ireland, to prioritise the previously identified barriers/enablers and operationalise the proposed deprescribing strategies created from feasible BCTs and identify the most important strategy to facilitate deprescribing. Results Overall, 34 BCTs were mapped to previously identified barriers/enablers to deprescribing in LTC. For the Delphi survey, 33 HCPs were invited, 20 agreed and it was completed by 16 participants. The Delphi consisted of two rounds. Participants reached consensus that 26 of the BCTs could feasibly be implemented in LTC. Following the APEASE assessment, 21 BCTs were considered eligible for operationalisation. The roundtable discussion, consisting of eight HCPs, identified that lack of resources (time, staffing, technology), was the most important barrier to address. The agreed implementation strategy to enhance engagement with deprescribing processes was an education session prior to a multidisciplinary team (MDT) meeting, led by a nurse from the LTC setting. This was designed from 11 BCTs, including action planning, social support and environmental restructuring addressing the predominant barrier. Incorporating the MDT reduces the burden which would exist if the responsibility was placed on one HCP. Meeting at the LTC site addresses the insufficient technology, as patient information is available. Conclusion This study describes an implementation strategy design process following principles of behavioural and implementation science. Engaging targeted end users throughout the process allows for the creation of a strategy which is intended to address the main perceived barrier to deprescribing of insufficient resources. A limitation of this study is the specificity of the intervention for Irish LTC context, which may have different staffing and organisational structures compared to international healthcare systems.

Public sector physiotherapists' organisation and profile: Implications for intensive care service.

Physiotherapists are essential in the management of hospitalised patients. The way in which a physiotherapy service is offered in intensive care units (ICUs) can affect ICU patient outcomes. To provide a clear picture of the organisation and structure of physiotherapy departments, the number and types of ICUs requiring physiotherapy services and the profile of physiotherapists working in South African public-sector central, regional and tertiary hospitals that house Level I-IV ICUs. Cross-sectional survey design using SurveyMonkey, analysed descriptively. One hundred and seventy units (the majority Level I, functioning as mixed [37%, n = 58] and neonatal [22%, n = 37] units) are serviced by 66 physiotherapy departments. The majority of physiotherapists (61.5%, n = 265) were younger than 30 years, had a bachelor's degree (95.1%, n = 408) and were employed in production Level I and community service posts (51%, n = 217) with a physiotherapy-to-hospital-bed ratio of 1:69. Insight into the organisational structure of physiotherapy departments and physiotherapists working in public-sector hospitals with ICU facilities in South Africa was provided. It is evident that physiotherapists employed within this sector are young and early in their career development. The large number of ICUs functioning within these hospitals and high bed-to-physiotherapist ratio is concerning, highlighting the high burden of care within this sector and the possible effect on physiotherapy services in the ICUs. A high burden of care is placed on public-sector hospital-based physiotherapists. The number of senior-level posts within this sector raises concern. It is not clear how the current staffing levels, physiotherapist profile and structure of hospital-based physiotherapy departments affect patient outcomes.

Harmonizing Qualitative Data Across Multiple Health Systems to Identify Quality Improvement Interventions: A Methodological Framework Using PROSPR II Cervical Research Center Data as Exemplar

Background: Heterogeneity in healthcare systems’ organizational structures, policies and decisions influences practice implementation and care delivery. While quantitative data harmonization has been used to compare outcomes, few have conducted cross-site qualitative inquiry of healthcare delivery; thus, little is known about how to harmonize qualitative data across multiple settings. Objective: We illustrate a methodological approach for a theory-driven qualitative data harmonization process for the PROSPR II Cervical Research Center, a large multi-site, mixedmethods study evaluating cervical cancer screening across three diverse healthcare settings. Methods: We compared three geographically, socio-demographically, and structurally diverse healthcare systems using a multi-modal qualitative data collection strategy. We grounded our sampling strategy in a cervical cancer screening process model, then tailored it for system-specific differences (e.g., clinic staffing structure and individual roles). Data collection tools included domains corresponding to shared research objectives (e.g., abnormal follow-up) while accommodating local context. Analysis drew on operational domains from the screening process model and constructs from the Consolidated Framework for Implementation Research and Normalization Process Theory. Results: Exemplars demonstrate how data harmonization revealed insights suggesting opportunities to improve clinical processes across healthcare systems. Discussion: This analysis advances the application of qualitative methods in implementation science, where assessing context is key to responding to organizational challenges and shaping implementation strategies across multiple health systems. We demonstrate how systematically collecting, analyzing and harmonizing qualitative data elucidates the impact of process factors and accelerates efforts to identify opportunities for quality improvement interventions.

