Learning Organizations in Construction

The transformation of organizations from production-oriented entities to proactive learning entities that continuously leverage the knowledge of the workforce is a primary objective of management researchers. This focus has significant relevance to the construction industry where production-related research has predominantly overshadowed organizational development research. As one effort to change this emphasis, the writers present a research effort designed to study current organization learning techniques and technologies fielded by organizations both inside and outside of the construction industry. Through a series of exploratory case studies, the writers developed a maturity model together with the Construction Industry Institute that provides construction organizations with a framework for developing a learning organization culture. The maturity model focuses on learning organization characteristics of leadership, processes and infrastructure, communication/collaboration, education, and culture at the organization, community, and individual levels. This paper introduces the results of that effort including a presentation of the learning organization maturity model, framework application, and the overall characteristics of a learning organization.     

The Polish experience of quality improvement in primary care

THE POLISH HEALTH CARE SYSTEM: The health care system in Poland is based on a model typical of east-central European countries, with features such as state-owned health care organizations, centralized management and administration, and primacy of access to care over quality. Poorly planned and uncoordinated reforms have been undertaken to transfer some of the authority for health service management to local governments. PRIMARY HEALTH CARE IN POLAND: The reform of the health care system entails substitution of family physician-based for medical specialist-based primary care. Newly trained family physicians, as the first to start private surgery clinics financed from public sources, are the forerunners of the comprehensive reform and property structure transformation. MAKING THE TRANSITION FROM QUALITY ASSURANCE TO QUALITY IMPROVEMENT: Since the early 1990s, more and more organizations, individuals, and professional groups have begun to perceive health care regulations and other external control mechanisms as ineffective. Attempts have been made to replace periodic, restrictive activities with systematic continuous quality improvement efforts. Systems of voluntary accreditation are being developed and fostered. Groups have started meeting to develop medical practice guidelines and conduct peer review. Concern about quality of health care services is now reflected in the Polish legislation for the first time, as well as in numerous local and nationwide projects and publications. CONCLUSION: Despite some successes, the pioneers of quality improvement (QI) still have a long way to go. Continuation of educational activities and creation of a system of motivation for the development, of QI in primary care should be prioritized and encouraged.     

Synergistic effect of Epstein-Barr virus and tumor promoters on induction of lymphoma and carcinoma in nude mice

BACKGROUND: The core business of hospitals now requires, for both competitiveness and quality improvement reasons, that hospitals move beyond their physical and conceptual walls to form community partnerships. THE HOSPITAL'S ROLE AS A PARTNER IN COMMUNITY-BASED HEALTH IMPROVEMENT SYSTEMS: Hospitals, as organizations that are significant health care, social, and economic institutions in their communities, should play a leading role in mobilizing resources for such community-level health improvement efforts. MOVING OUTSIDE THE WALLS TO IMPROVE QUALITY: Three examples of extending hospital efforts into the community demonstrate that improvement of a problem involving hospital care can derive from a collaborative, community-based activity. In Boston, infection control--once a standard, strictly in-house procedure--has been forced by altered patterns of hospital use to become a largely community-based process. In Chicago, a variety of health care providers and community representatives have worked effectively to reduce mortality and morbidity in a single disease (asthma) model. In Akron, Ohio, Lifelink program hospitals, working together with community agencies and groups in a door-to-door neighborhood program, improved the effectiveness of prenatal care and the quality of birth outcomes. CONCLUSION: Efforts to work with community groups to improve health status should not be simply an optional do-good endeavor, as they have often been in the past, but rather an essential part of quality improvement and good business practice. Marketplace incentives will increasingly reward hospitals that are able to form successful community partnerships.     

Evaluations of organizational effectiveness in mental health programs

We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed "successful" by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness.     

Merger motorway. Giving staff the tools to reengineer

Mergers and health care agencies' response to mergers dominate current conversations in this evolving managed care environment. Hospitals are rapidly learning to adjust to declining occupancy rates and deceased utilization of resources. A business model to guide mergers was adapted to assist staff with the people, structural, cultural and political issues of organizational change. Creating successful new work environments, moving from a "We-they" mentality to unity and decreasing use of resources are outcomes described in this article.     

Managed care credentialing of advanced practice nurses

The enormous and rapid changes taking place in health care delivery are forcing institutions, organizations, and individual providers of care to reexamine their relationships and create new methods of assuring both quality of care and safety for consumers. One result has been the emphasis on systematic methods of credentialing, privileging, and measuring and evaluating an individual's qualifications and actual performance. This article discusses the credentialing and privileging processes that are either in place or evolving for physicians in the managed care health care systems. With the continued evolution of managed care in this country, advanced practice nurses may need to expand their credentialing process. This article provides information on the evolutionary events leading to credentialing and privileging, current and anticipated credentialing measures, sources of measurements, medicolegal issues, and suggestions for expansion of nurse credentialing. A comprehensive credentialing system will provide additional evidence of the nursing profession's capacity to play a major role in the reformed health care system.     

