Christel A. Woodward

Readiness for organizational change: A longitudinal study of workplace, psychological and behavioural correlates

To examine factors influencing readiness for healthcare organizational change, 654 randomly selected hospital staff completed questionnaires measuring the logistical and occupational risks of change, ability to cope with change and to solve jobrelated problems, social support, measures of Karaseks (1979) active vs. passive job construct (job demand× decision latitude) and readiness for organizational change. Workers in active jobs (Karasek, 1979) which afforded higher decision latitude and control over challenging tasks reported a higher readiness for organizational change scores. Workers with an active approach to job problem-solving with higher job change self-efficacy scores reported a higher readiness for change. In hierarchical regression analyses, active jobs, an active job problem-solving style and job-change self-efficacy contributed independently to the prediction of readiness for organizational change. Time 1 readiness for organizational change scores and an active approach to job problem-solving were the best predictors of participation in redesign activities during a year-long re-engineering programme.

Examining the Role of Health Services Research in Public Policymaking

Conceptual, methodological, and practical issues await those who seek to understand how to make better use of health services research in developing public policy. Some policies and some policymaking processes may lend themselves particularly well to being informed by research. Different conclusions about the extent to which policymaking is informed by research may arise from different views about what constitutes health services research (is it citable research or any professional social inquiry that can aid in problem solving?) or different views about what constitutes research use (is it explicit uses of research only, or does it also include tacit knowledge or the positions of stakeholders when they are informed by research and are influential in the policymaking process?). Some conditions may favor the use of research in policymaking, like sustained interactions between researchers and policymakers. Results from an exploratory study on the use of health services research by Canadian provincial policymakers illustrate these issues.

Outcome, prognosis, and risk in a longitudinal follow-up study.

This study reports the results of a 4-year follow-up of a community sample of children who were ages 4 to 12 in 1983 at the first wave of data collection. Results on outcomes revealed that conduct disorder showed the greatest stability especially from late childhood to early adolescence. In multivariate analyses, both family dysfunction and problems getting along with others significantly predicted the persistence of one or more psychiatric disorders 4 years later, and low income predicted one or more psychiatric disorders among children free of disorder 4 years earlier. The implications of the results for the child psychiatric field, especially prevention, are discussed.

Influence of Companion Animals on the Physical and Psychological Health of Older People: An Analysis of a One-Year Longitudinal Study

OBJECTIVE: To examine whether companion animals or attachment to a companion animal was associated with changes in physical and psychological health in older people and whether the relationships between physical and psychological health and human social networks were modified by the presence or absence of a companion animal.

Agreement between Self-reported and Routinely Collected Health-care Utilization Data among Seniors

OBJECTIVE To examine the agreement between self-reported and routinely collected administrative health-care utilization data, and the factors associated with agreement between these two data sources. DATA SOURCES/STUDY SETTING A representative sample of seniors living in an Ontario county within Canada was identified using the Ontario Ministry of Healths Registered Persons Data Base in 1992. Health professional billing information and hospitalization data were obtained from the Ontario Ministry of Health and Long-Term Care (OMH) and the Ontario Health Insurance Plan (OHIP). STUDY DESIGN A cross-sectional survey was carried out to assess any contact and frequency of contacts with health professionals and hospital admissions. Similar information was obtained from routinely collected administrative data. The level of agreement was assessed using the proportion of absolute agreement, Cohens kappa statistic (kappa), and the intraclass correlation coefficient (ICC). Logistic and linear regressions were used to identify factors that were associated with the magnitude and direction of disagreement respectively. DATA COLLECTION/EXTRACTION METHODS Telephone interviews were conducted on 1,054 seniors, and complete data were available for 1,038 seniors. Each respondents personal health number was used to electronically link survey data with health professional billing and hospitalization databases. PRINCIPAL FINDINGS Substantial to almost perfect agreement was found for the contact utilization measures, while agreement on volume utilization measures varied from poor to almost perfect. In surveys, seniors overreported contact with general practitioners and physiotherapists or chiropractors, and underreported contact with other medical specialists. Seniors also underreported the number of contacts with general practitioners and other medical specialists. The odds of agreement decreased if respondents were male, aged 75 years and older, had incomes of less than

The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital: a longitudinal study.

25,000, had poor/fair/good self-assessed health status, or had two or more chronic conditions. CONCLUSION The findings of this study indicate that there are substantial discrepancies between self-reported and administrative data among older adults. Researchers seeking to examine health-care use among older adults need to consider these discrepancies in the interpretation of their results. Failure to recognize these discrepancies between survey and administrative data among older adults may lead to the establishment of inappropriate health-care policies.

Changes in general health and musculoskeletal outcomes in the workforce of a hospital undergoing rapid change: a longitudinal study.

OBJECTIVES To examine changes over time in the hospital staffs perceptions of how rapid organizational change, caused by fiscal constraints imposed by governments, affects them, their work environment, and the quality of care and services that they provide. METHODS A random sample of hospital employees (n = 900) of a large Ontario teaching hospital participated in a longitudinal study which involved surveys at 3 measurement periods over a 2-year period. The questionnaire used in this study included scales reflecting work environment, emotional distress, personal resources, spillover from work to home and vice versa, and perceptions regarding patient care and the hospital as an employer. RESULTS Significant increases in depression, anxiety, emotional exhaustion, and job insecurity were seen among employees, particularly during the first year of the change process. By the end of the second year, employees reported deterioration in team work, increased unclarity of role, and increased use of distraction to cope. Job demands increased throughout the period whereas little change occurred in the employees job influence or decision latitude. Overall, the work environment was negatively affected. Although patient care was unaffected in the first year, a significant decline in perceptions of patient care, attention to quality improvement, and overall quality of care were later seen. CONCLUSIONS This study raises questions about whether hospital re-engineering and mergers will be able to achieve the cost reductions sought without sacrificing quality of work life. Along with the rapid change, there was increase in emotional distress among staff and a deterioration in their relationship with their employer.

THE ROLE OF GOAL ATTAINMENT SCALING IN EVALUATING FAMILY THERAPY OUTCOME

This article aimed to examine changes in general health and time with back pain and neck pain and to identify predictors of any such changes. Hospital workers were studied longitudinally with surveys in 1995, 1996, and 1997 (N = 712). Back and neck pain were reported only at the 2nd and 3rd surveys. There was a significant decline in general health and significant increases in time with neck pain and back pain. Predictors of changes in these outcomes were mainly work-related variables (initial or change values), such as job interference with family, job influence, work psychological demands, and hours worked.

Children as standardized patients: Initial assessment of effects

The role of an individualized goal attainment procedure as an outcome measure for brief family therapy is described. Establishment of a scale and assessment of goal attainment at six-month follow-up are reported in a study of some 270 families. Results support the procedure as being a reliable and valid means of examining the outcome status of treated families.

Perspectives of Graduates Two or Five Years After Graduation from a Three-Year Medical School.

In this exploratory study, we examined the effects of simulating experienced by children who are standardized patients (SPs). In 1993, a random sample of children in the McMaster University SP pool were invited to attend a focus group. The data were transcribed, content analyzed, and reviewed by participants to ensure that they were trustworthy. All(N = 7) of the child SPs (age 6–18) who were invited to the focus group attended, except those who had moved away. The children reported that they acquired important skills and information through simulating. Developmental differences were observed in the nature of the effects reported. The teenagers reported sophisticated learning about communication, their behavior, adults, and life in general. Our results suggest care should be taken in selecting children as SPs and their SP roles to ensure that this experience benefits them. Further exploration of the effects of being an SP on children is advocated.