ВПЛИВ ГІБРИДНИХ ВІЙН ПРОТИ УКРАЇНИ НА ІНФОРМАЦІЙНО-МЕДІЙНІ ПІДРОЗДІЛИ ЗБРОЙНИХ СИЛ ЛИТОВСЬКОЇ РЕСПУБЛІКИ (2013-2021РР.)

The article examines the activities of the information, media and cyber units of the Armed Forces of the Republic of Lithuania and its Ministry of Defense as constituent components in informing their own population, the international community and enlisting maximum support for their actions, countering information threats through mass media and cyber attacks from unfriendly countries that are trying to influence the Republic of Lithuania. The peculiarities of national legislation regarding national and information security, the functioning of the strategic communications system, the activities of the press services of the Armed Forces of the Republic of Lithuania and their mass media, methods of responding to information incidents and the formation of relevant reports are analyzed. The task and structure of the military mass media (newspapers, radio and television, Internet resources), information agencies and press services have been studied. For the first time, the activities and organizational staffing structure of the information and media structures of the Armed Forces of Lithuania were investigated; normative and legal acts on issues of strategic communications and response to information incidents have been introduced into scientific circulation. The article also examines and compares certain differences between the information and media structures of the Armed Forces of Ukraine and the Armed Forces of the Republic of Lithuania. In particular, staffing of military mass media with servicemen and independent civilian workers. Thestudy describes how the beginning and subsequent armed and hybrid aggression of the Russian Federation against the Ukrainian people from 2014 until the start of a full-scale war in 2022 affected the activities of the information and media structures of the Republic of Lithuania and the adjustment of the state's regulatory and legal legislation in the information and cyber sphere .

Common Practices in Orphanages: A Case Study of Bauchi Nigeria

Orphanages worldwide are responsible for providing the support and resources for a whole development in the lives of orphans and vulnerable children. This research discusses the availability and ways of running orphanages in Bauchi State. Data are mainly generated through interview with orphanage directors across the study area and review of related literatures. The findings of the research offer an important clarity on the most common practices that orphanage houses use to care for orphans. It revealed that Among the main challenges in common practice of orphanages in Bauchi State includes; education, health, finances, and the staffing structure. It revealed that the status of extant practices in orphanages in the study area needs to be upgraded, the structure needs to be formalized and the directors need to educate. The future studies should follow these findings to measure the quality and effectiveness of the common practices in Bauchi orphanages as well as Nigeria at large.

THE LONG-TERM CARE STAFFING CRISIS AND COVID-19: ROLE OF THE NURSE PRACTITIONER

Abstract The residential long-term care sector has historically suffered from seemingly intractable staffing challenges in terms of ensuring adequate clinical expertise and a supportive work environment to address the complex health care needs of residents. Considerable evidence has demonstrated the devastating effect of COVID-19 on this fragile residential long-term care staffing structure, resulting in adverse outcomes among staff and residents alike, with the potential for permanent devastation without directed intervention. Drawing upon data from an Ontario-based study of nurse practitioner deployment during COVID-19, this talk will share an emergent approach to re-shaping expertise and capacity in Ontario, Canada through embedding nurse practitioners in residential long-term care homes. Results of this work helped to inform health policy action in the province to scale-up the use of nurse practitioners in long-term care homes, in order to enhance staff expertise and tackle the significant inequities of access to care among nursing home residents.