Johannes Steyrer

Going beyond the individual

New forms of organising and new forms of individuals private and professional life concepts have affected organisations as well as careers. The resulting new forms of careers are characterised by two major elements: organisations are no longer the primary arena for professional careers and the diversity of careers and career paths is sharply increasing. At the level of global careers similar developments can be observed. In addition, two specifics can be mentioned: a number of additional forms of working internationally supplement expatriation in its classic sense and there seems to be an increasing pressure on the speed and diversity of international assignments. There is comparatively little theoretical insight into these developments. Departing from a sociological perspective and using the theoretical framework of late French Sociologist Pierre Bourdieu, this paper takes a career field and habitus perspective of careers. Based on that, it tries to identify areas of contribution for the global career discussion that can emerge from such an approach.

Attitude is everything? The impact of workload, safety climate, and safety tools on medical errors: A study of intensive care units

BACKGROUND Hospitals face an increasing pressure toward efficiency and cost reduction while ensuring patient safety. This warrants a closer examination of the trade-off between production and protection posited in the literature for a high-risk hospital setting (intensive care). PURPOSES On the basis of extant literature and concepts on both safety management and organizational/safety culture, this study investigates to which extent production pressure (i.e., increased staff workload and capacity utilization) and safety culture (consisting of safety climate among staff and safety tools implemented by management) influence the occurrence of medical errors and if/how safety climate and safety tools interact. METHODOLOGY/APPROACH A prospective, observational, 48-hour cross-sectional study was conducted in 57 intensive care units. The dependent variable is the incidence of errors affecting those 378 patients treated throughout the entire observation period. Capacity utilization and workload were measured by indicators such as unit occupancy, nurse-to-patient/physician-to-patient ratios, levels of care, or NEMS scores. The safety tools considered include Critical Incidence Reporting Systems, audits, training, mission statements, SOPs/checklists, and the use of barcodes. Safety climate was assessed using a psychometrically validated four-dimensional questionnaire.Linear regression was employed to identify the effects of the predictor variables on error rate as well as interaction effects between safety tools and safety climate. FINDINGS Higher workload has a detrimental effect on safety, whereas safety climate-unlike the examined safety tools-has a virtually equal opposite effect. Correlations between safety tools and safety climate as well as their interaction effects on error rate are mostly nonsignificant. PRACTICE IMPLICATIONS Increased workload and capacity utilization increase the occurrence of medical error, an effect that can be offset by a positive safety climate but not by formally implemented safety procedures and policies.

Leadership in transformation - between local embeddedness and global challenges*

Based on empirical studies in Romania, Estonia, Germany, and Austria within the GLOBE project, the authors try to answer the question of cultural embeddedness of leadership patterns in an environment of more and more globalised management. Special emphasis is put on the match/mismatch of the observed styles of leadership behaviour of CEOs with regional and global expectations, on the differences and similarities between the examined countries, the influence of transformational settings in the CEE countries, and the prospective changes due to a new generation of managers. Auf der Basis empirischer Studien in Rumanien, Estland, Deutschland und Osterreich im Rahmen des GLOBE - Projektes, gehen die Autoren der Frage nach der kulturellen Einbindung von Fuhrungsmustern unter Bedingungen eines zunehmend globalisierten Managements nach. Im Zentrum stehen dabei der Vergleich der beobachteten Fuhrungsstilmuster von Geschaftsfuhrern mit den regionalen und globalen Erwartungen der Nachgeordneten, die Unterschiede und Ahnlichkeiten zwischen den untersuchten Landern, der Einfluss der Transformationsbedingungen in den MOE-Staaten sowie die erwarteten Veranderungen durch einen Generationswechsel im Management.

Messung und Erfolgswirksamkeit transformationaler Fu hrung

Diese empirische Studie untersucht die Beziehung zwischen transformationaler und transaktionaler Führung und deren langfristige bzw. kurzfristige Erfolgswirksamkeit. Das Führungsverhalten wird anhand des Multifactor Leadership Questionnaires (MLQ) gemessen, dessen psychometrische Qualität überprüft wird. Wir verwenden objektive Erfolgsindikatoren von Bankbetrieben, bei deren Herleitung situative Einflußfaktoren berücksichtigt werden. Wir finden Unterstützung dafür, daß die Erfolgswirksamkeit transformationaler über jene transaktionaler Führung hinausgeht. Transformationale Führung in Form eines freundlichen, individuell wertschätzenden Führungsverhaltens ist positiv mit kurzfristigem und negativ mit langfristigem Erfolg assoziiert.

