M. Duncan

A survey of sitting time among UK employees

BACKGROUND Sedentary behaviour is a known risk factor for a wide range of chronic diseases. This major health risk is likely to increase given the increasingly sedentary nature of work. AIMS To investigate the prevalence of sedentary behaviour in a sample of UK working-aged adults, across a range of employment sectors. METHODS A cross-sectional survey conducted with organizations throughout the UK in the education, government administration, retail, telecommunications and service industry sectors. The questionnaire examined employee and organizational information, self-reported domain-specific sitting time, sleep and physical activity. RESULTS A total of 1141 employees completed the questionnaire, of which 504 completed all aspects of the Domain-Specific Sitting Time Questionnaire for work day sitting. Work time sitting accounted for more than half of the total daily sitting time on a work day (54%). Significantly more time was reported sitting on a work day than time reported sleeping (P < 0.001). Males spent more time sitting at work and using a personal computer at home compared with females. Workers in the telecommunications industry had the highest sitting times. There were significant positive associations between sitting time and body mass index. CONCLUSIONS There is a pressing need for future workplace health interventions to reduce employee sitting times.

Implementing resilience engineering for healthcare quality improvement using the CARE model: a feasibility study protocol

BackgroundResilience engineering (RE) is an emerging perspective on safety in complex adaptive systems that emphasises how outcomes emerge from the complexity of the clinical environment. Complexity creates the need for flexible adaptation to achieve outcomes. RE focuses on understanding the nature of adaptations, learning from success and increasing adaptive capacity. Although the philosophy is clear, progress in applying the ideas to quality improvement has been slow. The aim of this study is to test the feasibility of translating RE concepts into practical methods to improve quality by designing, implementing and evaluating interventions based on RE theory. The CARE model operationalises the key concepts and their relationships to guide the empirical investigation.MethodsThe settings are the Emergency Department and the Older Person’s Unit in a large London teaching hospital. Phases 1 and 2 of our work, leading to the development of interventions to improve the quality of care, are described in this paper. Ethical approval has been granted for these phases. Phase 1 will use ethnographic methods, including observation of work practices and interviews with staff, to understand adaptations and outcomes. The findings will be used to collaboratively design, with clinical staff in interactive design workshops, interventions to improve the quality of care. The evaluation phase will be designed and submitted for ethical approval when the outcomes of phases 1 and 2 are known.DiscussionStudy outcomes will be knowledge about the feasibility of applying RE to improve quality, the development of RE theory and a validated model of resilience in clinical work which can be used to guide other applications. Tools, methods and practical guidance for practitioners will also be produced, as well as specific knowledge of the potential effectiveness of the implemented interventions in emergency and older people’s care. Further studies to test the application of RE at a larger scale will be required, including studies of other healthcare settings, organisational contexts and different interventions.

Emergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience

Study objective: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice. Methods: This was a mixed‐method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16‐month period in a large UK ED (n=30 observations). Results: The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need (“work as done”) was found to be incompletely specified in policies (“work as imagined”). Conclusion: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.

Walking Works Wonders: a tailored workplace intervention evaluated over 24 months

Abstract This article presents longitudinal data from 1120 participants across 10 worksites enrolled in Walking Works Wonders, a tailored intervention designed to increase physical activity and reduce sedentary behaviour. The intervention was evaluated over 2 years, using a quasi-experimental design comprising 3 conditions: tailored information; standard information and control. This study explored the impact of the intervention on objective measures (BMI, %Fat, waist circumference, blood pressure and heart rate) and self-reported measures of physical activity, sedentary behaviour, physical and psychological health. Interventions tailored to employees’ stage of change significantly reduced BMI and waist circumference compared to standard and control conditions. Employees who received either a standard or tailored intervention demonstrated significantly higher work ability, organizational commitment, job motivation, job satisfaction and a reduction in intention to quit the organization. The results suggest that adopting a tailored approach to interventions is particularly effective in terms of improving health in the workplace. Practitioner Summary: This study describes Walking Works Wonders, a tailored intervention, which aims to encourage physical activity in the workplace. The study evaluated Walking Works Wonders over a 2 year period and demonstrated that interventions are more effective in improving health outcomes where the information is tailored to employees’ stage of change.

Walking Works Wonders: A Workplace Health Intervention Evaluated Over 24 Months

Walking Works Wonders (WWW) is a workplace intervention designed to increase physical activity and reduce sedentary behaviour. WWW involves tailoring health information according to employees’ readiness for change. The approach recognises that when attempting to motivate behaviour change, success is greater when interventions align with recipients’ attitudes and beliefs. The impact of the tailored approach was investigated by comparing tailored interventions with standard conditions and control groups in a 24-month longitudinal study in 10 worksites across the UK. Employees who received either a standard or tailored intervention demonstrated significantly higher self-reported work ability and improved organizational commitment, job motivation, job satisfaction, and a reduction in intention to quit the organization. The tailored interventions significantly reduced BMI and waist circumference compared to standard and control conditions. Workplace health interventions designed to increase physical activity and reduce sedentary behaviour are likely to be more effective where the information is tailored to employees’ readiness to change.

Emergency Department Escalation in Theory and Practice

Study objective: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice. Methods: This was a mixed‐method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16‐month period in a large UK ED (n=30 observations). Results: The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need (“work as done”) was found to be incompletely specified in policies (“work as imagined”). Conclusion: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.

The practice of emergency medicine/original researchEmergency Department Escalation in Theory and Practice: A Mixed-Methods Study Using a Model of Organizational Resilience

Study objective: Escalation policies are used by emergency departments (EDs) when responding to an increase in demand (eg, a sudden inflow of patients) or a reduction in capacity (eg, a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying “normal” processes. The study objective is to examine escalation policies in theory and practice. Methods: This was a mixed‐method study involving a conceptual analysis of National Health Service escalation policies (n=12) and associated escalation actions (n=92), as well as a detailed ethnographic study of escalation in situ during a 16‐month period in a large UK ED (n=30 observations). Results: The conceptual analysis of National Health Service escalation policies found that their use requires the ability to dynamically reconfigure resources (staff and equipment), change work flow, and relocate patients. In practice, it was discovered that when the ED is under pressure, these prerequisites cannot always be attained. Instead, escalation processes were adapted to manage pressures informally. This adaptive need (“work as done”) was found to be incompletely specified in policies (“work as imagined”). Conclusion: Formal escalation actions and their implementation in practice differed and varied in their effectiveness. Monitoring how escalation works in practice is essential in understanding whether and how escalation policies help to manage workload.

Working Late: strategies to enhance productive and healthy environments for the older workforce

Aims and objectives: Working Late is a 4 year multidisciplinary research project addressing practice and policy issues associated with later life working. The project is funded by the New Dynamics of Ageing (NDA) Programme. Methods: The Working Late research adopts a mixed method research approach of focus groups, interviews, surveys, interventions and the development of a design resource to enhance health and quality of working life across the life span. Results: This paper describes findings from the surveys and physical activity interventions along with the development of the design resource which captures the needs of the older workforce. Discussion: This research unites key policy themes: the need to maintain workforce capacity and flexibility; the need to retain older people in the workforce; and the need to support active healthy ageing. Conclusion: This project brings together the policy domains of employment dynamics, work systems design and health and the outputs will inform policies and practices aiming to remove barriers to later life workforce participation, and promote the health and well-being of older workers.