Staff Preferences Research Articles

The Head Injury Transportation Straight to Neurosurgery (HITS-NS) randomised trial: a feasibility study.

Reconfiguration of trauma services, with direct transport of traumatic brain injury (TBI) patients to neuroscience centres (NCs), bypassing non-specialist acute hospitals (NSAHs), could potentially improve outcomes. However, delays in stabilisation of airway, breathing and circulation (ABC) and the difficulties in reliably identifying TBI at scene may make this practice deleterious compared with selective secondary transfer from nearest NSAH to NC. National Institute for Health and Care Excellence guidance and systematic reviews suggested equipoise and poor-quality evidence - with regard to 'early neurosurgery' in this cohort - which we sought to address. Pilot cluster randomised controlled trial of bypass to NC conducted in two ambulance services with the ambulance station (n = 74) as unit of cluster [Lancashire/Cumbria in the North West Ambulance Service (NWAS) and the North East Ambulance Service (NEAS)]. Adult patients with signs of isolated TBI [Glasgow Coma Scale (GCS) score of < 13 in NWAS, GCS score of < 14 in NEAS] and stable ABC, injured nearest to a NSAH were transported either to that hospital (control clusters) or bypassed to the nearest NC (intervention clusters). recruitment rate, protocol compliance, selection bias as a result of non-compliance, accuracy of paramedic TBI identification (overtriage of study inclusion criteria) and pathway acceptability to patients, families and staff. 'Open-label' secondary outcomes: 30-day mortality, 6-month Extended Glasgow Outcome Scale (GOSE) and European Quality of Life-5 Dimensions. Overall, 56 clusters recruited 293 (169 intervention, 124 control) patients in 12 months, demonstrating cluster randomised pre-hospital trials as viable for heath service evaluations. Overall compliance was 62%, but 90% was achieved in the control arm and when face-to-face paramedic training was possible. Non-compliance appeared to be driven by proximity of the nearest hospital and perceptions of injury severity and so occurred more frequently in the intervention arm, in which the perceived time to the NC was greater and severity of injury was lower. Fewer than 25% of recruited patients had TBI on computed tomography scan (n = 70), with 7% (n = 20) requiring neurosurgery (craniotomy, craniectomy or intracranial pressure monitoring) but a further 18 requiring admission to an intensive care unit. An intention-to-treat analysis revealed the two trial arms to be equivalent in terms of age, GCS and severity of injury. No significant 30-day mortality differences were found (8.8% vs. 9.1/%; p > 0.05) in the 273 (159/113) patients with data available. There were no apparent differences in staff and patient preferences for either pathway, with satisfaction high with both. Very low responses to invitations to consent for follow-up in the large number of mild head injury-enrolled patients meant that only 20% of patients had 6-month outcomes. The trial-based economic evaluation could not focus on early neurosurgery because of these low numbers but instead investigated the comparative cost-effectiveness of bypass compared with selective secondary transfer for eligible patients at the scene of injury. Current NHS England practice of bypassing patients with suspected TBI to neuroscience centres gives overtriage ratios of 13 : 1 for neurosurgery and 4 : 1 for TBI. This important finding makes studying the impact of bypass to facilitate early neurosurgery not plausible using this study design. Future research should explore an efficient comparative effectiveness design for evaluating 'early neurosurgery through bypass' and address the challenge of reliable TBI diagnosis at the scene of injury. Current Controlled Trials ISRCTN68087745. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 1. See the NIHR Journals Library website for further project information.

Survey of Hospitals Lighting: Daylight and Staff Preferences

Hospital staff's preferences for daylighting to notions of the effects of daylight on patient's recovery times and processes, their experiences of daylight when treating and diagnosing patients and patient comfort levels is studied. A questionnaire survey was developed as a tool to review subjective judgments of the staff lighting needs and satisfaction. Responses obtained from one hundred and thirty four staff showed that seventy nine percent of the participants identify daylight in patient's room as a factor helping them do their work more easily, and Seventy seven percent of the surveyed nurses and doctors claimed that daylight is an important element in patient rooms to aid in reviewing patient recovery through recognizing and interpreting changes in patient skin color. Seventy eight percent of hospital nurses and all the surveyed doctors believe that daylight has many health benefits including fast recovery and reduced length of stay for patients. Moreover, ninety two percent of the surveyed staff stated that patients preferred to stay in rooms with access to daylight as it makes them feel comfortable. These results should be taken on board by hospital designers and regulation makers as an indication of the importance of using good daylight in hospital wards to achieve two important goals of improving both hospital staff working conditions and the patient's healing environment.

