Larry A. Mallak

Exploring emergency physician-hospitalist handoff interactions: development of the Handoff Communication Assessment.

STUDY OBJECTIVE We develop and evaluate the Handoff Communication Assessment, using actual handoffs of patient transfers from emergency department to inpatient care. METHODS This was an observational qualitative study. We derived a Handoff Communication Assessment tool, using categories from discourse coding described in physician-patient communication, previous handoff research in medicine, health communication, and health systems engineering and pilot data from 3 physician-hospitalist handoffs. The resulting tool consists of 2 typologies, content and language form. We applied the tool to a convenience sample of 15 emergency physician-to-hospitalist handoffs occurring at a community teaching hospital. Using discourse analysis, we assigned utterances into categories and determined the frequency of utterances in each category and by physician role. RESULTS The tool contains 11 content categories reflecting topics of patient presentation, assessment, and professional environment and 11 language form categories representing information-seeking, information-giving, and information-verifying behaviors. The Handoff Communication Assessment showed good interrater reliability for content (kappa=0.71) and language form (kappa=0.84). We analyzed 742 utterances, which provided the following preliminary findings: emergency physicians talked more during handoffs (67.7% of all utterances) compared with hospitalists (32.3% of all utterances). Content focused on patient presentation (43.6%), professional environment (36%), and assessment (20.3%). Form was mostly information-giving (90.7%) with periodic information-seeking utterances (8.8%) and rarely information-verifying utterances (0.4%). Questions accounted for less than 10% of all utterances. CONCLUSION We were able to develop and use the Handoff Communication Assessment to analyze content and structure of handoff communication between emergency physicians and hospitalists at a single center. In this preliminary application of the tool, we found that emergency physician-to-hospitalist handoffs primarily consist of information giving and are not geared toward question-and-answer events. This critical exchange may benefit from ongoing analysis and reformulation.

Measuring resilience in health care provider organizations

Health care providers offer an ideal setting to study the effectiveness of resilient behavior. The notion of a resilient organization is an emerging concept for understanding and coping with the modern-day pace of change and associated work stress. Resilience is the ability of an individual or organization to expeditiously design and implement positive adaptive behaviors matched to the immediate situation, while enduring minimal stress. This paper reports on the development and testing of several scales designed to measure aspects of resilience in the health care provider industry. Six factors explaining over half the instrument variance were found, including: goal-directed solution seeking; avoidance; critical understanding; role dependence; source reliance; and resource access. Results are discussed and future research is outlined.

A cultural study of ISO 9000 certification

Reports an exploratory investigation of the organizational cultural values supporting and inhibiting certification to the ISO 9000 series of quality standards. As more firms pursue certification to ISO 9000 based quality system standards, the hypothesis emerges of a common cultural profile to support successful certification. This hypothesis was investigated by asking management representatives of firms currently registered to the ISO 9000 standards to evaluate the roles of specific organizational values in their successfully registered firms. A modified version of an existing culture measurement procedure was used to measure culture. Factor analysis identified factors working towards and against attainment of ISO 9000 certification. The results of this study suggest organizations seeking ISO 9000 certification should be decisive, team‐oriented, risk‐averse, and should value stability, pay attention to detail, value high levels of organization and value working in a co‐operative environment with good interpersonal relationships. Offers suggestions for extending this research beyond the current study.

Culture, the built environment and healthcare organizational performance

Healthcare organization performance is a function of many variables. This study measured relationships among culture, the built environment, and outcome variables in a healthcare provider organization. A culture survey composed of existing scales and custom scales was used as the principal measurement instrument. Results supported culture strength’s links with higher performance levels and identified the built environment’s role as a moderating variable that can lead to improved processes and outcomes. Job satisfaction and patient satisfaction were found to be significantly and positively correlated with culture strength and with ratings of the built environment.

Diagnosing culture in health‐care organizations using critical incidents

The critical incident technique (CIT) provides a means to produce rich cultural information from organizational members in an effort to describe the organization’s culture. Very few published studies have used CIT to diagnose culture. In combination with other methods, CIT can be an integral element of a larger study of an organization’s culture. In this study, CIT was used in a US acute care hospital that had recently occupied a new

Challenges in implementing e-learning

181 million replacement hospital having an emphasis on patient‐centered care and a healing environment. Individual CIT “stories” supplied rich detail about the hospital’s culture, providing opportunities to communicate how people behave with respect to the culture. Consequently, CIT results provide specific information on what people do that supports the culture and what they do that works against the culture.

Toward a theory of organizational resilience

Todays technology affords many new options to design and deliver educational and training content. However, the adoption rate, cost, features, and infrastructure supporting these technologies can inhibit e-learning effectiveness. This paper draws from the literature and from recent uses of e-learning technologies in engineering management courses to identify ways of teaching and learning more effectively.

Using Culture Gap Analysis to Manage Organizational Change

Workers are experiencing rapid amounts of change from many sources. Several disciplines have approached this issue from their unique perspectives. How individuals and organisations respond to change affects key outcomes. This paper works toward a unified theory of resilience to help embrace and manage organizational change effectively. The notion of a resilient organization is an emerging concept for understanding and coping with the modern day pace of change and associated work stress. Resilience is the ability of an individual or organization to expeditiously design and implement positive adaptive behaviors matched to the immediate situation, while enduring minimal stress.

Using Desired Culture Analysis to Manage Decentralized Operations

ABSTRACTMost organizations have gaps between their existing and their desired cultures. These culture gaps provide insight to an organizations ability to change and effective targets of change. Engineering and technical managers concerned about the cultures of their organizations in the midst of ISO 9000 certification processes, rapid changes and growth, and dramatic market and technological restructuring now have a tool and a process for evaluating their organizations.We devised an instrument to measure these culture gaps. We applied this instrument in a university-based R&D facility for pilot testing and then conducted a full study at the headquarters of a life insurance firm. We found that divisions having people who were supportive, tolerant, fair, and cooperative had higher teamwork scores. High pay for good performance, employment security, praise for performance, and opportunities for professional growth corresponded with higher levels of employee commitment. Managers can use information about the...

Delayering in a US Army R&D organization

Abstract: The purpose of this article is to extract lessons and implications for managers in decentralized operations who seek to integrate their organizational culture across all operations. This is accomplished via a case study of the role of culture measurement and resultant action planning in a regional healthcare system in the midwest United States. The systems vision was to provide a seamless patient experience everywhere in the system. Managers in engineering and technical organizations having decentralized functions can learn from this systems experience in using culture measurement to support organizational system integration.