Grant T. Savage

Behavioral integrity for safety, priority of safety, psychological safety, and patient safety: a team-level study

This article clarifies how leader behavioral integrity for safety helps solve followers double bind between adhering to safety protocols and speaking up about mistakes against protocols. Path modeling of survey data in 54 nursing teams showed that head nurse behavioral integrity for safety positively relates to both team priority of safety and psychological safety. In turn, team priority of safety and team psychological safety were, respectively, negatively and positively related with the number of treatment errors that were reported to head nurses. We further demonstrated an interaction effect between team priority of safety and psychological safety on reported errors such that the relationship between team priority of safety and the number of errors was stronger for higher levels of team psychological safety. Finally, we showed that both team priority of safety and team psychological safety mediated the relationship between leader behavioral integrity for safety and reported treatment errors. These results suggest that although adhering to safety protocols and admitting mistakes against those protocols show opposite relations to reported treatment errors, both are important to improving patient safety and both are fostered by leaders who walk their safety talk.

Project Stakeholder Management—Past and Present

In this special issue on project stakeholder management, the aim is to advance the understanding of this topic by looking into theory outside the project management field and by presenting findings from case studies. In this overview article, we identify the theoretical roots of the stakeholder concept and the current state of the field. We point to early proponents of stakeholder thinking. In addition, we point to recent concepts and developments outside the project management field that are relevant in the project management context; then, we introduce the articles included in the special issue; and, finally, we identify other relevant publications.

International research in health care management : its need in the 21st century, methodological challenges, ethical issues, pitfalls, and practicalities

PURPOSE This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them. DESIGN/METHODOLOGY/APPROACH The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research. FINDINGS International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success. ORIGINALITY/VALUE This commentary addresses salient issues pertaining to international research in one comprehensive account.

Stakeholder Dynamics During the Project Front‐End: The Case of Nuclear Waste Repository Projects

Understanding stakeholder dynamics and their impact on project management is crucial, especially for large and complex projects such as nuclear waste repositories. This study examines the stakeholder dynamics during the project front-end stage of two pioneering nuclear waste repository projects. To analyze changes in stakeholders’ importance and position on a project, we propose and apply a new conceptual framework: a stakeholder salience-position matrix. The study explicates how stakeholder dynamics are influenced by the interaction of stakeholders’ influence behavior, stakeholder management activities, and the projects contextual conditions. Prior stakeholder literature has rarely conceptualized the elements of stakeholder dynamics in a systematic manner.

Environmental factors and quality improvement in county and local health departments.

OBJECTIVE On the basis of resource dependency theory and the uncertainty principle, this study examines the relationship between the local public health market environment and the use of quality improvement (QI) strategies in local health departments. DESIGN This cross-sectional study uses secondary data from the 2008 National Association of County & City Health Officials profile study, the Health Resources and Services Administrations Area Resource File, and the County Health Rankings 2010 data set. SETTING AND PARTICIPANTS US local health departments. MAIN OUTCOME MEASURES Seven binary dependent variables that represented the use of QI processes or QI training within local health departments were used. Eight independent variables were identified and operationalized to measure the constructs of munificence, dynamism, and complexity for the local public health market environment. Bivariate and multivariate regression analyses were used. RESULTS Two of the 3 munificence variables were positively associated with QI, as predicted. These included percentage of zip codes with healthy food outlets (β = +.016, P < .05) and the number of primary care physicians per capita (β = +1.327, P < .05). Two of the 3 measures of complexity were, as predicted, negatively associated with indicators of QI. These included smoking prevalence (β = -.118, P < .05) and obesity rates (β = -.081, P < .10). With respect to dynamism, 1 variable (change in population size over a 5-year period) was unexpectedly, positively related to QI (β = +.118, P < .10 and β = +0.235, P < .05). CONCLUSIONS Overall findings provide moderate support for the use of resource dependency theory and the uncertainty perspective to understand the influence of the external environment on QI within the local public health setting. Future research should examine other ways of operationalizing these environmental constructs to examine the relationship between the environment and other elements of public health practice.

The Role of Individual and Collective Mindfulness in Promoting Occupational Safety in Health Care.

Although the importance of safety regulations is highly emphasized in hospitals, nurses frequently work around, or intentionally bypass, safety regulations. We argue that work-arounds occur because adhering to safety regulations usually requires more time and work process design often lacks complementarity with safety regulations. Our main proposition is that mindfulness is associated with a decrease in occupational safety failures through a decrease in work-arounds. First, we propose that individual mindfulness may prevent the depletion of motivational resources caused by worrying about the consequences of time lost when adhering to safety regulations. Second, we argue that collective mindfulness may provide nursing teams with a cognitive infrastructure that facilitates the detection and adaptation of work processes. The results of a multilevel analysis of 580 survey responses from nurses are consistent with our propositions. Our multilevel analytic approach enables us to account for the unique variance in work-arounds that individual and collective mindfulness explain.