Workforce Management and Scheduling Under Flexible Demand

We develop a mathematical model for planning and scheduling staff and demand, considering a time window for on-time demand fulfillment, as well as individual staff characteristics, preferences, and availability. We also discuss a version where the staff schedule is fixed. The model can be applied in many service settings, such as warehouses, fulfillment centers, and back-office services. We develop a user-friendly decision-support tool that employs the model and the solution methodology, and we implement it in a healthcare back-office services provider, considering additional operational practices of this company, such as team leader scheduling. We conduct a computational study to develop insights regarding the trade-offs between the on-time demand fulfillment and the quality of the staff schedule, the effect of a change in the demand fulfillment time window, the impact of client behavior (e.g., batch arrivals of demand), and the consequences of considering additional preferences and operational constraints. We also evaluate the robustness of the staff schedule generated by the model under different demand scenarios. Finally, we present a heuristic to set high-quality staff schedules quickly. After the implementation, the company reported a 25% increase in staff productivity.

MEDICAL STAFF SCHEDULING USING SIMULATED ANNEALING

Purpose: The efficiency of medical staff is a fundamental feature of healthcare facilities quality. Therefore the better implementation of their preferences into the scheduling problem might not only rise the work-life balance of doctors and nurses, but also may result into better patient care. This paper focuses on optimization of medical staff preferences considering the scheduling problem. Methodology/Approach: We propose a medical staff scheduling algorithm based on simulated annealing, a well-known method from statistical thermodynamics. We define hard constraints, which are linked to legal and working regulations, and minimize the violations of soft constraints, which are related to the quality of work, psychic, and work-life balance of staff. Findings: On a sample of 60 physicians and nurses from gynecology department we generated monthly schedules and optimized their preferences in terms of soft constraints. Our results indicate that the final value of objective function optimized by proposed algorithm is more than 18-times better in violations of soft constraints than initially generated random schedule that satisfied hard constraints. Research Limitation/implication: Even though the global optimality of final outcome is not guaranteed, desirable solutionwas obtained in reasonable time. Originality/Value of paper: We show that designed algorithm is able to successfully generate schedules regarding hard and soft constraints. Moreover, presented method is significantly faster than standard schedule generation and is able to effectively reschedule due to the local neighborhood search characteristics of simulated annealing.

Emergence, Dynamics and Institutionalisation of Un-Nato Cooperation in Kosovo and Afghanistan

International organisations (IOs) like UN, NATO and EU have been tasked with cooperating to provide numerous services that include security, distribution of humanitarian relief and management of reconstruction efforts. These joint operations have triggered the proliferation of scholarship on inter-organisational cooperation with competing theoretical explanations about the factors that facilitate and impede such cooperation. This article compares and contrasts the emergence, dynamics and institutionalisation of such cooperation involving the United Nations (UN) and the North Atlantic Treaty Organisation (NATO) in two of the organisations' largest missions – in Kosovo and Afghanistan. It argues that in all stages – emergence, dynamics and institutionalisation – cooperation is more successful when it emerges or is endorsed by officers operating in the field, when IOs overcome 0ureaucratic, resource and environmental constraints for cooperation and finally when the IOs choose a decentralised or informal way to manage their relationship. The article advances the argument that inter-organisational cooperation is more likely to emerge informally among the field staff because it is more responsive to the surrounding environment and tends to overcome differences of organisational culture in order to divide tasks based on their expertise. To this end, the cases of Kosovo and Afghanistan validate the argument that formal and imposed cooperation driven solely by member-states and IO headquarters is insufficient to overcome 0ureaucratic, resource and environmental constraints. Similarly, centralised attempts to institutionalise inter-governmental cooperation cannot be effective unless they take into account the preferences of field staff, IO partners and mediators.

Staff's views on managing symptoms of dementia in nursing home residents.

Aim To identify the most common and distressing behavioural and psychological symptoms of dementia (BPSD) in nursing homes and to identify staff preferences regarding its behavioural management. Method A descriptive cross-sectional survey was completed by a self-selected sample of 247 staff working in 21 nursing homes in a defined catchment area. The survey contained items relating to experience in aged care work, attitudes towards BPSD, ratings of the importance of certain behavioural strategies for managing BPSD, and the Challenging Behaviour Scale. Results Shouting, wandering and restlessness had the highest incidence, frequency and difficulty ratings. Frequency of BPSD and level of satisfaction with how they were managed had the greatest effect on overall level of difficulty in managing behaviours. Staff rated discussing behavioural concerns at a group level and with senior nursing staff as the most important behavioural strategies. Conclusion A strong relationship was found between frequency and difficulty of BPSD. Therefore, interventions targeted at lowering frequency of BPSD are recommended. Communication across a number of levels may enhance the implementation of behavioural interventions.

