Angela Carter

Creative Requirement A Neglected Construct in the Study of Employee Creativity

We identify the creative requirement of a job as a neglected predictor of employee creativity and propose that it may account for relationships between traditional work factors and creativity. As such, it may represent a more effective means of increasing creativity than changes in job design. Using structural equation modeling, we tested this model against four competing models using a sample of 1,083 health service employees. Creative requirement was found to account for much of the variance by fully mediating the effects of supportive leadership and role requirements and partially mediating those of empowerment and time demands. We conclude that creative requirement is an important proximal determinant of employee creativity and a potentially significant intervention.

Job Demands–Control–Support model and employee safety performance

The aim of this study was to explore whether work characteristics (job demands, job control, social support) comprising Karasek and Theorells (1990) Job Demands-Control-Support framework predict employee safety performance (safety compliance and safety participation; Neal and Griffin, 2006). We used cross-sectional data of self-reported work characteristics and employee safety performance from 280 healthcare staff (doctors, nurses, and administrative staff) from Emergency Departments of seven hospitals in the United Kingdom. We analyzed these data using a structural equation model that simultaneously regressed safety compliance and safety participation on the main effects of each of the aforementioned work characteristics, their two-way interactions, and the three-way interaction among them, while controlling for demographic, occupational, and organizational characteristics. Social support was positively related to safety compliance, and both job control and the two-way interaction between job control and social support were positively related to safety participation. How work design is related to employee safety performance remains an important area for research and provides insight into how organizations can improve workplace safety. The current findings emphasize the importance of the co-worker in promoting both safety compliance and safety participation.

Strain as a moderator of the relationship between work characteristics and work attitudes.

Research on the psychological effects of work characteristics has investigated their relationships with both work attitudes and psychological strain, with the latter 2 variables being treated as alternative or joint dependent variables. The focus of this article is to propose that strain moderates the relationship between perceptions of work characteristics and work attitudes. The proposition is tested on a maximum sample of 9,327 health care employees by using moderated multiple regression followed by subgroup comparisons. The results strongly support the moderating effect, showing that as strain increases, the strength of the relationship between perceptions of work characteristics and work attitudes decreases.

Evaluation of workforce and organizational issues in establishing primary angioplasty in England

Objective To assess workforce and organizational issues in establishing a primary angioplasty service in England. Methods Staff associated with the heart attack pathway at seven acute hospitals participating in the National Infarct Angioplasty Project (NIAP) completed a questionnaire, participated in focus groups and interviews, and observations were undertaken in catheter laboratories. Results All seven hospitals implemented primary angioplasty though not all provided a 24-hour service. Hospitals varied in size, number of staff involved in the delivery of angioplasty and the volume of cases. Hospitals that developed the service by incremental expansion encountered more problems than hospitals that planned for a full service at the outset. Simple, direct access to a catheter laboratory reduced delays and could be facilitated by an angioplasty gatekeeper. Little attention was paid to later cardiac rehabilitation. Multiskilling and the ability to work across traditional professional boundaries appeared to provide substantial advantages. Building relationships with key staff and auditing the heart attack pathway were critical to successful service development. Differences in remuneration and rest for staff undertaking out-of-hours working threatened sustainability. Conclusions Primary angioplasty was feasible in varied settings and generally supported by staff. However, the participating hospitals were selected enthusiasts, only some implemented a 24-hour service and activity levels were relatively low. Organizational and workforce issues need to be addressed to achieve an efficient and sustainable service.

What do hospital mortality rates tell us about quality of care

Hospital mortality rates could be useful indicators of quality of care, but careful statistical analysis is required to avoid erroneously attributing variation in mortality to differences in health care when it is actually due to differences in case mix. The summary hospital mortality indicator is currently used by the English National Health Service (NHS). It adjusts mortality rates up to 30 days after discharge for patient age, sex, type of admission, year of discharge, comorbidity, deprivation and diagnosis. Such risk-adjustment methods have been used to identify poor performance, most notably at mid-Staffordshire NHS Foundation Trust, but their use is subject to a number of limitations. Studies exploring whether variation in risk-adjusted mortality can be explained by variation in healthcare have reached conflicting conclusions. Furthermore, concerns have been raised that the proportion of preventable deaths among hospital admissions is too small to produce a reliable ‘signal’ in risk-adjusted mortality rates. This provides hospital managers, regulators and clinicians with a considerable dilemma. Variation in mortality rates cannot be ignored, as they might indicate unacceptable variation in healthcare and avoidable mortality, but they also cannot be reliably used to judge the quality of healthcare, based on current evidence.