Managed competition in practice: 'value purchasing' by fourteen employers

Many large U.S. companies have transformed their procurement of health benefits in the 1990s by combining the principles of managed competition with other business tactics to create a business-savvy hybrid of the private sector's own design, often referred to as "value purchasing." Until recently, few policymakers or health care observers believed that large firms would be a force in health system reform. Yet to implement value purchasing, the large companies in this study created new organizational forms, provided employees with financial incentives to select low-cost health plans, and used business tactics such as competitive bidding to negotiate more favorable rates and to improve quality among health plans. The financial results were impressive for the companies studied. In addition, the companies' demands on the health care delivery system are multiplying as the interface between business firms and health care organizations changes. These demands will only increase as the practices we found become more widespread.     

Conflict across organizational boundaries: Managed care organizations versus health care providers.

This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing leadership: to thrive in a world of change

Change is becoming the norm in health care environments. Nurse executives in leadership positions are an essential part of an institution's ability to adapt successfully and flourish with change. It is important for the nurse executive to have a clear concept of leadership, the change process, and organizational cultures. This will allow the nurse executive to create an environment within the organization where change is seen in a positive manner and staff are empowered to meet the challenges of health care today.     

Curriculum trends in nurse-midwifery education. Views of program directors

The purpose of this study was to determine the extent to which nurse-midwifery education programs are addressing the practice competencies that have been recommended by the Pew Health Professions Commission and others as essential for effective practice in the 21st century. This study was part of a larger survey of eleven health professions education programs. The 56 nurse-midwifery program directors whose names and addresses were provided by the American College of Nurse-Midwives were surveyed by mailed questionnaire, with a response rate of 59% (n = 33). The study sought to identify current and ideal emphasis placed on 33 broad topics, most important curriculum topics, and barriers to curriculum change as perceived by respondents. Findings revealed that nurse-midwifery program directors would like to see greater emphasis placed on every topic except one (tertiary/quaternary care). Desired increases ranged from .04 to 1.36. The overall mean rating for all topics was 3.51 for current emphasis (5-point scale) and 4.18 for ideal emphasis, both of which were higher than any other survey group. The greatest desired increases (> 1.00) were for "primary care," "managed care," "use of electronic information systems," and "business management of practice." Respondents identified "primary care," "health promotion/disease prevention," and "accountability for cost-effectiveness and patient outcomes" as the most important topics. The top three barriers to curriculum change were identified as "already crowded curriculum," "inadequate funding," and "limited availability of clinical learning sites," the last being statistically significant compared with other survey groups. Findings indicate that nurse-midwifery program directors perceived that they are adequately addressing most of the curriculum topics, while continuing to focus on the need for curriculum change as the health care environment changes.     

A broader vision for managed care, Part 1: Measuring the benefit to communities

For the past quarter-century managed care plans have been judged almost exclusively in terms of their influence on the health and health care of individual enrollees. However, policymakers are now paying attention to the ways in which health care organizations affect the broader well-being of their communities. These forms of "community benefit" emerged originally from legal criteria for tax exemption but are increasingly applied to all health care organizations, whatever their form of ownership. In this paper we identify different paradigms for defining community benefit and trace the factors that have encouraged or discouraged their application to health care. We suggest several strategies encouraging managed care plans to broaden their goals to include community benefit.     

Planning flexible learning to match the needs of consumers: a national survey

The injection of market forces into the National Health Service (NHS) has led to nurse education being viewed as a commodity which educational institutions supply and NHS employers purchase. Conscious of the costs of paying for courses within this new consumer culture, NHS trusts and other health service employers are increasingly looking for cost-effective flexible training to educate their workforce quickly and efficiently. Parallel to this is the accelerated demand for continuing professional development (CPD) brought about by the inception of the UKCC's Post-Registration Education and Practice Project (PREPP). Both registered and enrolled nurses are finding they need professional updating and skills and thus increased access to courses. The increased demand for education and training brought about by these changes cannot be met through traditional methods alone, requiring educational institutions to re-appraise their methods of delivery and introduce more flexible approaches to learning. There is every evidence that this is now the case with open learning, distance learning and flexible approaches to learning ever growing in popularity as providers of nurse education recognize the benefits such approaches offer. The emphasis is on meeting the diverse needs of the health care employers and individuals by providing education that is flexible, learner-centred and customer focused. This paper presents the findings of a national survey to ascertain how providers of flexible education plan educational programmes to meet the needs of their customers. Based on data collected from 120 educational institutions within the higher education, health and social care and private sectors, it highlights: the ways in which flexible learning programmes and courses are delivered; what aspects of flexibility are considered important when designing programmes to meet the needs of prospective customers; and what approaches are used to assess demand for flexible education. The study stresses the need for providers of flexible education to take into account the dual perspectives of those who have a stake in the flexibility of nurse education; NHS employers as funders of students and individual healthcare professionals themselves.     