Remaining in the nursing home versus transfer to acute care: resident, family, and staff preferences.

Resident and family insistence on transfer is a major factor in the occurrence of potentially avoidable transfers from nursing homes (NHs) to acute care. The purpose of this study was to explore resident, family, and staff preferences regarding transfer to acute care. A sample of 271 NH residents, family members, staff, and medical providers were interviewed. Seventy-seven percent of residents reported that they had not given any thought to the question of whether they would want to be transferred to acute care. Family members wanted more information than residents, but more residents (39%) thought they should be fully involved in the transfer decision than their family members (12%) or staff (12%). Staff preferred keeping residents in the NH. Families were divided between transferring residents and having them remain in the NH. More residents indicated that their desire to transfer would depend on the severity of their condition and their prognosis. Ethnic group differences were noted. Results suggest that discussion of this issue should occur soon after admission and that differences in perspectives may be expected from those involved.

Continuity of care in community midwifery.

Continuity of care is often critical in delivering high quality health care. However, it is difficult to achieve in community health care where shift patterns and a need to minimise travelling time can reduce the scope for allocating staff to patients. Community midwifery is one example of such a challenge in the National Health Service where postnatal care typically involves a series of home visits. Ideally mothers would receive all of their antenatal and postnatal care from the same midwife. Minimising the number of staff-handovers helps ensure a better relationship between mothers and midwives, and provides more opportunity for staff to identify emerging problems over a series of home visits. This study examines the allocation and routing of midwives in the community using a variant of a multiple travelling salesmen problem algorithm incorporating staff preferences to explore trade-offs between travel time and continuity of care. This algorithm was integrated in a simulation to assess the additional effect of staff availability due to shift patterns and part-time working. The results indicate that continuity of care can be achieved with relatively small increases in travel time. However, shift patterns are problematic: perfect continuity of care is impractical but if there is a degree of flexibility in the visit schedule, reasonable continuity is feasible.

Heart failure and chronic obstructive pulmonary disease multimorbidity at hospital discharge transition: a study of patient and carer experience.

Care for patients with multimorbidity represents a major challenge not only for patients and carers but to health-care systems. Hospital discharge transition is a critical point at which challenges for multimorbidity may amplify. The main objective of the study was to explore the experiences of heart failure (HF) and chronic obstructive pulmonary disease (COPD) multimorbid patients and their carers on hospital discharge. Secondary objectives included identification of gaps in the health care of multimorbidity and optimal solutions from patients and carers' perspectives. Mixed methods were applied to collect data using patient self-completion questionnaire from an adapted version of the American Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and in-depth interviews. Participants were recruited from two cardiology and respiratory wards at a large regional hospital in England, and all had a multimorbidity diagnosis of COPD and HF. Findings revealed that patients experienced difficulties in their communication with health-care professionals and there were specific challenges with information about medication. Qualitative descriptions revealed that experiences fell into two main categories: (i) information transfer to patients with multimorbidity in terms of issues with medication and clarity of information on diagnosis and (ii) communication and continuity of care after discharge. Respondents highlighted gaps in the management of patients with multimorbidity of HF and COPD at the critical time of care transition. They suggested the need for a comprehensive, coordinated and integrated approach to incorporate patients, carers and staff preferences for treatment on discharge from hospital.

Preference for a single or shared room in a UK inpatient hospice: patient, family and staff perspectives

ObjectiveThis study investigated the preferences of patients, family and staff for single or shared rooms in a UK hospice.MethodSemistructured interviews were conducted with patients, informal carers and staff at a...

Modelling a Nurse Shift Schedule with Multiple Preference Ranks for Shifts and Days-Off

When it comes to nurse shift schedules, it is found that the nursing staff have diverse preferences about shift rotations and days-off. The previous studies only focused on the most preferred work shift and the number of satisfactory days-off of the schedule at the current schedule period but had few discussions on the previous schedule periods and other preference levels for shifts and days-off, which may affect fairness of shift schedules. As a result, this paper proposes a nurse scheduling model based upon integer programming that takes into account constraints of the schedule, different preference ranks towards each shift, and the historical data of previous schedule periods to maximize the satisfaction of all the nursing staff's preferences about the shift schedule. The main contribution of the proposed model is that we consider that the nursing staff’s satisfaction level is affected by multiple preference ranks and their priority ordering to be scheduled, so that the quality of the generated shift schedule is more reasonable. Numerical results show that the planned shifts and days-off are fair and successfully meet the preferences of all the nursing staff.