“Unternehmensberatung” — Stand der deutschsprachigen Theorienbildung und empirischen Forschung

Die vorliegende Arbeit versucht, den aktuellen Forschungsstand der deutschsprachigen Literatur zum Themenbereich “Unternehmensberatung” im Sinne eines “state of the field” sowohl auf theoretischer als auch auf empirischer Ebene aufzuarbeiten. Dabei werden den verschiedenen Entwicklungstendenzen nachgegangen, Forschungsdefizite herausgearbeitet bzw. offen gebliebene Fragestellungen aufgeworfen. Im Rahmen tabellarischer Darstellungen finden sich die wichtigsten Publikationen seit 1970 inhaltlich beschrieben, um die facettenreiche Diskussion in gut fasbarer Form zu veranschaulichen. Da der aktuelle Diskussionsstand zu verschiedenen theoretischen Themen von anderen Autoren in diesem Buch aufgearbeitet wird, beschrankt sich der Theorieteil in erster Linie auf die verschiedenen Explikationsversuche des Objektbereiches und die funktionalen Beitrage der Unternehmensberatung. Im Anschlus daran wird allerdings ein Modell zentraler Betrachtungsebenen fur eine gesamthafte Theorie der Unternehmensberatung skizziert. Der Abschnitt uber die empirischen Forschungsarbeiten referiert schlusendlich bedeutsame Forschungsergebnisse zu angebots- und nachfrageorientierten Aspekten des Beratungsgeschehens und nimmt eine kritische Bewertung des vorliegenden Erkenntnisstandes vor.

Einmal gut, immer gut? Einflussfaktoren auf Karrieren in ‚neuen' Karrierefeldern **

Der Beitrag hat zum Ziel, organisationale- „und, interpersonale” Einflussfaktoren auf Managementkarrieren in post-organisationalen Kontexten zu diskutieren. Nach einer Spezifikation relevanter Termini wird anhand der Dimensionen Kopplung und Konfiguration eine Typologie neuer Karrierefelder entwickelt, die eine Fokussierung auf zentrale Bestimmungsmerkmale neuer Karriereformen ermöglicht. Im Anschluss daran werden Indikatoren vorstellt, die auf Tendenzen einer Substitution unselbständiger Erwerbstätigkeit in Richtung von Beschäftigungsformen in den neuen Karrierefeldern verweisen. Schließlich werden im Sinne eines, State of the Art „Forschungsbefunde zu zentralen organisationalen und interpersonalen Einflussfaktoren auf Karrieren aufgearbeitet. Im abschließenden Teil kommt es zur Formulierung und Diskussion von Thesen darüber, wie sich aufgrund der geänderter Kontextbedingungen die Relevanz einzelner Einflussfaktoren verschieben könnte.

Can Expatriation Research Learn from Other Disciplines?: The Case of International Career Habitus

Even though there is a rich diversity of empirical research and theory building about particular aspects of international careers, more comprehensive theoretical models are rare. This paper contributes to career theory by outlining major elements of a comprehensive theoretical frame for describing and explaining international careers. It proposes a field and habitus perspective of careers based on the work of French sociologist Pierre Bourdieu. Such a perspective enhances the insight into the structure-agency problem of international careers, offers an opportunity to exceed single personality factors through the concept of career habitus, and supports a differentiated view of the international career arena.

Development and validation of a patient safety culture questionnaire in acute geriatric units.