Building Healthy Workplaces: Where We Need to Be.

Many organizations are struggling to define a "healthy" workplace, to assess both the "healthy" and "unhealthy" aspects of their own environment, and to implement initiatives to improve the quality of their work and workplace. There is a huge body of literature documenting the direct and indirect costs of work stress. Research conducted primarily since the 1960s has identified the principal characteristics of jobs that affect well-being. There is a clear parallel between the literature addressing job design as a means of increasing motivation and organizational effectiveness and job design as a means of improving individual well-being. These observations and the supporting literature suggest three principal foundation blocks for a national strategy to address issues of work and mental health. We advocate a focus on the assessment of leading indicators of mental and physical health in the workplace. On the issue of job stress, the organizational research suggests a dual focus, not only on these types of stress management intervention, but also on changing the job stressors through activities such as job design and leadership training. Third, implementation of these first two points requires education and training at two levels: in the workplace and among mental-health professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

La constitution d’un milieu de travail sain: Où nous devons être.

Many organizations are struggling to define a "healthy" workplace, to assess both the "healthy" and "unhealthy" aspects of their own environment, and to implement initiatives to improve the quality of their work and workplace. There is a huge body of literature documenting the direct and indirect costs of work stress. Research conducted primarily since the 1960s has identified the principal characteristics of jobs that affect well-being. There is a clear parallel between the literature addressing job design as a means of increasing motivation and organizational effectiveness and job design as a means of improving individual well-being. These observations and the supporting literature suggest three principal foundation blocks for a national strategy to address issues of work and mental health. We advocate a focus on the assessment of leading indicators of mental and physical health in the workplace. On the issue of job stress, the organizational research suggests a dual focus, not only on these types of stress management intervention, but also on changing the job stressors through activities such as job design and leadership training. Third, implementation of these first two points requires education and training at two levels: in the workplace and among mental-health professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transcultural therapy. 2: Mental health and learning disabilities

The first article in this two-part series (Vol 7(15): 901-6) examined the issues surrounding healthcare provision in the context of the UK as a multicultural society in relation to mental health and learning disabilities. This second article considers the development of psychotherapy, theory and skills of working in terms of its impact and influence upon the education and practice of community mental health nurses and community nurses in learning disability within the UK. The major schools of influence in psychology will be examined in relation to their limitations for practice with clients from various cultures. In addition, three multicultural models of counselling which address cultural diversity will be appraised. Finally, the need for educational systems and service providers to foster and develop positive cultural attitudes among nurse practitioners will be emphasized. Both individual practitioners and employment organizations will need to be much more responsive and committed to developing multicultural services as we approach the millennium.     

Bridge to the future: nontraditional clinical settings, concepts and issues

Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.     

Patient education: a mandate for health care in the 21st century

OBJECTIVE: This first article, of a two-part series, presents the foundation for patient education in the nuclear medicine department. The need for patient education through mandates, such as the JCAHO, is discussed and the relevant literature surrounding the delivery of patient education is reviewed. The emphasis is on proper learning by patients, including the means of maximizing the facilitators to learning and minimizing barriers that limit patient learning in the clinical setting. After completing the article, the reader should be able to: (a) describe the mandates for patient education; (b) discuss the current practice of patient education in health care; (c) describe the effective implementation of learning; (d) list barriers and facilitators to patient learning; and (e) give examples of how barriers to learning can be minimized and facilitators can be maximized. Practical applications will be discussed in the second article.     

The NHS as a learning organization: aspirations beyond the rainbow?

AIM: It is the intention of this paper to review the issues and challenges organizations face when aspiring to embrace and enact the tenets of a learning organization; and in particular the perceived impact on management strategy, structure and leadership styles. The paper is predicated on the premise that learning and knowledge act as vital strategic resources, crucial not only to organizations in terms of competitive advantage but to ethical enterprise per se. BACKGROUND: Modern life is characterized by change, against the backdrop of this continual turmoil, organizational learning has emerged as a dominant theme within contemporary management theory, with many commentators increasingly locating the capacity of an aspiring organization to accommodate the ethos of organizational learning, as the vital component in ensuring enduring efficiency, innovation and competitiveness. However, the utility of such learning needs to be scrutinized and evaluated in terms of service need and expectation. ORIGINS OF INFORMATION: The paper will expand upon wider theoretical debates extant within the literature, by considering the concept and utility of the learning organization with specific reference to management reform extant within the British National Health Service (NHS). DATA ANALYSIS: During the course of the review the various the theoretical positions contributing to the notion of the learning organization will be analysed, the practical ramifications of which will be examined in the context of reflective practice, clinical supervision and the wider cultural background of nursing and the NHS. CONCLUSIONS: The paper concludes that the NHS needs to reorientate management perspectives to focus attention more acutely on systems which are deliberately designed to facilitate shared learning, to unravel the ambiguities of organizational life, to affirm management belief in the nursing contribution and to achieve an as yet unrealized potential in terms of patient care and advanced nursing practice.