Preferences of Professors about Research and Teaching

This paper aims to analyze preferences of academic teaching staff of Russian universities about research and teaching, as well as structure of their working hours, academic research performance, and related differences between universities with or without special status, based on the results of two international studies that embraced Russia: International Academic P rofession (1991–1993) and Changing Academic Profession (2007–2012). In Russia, most professors prefer teaching over academic research, unlike in many other countries, distribution of preferences being the same for teachers at “national research universities” and higher education institutions with no special status. Professors who prefer academic research over teaching acquire research skills as they study and then apply efforts to get inancing for their research, working more hours weekly than their teaching colleagues (average 42 vs. 38 hours per week respectively). Although faculty staff who prefer research over teaching have a higher workload and solve less routine problems in their work, they suffer much less stress and are much more satisfied with what they are doing. The conclusion thus is that distribution of professor preferences reflects peculiarities of the higher education system in the USSR and the Russian Federation, such as: focus on teaching, dissociation between science and universities, poor financing of universities as such and particularly of their academic research.

Commentary on: The benefits of international rotations to resource-limited settings for U.S. surgery residents

The accompanying article by Henry et al is an interesting investigation of the increasing preferences of house staff and medical institutions to seek international experiences at some point during residency training. They have documented a large number of potential benefits, but it is notable that few items on their long list get >1–9% agreement from the respondents in their survey, indicating that the perceptions of the benefits are quite diverse among those who participate. Many aspects of the current enthusiasm for international rotations could be considered faddish rather than of proven benefit, either for the resident who participates or the patient and institution where the rotation occurs. A certain amount of hyperbole is often heard in the advocacy for such rotations, and much of the enthusiasm may result simply from the novelty of seeing a totally different people and culture that are exotic and exciting. The longstanding dictum of primum non nocere applies here particularly. Patients in a third-world environment are not ‘‘informed consumers,’’ and they are often desperate to obtain health care; their protection from well-intended but sometimes harmful interventions will not necessarily be monitored at the treating site and is the responsibility of the sponsoring institution. On balance, the potential benefit of these rotations for both residents and the international patients they may treat is significant if the parent

Defining characteristics of communication quality in culture-changed long-term healthcare facilities

Inter-staff communication plays a significant role on the efficiency of healthcare delivery and on patients’ health outcomes; however, previous studies focused on communication and its associated effects at facilities, such as resident-centered long-term care settings, are extremely limited. The current survey study investigates inter-staff communication characteristics and patterns based on staff's roles and responsibilities in a culture-changed nursing home. ‘Timeliness’, ‘accuracy’, ‘understanding’, ‘effectiveness’, and ‘openness’, five dimensions of communication quality, are used to evaluate staff's preferred communication modalities and behaviors. Results found that 28.3% of respondents have more than one role or responsibility. Therefore, strategies for communication modalities and qualities vary accordingly. Among different modalities, synchronous communication modalities were most preferred to achieve the five communication quality dimensions in all groups, but there were significant differences between roles when using the asynchronous modalities to achieve understandable and effective communication. In conclusion, management should serve as a mediator in setting up a series of communication policies that not only achieve communication quality within a facility and satisfy staff's communication preferences, but also maintain efficient operational workflow and residents’ quality of life in the resident-centered long-term care facility.

Multi-objective operating room scheduling considering desiderata of the surgical team

Optimizing the daily operating room schedule can be problematic because of the many constraints that need to be taken into account, and solving this issue within a reasonable time span is difficult. The originality of the present study is the consideration of the surgical team's wishes in the establishment of an operating room schedule. To resolve the operating room scheduling problem, we took advantage of the “expressive power” of the constraint programming paradigm to include multiple real-life constraints in our model, such as availability, staff preferences, and affinities among staff members. The aim of this research was to optimize use of the operating room by minimizing the makespan, minimizing overtime hours, and maximizing affinities among members of the surgical team. We developed a “generic” model that includes most of the problems encountered in the literature as well as constraints apparent in our hospital. The results achieved when using this model in a real-life situation are presented at the end of the paper.