Background: Older patients (≧65 years) are exposed to more harm resulting from adverse events in hospitals than younger patients. Theoretical considerations and empirical findings suggest that safety culture is the key to improving the quality of health care. Objective: To describe the development of a German-language instrument for assessing patient safety culture (PSC) and its reliability and validity; to verify criterion validity by means of a cross-sectional analysis of the impact of PSC on clinical quality that compares acute geriatric units with a sample from intensive care, surgery and trauma surgery departments, and to report variations in the PSC profile between these groups. Methodology: Using a review of existing safety culture surveys, multidimensional scaling procedures and expert interviews, we tested the content and convergent validity of a 158-item questionnaire completed by 508 physicians and nurses from 31 acute geriatric units and 7 comparison departments. Criterion validity was verified by various regression models with a self-reported measure of adverse events. Differences in PSC profiles were analyzed using a one-factorial ANOVA and regression models. Results: We identified 7 constructs of PSC and demonstrated substantial convergent and criterion validity. In the acute geriatric units, higher levels of ‘management commitment to patient safety’ and lower levels of ‘error fatalism’ were associated with a reduced incidence of medical errors. In the comparison group, only the variable ‘active learning from mistakes’ was relevant for safety performance. Our results also indicate that acute geriatric units display higher standards than the comparison group in all the aspects of patient safety examined. Conclusion: It is possible to measure salient features of PSC using a valid and reliable survey. Some aspects of PSC are more closely related to safety events than others. In acute geriatric units, patient safety appears to be influenced mainly by management’s determination of how things are done whereas improvement of the system itself in a more incremental manner is required in the other high-risk ward types.

Two sides of the safety coin?: How patient engagement and safety climate jointly affect error occurrence in hospital units.

Background: Safety climate (SC) and more recently patient engagement (PE) have been identified as potential determinants of patient safety, but conceptual and empirical studies combining both are lacking. Purposes: On the basis of extant theories and concepts in safety research, this study investigates the effect of PE in conjunction with SC on perceived error occurrence (pEO) in hospitals, controlling for various staff-, patient-, and hospital-related variables as well as the amount of stress and (lack of) organizational support experienced by staff. Besides the main effects of PE and SC on error occurrence, their interaction is examined, too. Methodology/Approach: In 66 hospital units, 4,345 patients assessed the degree of PE, and 811 staff assessed SC and pEO. PE was measured with a new instrument, capturing its core elements according to a recent literature review: Information Provision (both active and passive) and Activation and Collaboration. SC and pEO were measured with validated German-language questionnaires. Besides standard regression and correlational analyses, partial least squares analysis was employed to model the main and interaction effects of PE and SC on pEO, also controlling for stress and (lack of) support perceived by staff, various staff and patient attributes, and potential single-source bias. Findings: Both PE and SC are associated with lower pEO, to a similar extent. The joint effect of these predictors suggests a substitution rather than mutually reinforcing interaction. Accounting for control variables and/or potential single-source bias slightly attenuates some effects without altering the results. Practice Implications: Ignoring PE potentially amounts to forgoing a potential source of additional safety. On the other hand, despite the abovementioned substitution effect and conjectures of SC being inert, PE should not be considered as a replacement for SC.

A national survey of defensive medicine among orthopaedic surgeons, trauma surgeons and radiologists in Austria: evaluation of prevalence and context

RATIONALE, AIMS AND OBJECTIVES Defensive medical practice represents an increasing concern in European countries and is reported to account for rising health care expenditures. Malpractice liability, current jurisdiction and the increasing claim for accountability appear to result in additional diagnostic requests with marginal clinical benefit. Investigations that evaluate the national Austrian prevalence and contextual principles and consequences of defensive medicine are lacking so far. METHOD Orthopaedic and trauma surgeons as well as radiologists from public hospitals in Austria were invited to complete a study questionnaire retrieving personal estimation of the quantity of patient contacts and defensive requests in a typical month, subjective judgement of medico-legal climate, evolving defensive trends, working time usage for defensive considerations and prior confrontations with malpractice liability claims. RESULTS The prevalence of defensive medicine was found to be 97.7%. The average orthopaedic or trauma surgeon requests 19.6 investigations per month for defensive reasons, which represents 28% of all diagnostic examinations. High-quality imaging modalities and short-term admissions yield increasing defensive significance. Participants are confronted with 1.4 liability claims per month. During the treatment of high-risk patients, 81% of doctors request additional diagnostic procedures for defensive considerations. Expenditure of time for defensive practice amounts to 9.2 hours/month in radiology and to 17 and 18% of total working time, respectively, in orthopaedic and trauma surgery. CONCLUSION Defensive medical practice represents a serious and common challenge in Austria. Our results indicate the urgent necessity for confrontation with and solution for the increasing effort of self-protection within the health care system.