Antecedents to workplace injury in the health care industry: A synthesis of the literature.

Background: The U.S. Department of Labor has identified the health care industry as a major source of all U.S. workplace injuries. Studies have shown that injury within the health care workforce is related to high turnover rates, burnout, poor job satisfaction, and leaving the health care workforce permanently, thus contributing to the existing health care workforce shortages. Purpose: The purpose of this synthesis of the literature was twofold. The first was to conduct a comprehensive evaluation of the occupational health and safety literature to determine the key antecedents to health care provider injury. The second was to utilize the National Institute for Occupational Safety and Health (NIOSH) framework to organize the findings. Methodology: Empirical studies published between 1985 and 2013 examining work-related injuries sustained by nurses and nurses’ aides were systematically reviewed and evaluated for inclusion in the synthesis of the literature. Thirty-six studies met the criteria for inclusion. Using the NIOSH framework, antecedent variables to workplace injury were identified and then grouped into three broad categories that were highlighted during the synthesis: organization of work, job characteristics, and safety programs and training. A fourth category, individual characteristics, was added based on its use by many studies. Findings: Over half of the studies (n = 20) included factors within the organization of work category. Over two thirds of the studies (n = 26) included job characteristics such as task and demand. Nine studies contained information related to safety programs and training, whereas 17 studies included information on individual factors. The findings suggest that the NIOSH framework, with the addition of individual characteristics, provide a foundation for conceptually organizing occupational health and safety studies. Practice Implications: Health care administrators and leaders should be aware and understand the antecedents to workplace injury that will assist their organizations in developing training programs to reduce the current excessive rates of health care provider injury.

Patient safety: State-of-the-art in health care management and future directions

The needs for health system change and improved patient safety have been pointed out by policymakers, researchers, and managers for several decades. Patient safety is now widely accepted as being fundamental to all aspects of health care. The question motivating this special volume on patient safety is: How can the increased emphasis on patient safety among health care managers be more effectively translated into better policy and reduced clinical risk? The 12 contributions in this volume are divided into four sections: (1) theoretical perspectives on managing patient safety; (2) top management perspectives on patient safety; (3) health information technology (HIT) perspectives on patient safety; and (4) organizational behavior and change perspectives on patient safety. Patient safety is a topic that provides a fertile niche for management researchers to test existing theories and develop new ones. For example, the patient safety goals of reducing medical errors while maximizing health outcomes draws upon the tenets of evidence-based medicine (EBM), as well as the managerial theories of human relations, organizational culture, organizational development, organizational learning, organizational structure, quality improvement, and systems thinking. Indeed, these and other managerial theories are drawn upon and applied in different ways by the various contributors. Overall, the authors of this volume demonstrate that the future of patient safety for health care management requires health care professionals and managers who can successfully engage in multi-faceted projects that are socially and technically complex.

A Multi-topic Meta-classification Scheme for Analyzing Lobbying Disclosure Data

For the functioning of American democracy, the Lobbying Disclosure Act (LDA), for the very first time, provides data to empirically research interest groups behaviors and their influence on congressional policymaking. One of the main research challenges is to automatically find the topic(s), by short & sparse text classification, in a large corpus of unorganized, semi-structured, and poorly connected lobbying filings to reveal the underlying purpose(s) of these lobbying activities. Common techniques for alleviating data sparseness are to enrich the context of data by external information. This paper, however, proposed an inter-disciplinary yet practical solution to this problem using a Multi-Topic Meta-Classification (MTMC) scheme built upon a set of semantic attributes (i.e., General Issue, Specific Issue, and Bill Info.), integrated with a domain-specific Policy Agenda (PA) coding/labeling procedure. First, multi-label base-classifiers that have been transformed into multi-class classification problems were learned from the abovementioned three semantic sources, respectively, second, to render reliability classification, one meta-classifier per attribute was trained based on meta-instances dataset labeled in a cross-validation fashion, third, the final prediction is made via fusing the reliable outputs of such ensembles of classifiers. Experiments demonstrated satisfactory classification performance with various evaluation measures on such a real-world textual dataset that poses many challenges including problems with noisy data and semantic ambiguity.

International "best practices" in health care: the roles of context and innovation.

PURPOSE Explores recent approaches to international best practices and how they relate to context and innovation in health services. DESIGN/METHODOLOGY/APPROACH Critical review of existing research on best practices and how they created, diffused, and translate in the international setting. FINDINGS Best practices are widely used and discussed, but processes by which they are developed and diffused across international settings are not well understood. RESEARCH IMPLICATIONS Further research is needed on innovation and dissemination of best practices internationally. ORIGINALITY/VALUE This commentary points out directions for future research on innovation and diffusion of best practices, particularly in the international setting.