Organisational influences on the activity of chest pain units during the ESCAPE trial: a case study

Background The ESCAPE trial was a multicentre randomised controlled trial investigating the effectiveness of Chest Pain Unit (CPU) care. The process of CPU implementation and the activity of individual CPUs varied substantially between hospitals. The study reported here explored the organisational factors that influenced this variation. Method A multiple case study approach was taken treating each site as a ‘case’. Six intervention sites were studied. Qualitative data were collected through interviews with key personnel at each site. Results Activity of individual CPUs was not adequately explained by simple structural differences between hospitals, such as their size or location, or between CPUs, such as staffing and hours. Analysis suggested that the more active CPUs tended to have more of the following characteristics: being ‘primed’ by previous initiative or experience; appropriate leadership; a positive climate for innovation; established relationships between key staff/departments; role clarity amongst staff; an enthusiast for the development; and continuity of staffing. Role conflict, particularly between specialist nurses and others, was reported and had potential to interfere with development. Conclusion Organisational factors were identified that could have impacted on the outcomes of the ESCAPE trial through, for example, delays in discharge, and missed recruitment opportunities. Complex interventions such as the ESCAPE trial are prone to the effects of local organisational issues, some of which could be predicted and planned for. Findings from single centre studies of complex interventions should be treated with caution before a decision is taken to implement in a new setting.

A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements

Objectives To measure levels of, and change in junior doctor well-being, confidence and self-reported competence over their second postgraduate training year and the impact of emergency department (ED) placements on these outcomes. Design A longitudinal study using an online survey administered at four time points (2010–2011). Setting 28 Acute Hospital Trusts, drawn from nine participating Postgraduate Deaneries in England. Participants Junior doctors who had a placement in an ED as part of their second postgraduate training year. Main outcome measures Levels of anxiety, depression, motivation, job satisfaction, confidence and self-reported competence, collected at four time points spread over the period of the doctors second training year (F2). Results 217 junior doctors were recruited to the study. Over the year there was a significant increase in their overall job satisfaction, confidence and self-reported competence. Junior doctors also reported significantly increased levels of motivation and anxiety, and significantly decreased levels of extrinsic job satisfaction when working in ED compared with other specialties. There were also significant increases in both junior doctor confidence and self-reported competence after their placement in ED relative to other specialties. Conclusions While elements of junior doctor well-being worsened in their ED placement compared with their time spent in other specialties, the increased levels of anxiety and reduced extrinsic job satisfaction were within the normal range for other healthcare workers. These deficits were also balanced by greater improvements in motivation, confidence in managing common acute clinical conditions and perceived competence in performing acute procedures compared with benefits offered by placements in other specialties.

On the dynamics of work identity in atypical employment: setting out a research agenda

ABSTRACT Starting from the notion that work is an important part of who we are, we extend existing theory making on the interplay of work and identity by applying them to (so called) atypical work situations. Without the contextual stability of a permanent organizational position, the question “who one is” will be more difficult to answer. At the same time, a stable occupational identity might provide an even more important orientation to one’s career attitudes and goals in atypical employment situations. So, although atypical employment might pose different challenges on identity, identity can still be a valid concept to assist the understanding of behaviour, attitudes, and well-being in these situations. Our analysis does not attempt to “reinvent” the concept of identity, but will elaborate how existing conceptualizations of identity as being a multiple (albeit perceived as singular), fluid (albeit perceived as stable), and actively forged (as well as passively influenced) construct that can be adapted to understand the effects of atypical employment contexts. Furthermore, we suggest three specific ways to understand the longitudinal dynamics of the interplay between atypical employment and identity over time: passive incremental, active incremental, and transformative change. We conclude with key learning points and outline a few practical recommendations for more research into identity as an explanatory mechanism for the effects of atypical employment situations.

The value of emergency medicine placements for postgraduate doctors: views of Foundation Year 2 doctors and training leads in the emergency department (ED).

Objectives To examine the delivery of postgraduate training in the emergency medicine setting and its impact on postgraduate doctor (Foundation Year 2) performance and competence. Methods A national study in four emergency departments (EDs) in England between 2009 and 2010 was undertaken. Semistructured interviews with ED training leads (TLs) and focus groups with Foundation Year 2 (F2) doctors were carried out in each ED. Interviews and focus group data were analysed to compare the perspectives of F2 doctors and TLs on the delivery of training and performance and confidence of F2 doctors. Results Interviews were carried out with eight TLs and focus groups with 30 F2s. F2 doctors and EDTLs agreed that ED was a valuable environment for F2 doctors to develop their competence, with exposure to a broad range of patients and the opportunity to make decisions about clinical care. Diverging views existed around competence and performance of F2s. F2 doctors had anxieties about decision-making (particularly discharging patients) and required regular feedback to feel confident in their care. TLs recognised a need for more supervision and support for F2 doctors but this was challenging in a busy, performance-led service. Conclusions Emergency medicine placements were important in the development of confident and competent F2 doctors, particularly in the context of less clinical exposure in other specialty placements. However, there are competing tensions between elements of postgraduate learning and service delivery within emergency medicine that require addressing to enable trainees to optimally develop knowledge and skills in this environment.