At Your Leisure: Establishing a Popular Reading Collection at UBC Library

Objectives – This study investigated the leisure reading habits and preferences of students, faculty, staff, and community members at the University of British Columbia (UBC) in order to determine if a leisure reading collection would fulfill a need and, if so, what form that collection should take to best serve the population. &#x0D; &#x0D; Methods – This study, conducted in October 2010, consisted of a 19-question online questionnaire distributed to a random sample of UBC undergraduate students, graduate students, faculty, and community library users and an identical, open participation questionnaire for the entire UBC community, including staff and community members. In addition to some demographic information, the questionnaire gathered information about leisure reading habits, tendencies, and the participants’ preferences for a potential future leisure reading collection at UBC Library.&#x0D; &#x0D; Results – There were 467 valid responses out of 473 total responses received from UBC undergraduate students, graduate students, faculty, staff, and community members. Of the valid responses, 244 were received from the 1,500 random sample invitations (a 16.3% response rate). Additionally, the questionnaire was advertised for open participation for those not invited, resulting in the remaining 229 responses. Results of this study indicated overwhelming support for a leisure reading collection at UBC Library, with 94% of respondents stating they might or would use a leisure reading collection. This study also revealed strong leisure reading habits among all response groups. However, only 6% of respondents currently acquire most of their leisure reading materials from UBC Library. Additional analysis found that UBC Library already owns 81% of the titles and authors requested by respondents in the survey.&#x0D; &#x0D; Conclusions – Based on the findings, the strong support for a leisure reading collection, and the fact that many UBC campus residents are not eligible for a free municipal public library card and borrowing privileges, there is a genuine need for a leisure reading collection at UBC Library. The data indicates that if accessible and convenient, a leisure reading collection could provide an opportunity for those who do not already read for leisure to do so. Additionally, a UBC Library leisure reading collection could attract community members, including those who are not UBC Library cardholders. In response to the results of the study, a pilot leisure reading collection was created in September 2011. This will make leisure reading materials easier to access and will allow the Library to further analyze the potential of such a collection, ultimately determining its future.

The Research Preferences and Occupational Commitment of Academic Staff

The aim of this research is to reveal the research preferences of academic staff and to investigate the relationship between occupational commitment and research preferences in academicians. The sample comprises 130 academicians from Kahramanmaras Sutcu Imam University in Turkey. Reunamo's (2007) general model of agentive perception was used to design research preferences scale. Research preferences comprises four components namely; qualitative, quantitative, theoretic and participative. Occupational commitment measured by Mowday and Steers’ organizational commitment questionnaire (OCQ). The five-point Likert scale varying from strongly disagree to strongly agree was offered for the respondents. The SPSS Programme will be used for the analysis of the research data, obtained via questionnaires. The results and recommendations in the paper will be of interest to those involved in the field of research and education.

Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU.

BackgroundThe importance of involving parents in the end-of-life decision-making-process (EOL DMP) for their child in the neonatal intensive care unit (NICU) is recognised by ethical guidelines in numerous countries. However, studies exploring parents' opinions on the type of involvement report conflicting results. This study sought to explore parents' experience of the EOL DMP for their child in the NICU.MethodsThe study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP.FindingsQualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child.InterpretationParents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices.

Nested social groups within the social environment of a dementia care assisted living setting

The social environments of people with dementia are complex and still not fully understood. Investigating how residents in a dementia care setting navigate and participate within social groups is critical as the therapeutic benefits of social engagement are unequivocal. An ethnographic study of social environments within a dementia care residence revealed that there is active socialization and even strong and lasting friendships formed between people with dementia. Many of these relationships were observed to be a part of groups, ‘nested’ within the larger social environment. These ‘nested social groups’ had unique dynamics and their structuring was often influenced by outside factors (e.g. physical environment and staff preferences). The existence of these groups has implications for the experiences and quality of life of the residents in long-term care. Nested social groups will be defined and their function within the social environment will be discussed.

Attitudes towards health‐care robots in a retirement village

This study investigated the attitudes and preferences of staff, residents and relatives of residents in a retirement village towards a health-care robot. Focus groups were conducted with residents, managers and caregivers, and questionnaires were collected from 32 residents, 30 staff and 27 relatives of residents. The most popular robot tasks were detection of falls and calling for help, lifting, and monitoring location. Robot functionality was more important than appearance. Concerns included the loss of jobs and personal care, while perceived benefits included allowing staff to spend quality time with residents, and helping residents with self-care. Residents showed a more positive attitude towards robots than both staff and relatives. These results provide an initial guide for the tasks and appearance appropriate for a robot to provide assistance in aged care facilities and highlight concerns.