Journal of Health Organisation and Management

Why are there local shortfalls in anaesthesia consultant staffing?: A case study of operational workforce planning : Table of Contents

J.J. Pandit, A.N. Tavare, P. Millard — Mon Mar 22 02:05:22 GMT 2010

Abstract:
Purpose – Anecdotally, many hospitals experience shortfalls in anaesthetic consultant staffing. This paper aims to investigate whether these subjective experiences are confirmed objectively. Design/methodology/approach – The paper hypothesises that a simple model that estimated service delivery capability using consultant entitlements to annual and other types of leave would not (null hypothesis) accurately predict the magnitude of any shortfall that existed. It also hypothesises that excessive leave-taking was an important cause of any shortfall. A comparison is made between the model predictions for total leave taken and service delivery with results from a real data set from a large university teaching hospital's department of anaesthetics. Findings – The model prediction for leave (median total 45 days absence in a year per consultant, range (30-59)) closely matched the reality (median 41 days (tenth-ninetieth deciles 30-69)). Consequently, both model predictions and the real data for annual elective service delivery agreed: median 228 sessions (193-266) vs 232 (183-266) per consultant respectively. Taking into account likely service delivery by trainees (2,304-4,140 elective sessions in total annually) the predicted shortfall of 2,220 sessions was very close to the true elective service shortfall of 2,148 sessions for the department as a whole over the year. Practical implications – Rejecting the null hypothesis, it is concluded that a simple model that estimates elective service delivery using leave entitlements as the main factor can accurately predict actual service capability for a department. There is no evidence that excessive leave-taking occurs. Originality/value – The paper computes an estimate that 2.2-2.6 consultants per functional operating theatre are necessary to ensure that staffing matches the elective workload.

The hospitalist as coordinator: an observational case study : Table of Contents

Ulrike Burkhardt, Astrid Erbsen, Marjam Rüdiger-Stürchler — Mon Mar 22 02:05:22 GMT 2010

Abstract:
Purpose – The hospitalist concept aims for integration and continuity of care in inpatient treatment. The purpose of this paper is to understand how the hospitalist function emerges and unfolds on wards. Therefore, the paper aims to focus on interaction patterns and the role of the hospitalist. Design/methodology/approach – Building on methodological approaches in health care team research, this process-oriented case study used participatory observations and semi-structured interviews. Over a year, 14 observational days were conducted, simultaneously accompanying hospitalists, nurses and surgeons. Observational data illustrate the findings. Findings – The hospitalist function was perceived to have a positive impact. He/she serves as an informal leader by taking up five interrelated, mostly coordinative roles, which help to cope with different organisational gaps. The interaction patterns are bilateral, ad hoc, reactive, repetitive and dependent on chance and people. Roles, tasks and responsibilities are continuously negotiated. Research limitations/implications – Hospitalist research should make use of the debate in health care team research about overlapping roles, tasks and responsibilities. Additionally, one could look at the origins behind the evolvement of interaction patterns and the hospitalist's roles. Practical implications – The sole creation of the hospitalist function is not sufficient to tap its full potential. Organisational issues concerning the interaction processes need to be addressed. In so doing, the professions' orientations must be taken into account. Originality/value – This paper addresses theoretical and methodological gaps in hospitalist research. Using a process-oriented qualitative design, the findings question the prominent stimulus-response assumption. The focus on the interplay of functions and the hospitalists' roles lead to a more comprehensive picture of the patient-related interaction processes.

Anger-provoking events and intention to turnover in hospital administrators : Table of Contents

Karen Harlos — Mon Mar 22 02:05:22 GMT 2010

Abstract:
Purpose – The purpose of this paper is to examine anger associated with types of negative work events experienced by health administrators and to examine the impact of anger on intent to leave. Design/methodology/approach – Textual data analysis is used to measure anger in open-ended survey responses from administrative staff of a Canadian hospital. Multivariate regression is applied to predict anger from event type, on the one hand, and turnover intentions from anger, on the other. Findings – Person-related negative events contributed to administrator anger more than policy-related events. Anger from events predicted turnover intentions after adjusting for numerous potential confounds. Research limitations/implications – Future studies using larger samples across multiple sites are needed to test the generalizability of results. Practical implications – Results provide useful information for retention strategies through codifying respect and fairness in interactions and policies. Health organizations stand to gain efficiencies by helping administrators handle anger effectively, leading to more stable staffing levels and more pleasurable, productive work environments. Originality/value – This paper addresses gaps in knowledge about determinants of turnover in this population by examining the impact of administrator anger on intent to leave and the work events which give rise to anger. Given the strategic importance of health administration work and the high costs to health organizations when administrators leave, results hold particular promise for health human resources.

Selection of chairs of primary care trusts: Evidence of reliability and validity : Table of Contents

John Alban-Metcalfe, Beverly Alimo-Metcalfe, Miranda Hughes — Mon Mar 22 02:05:22 GMT 2010

Abstract:
Purpose – This paper aims to examine empirical evidence of the criterion, construct, and face validity of two processes commonly used in selection – selection interviews and assessment centres (ACs) – in the selection of chairs of primary care trusts. Design/methodology/approach – A critical review of the literature and an empirical investigation are undertaken. Findings – Evidence is presented of the reliability and the predictive, construct, and face validity of using a combination of selection interviews and AC methodology in appointments to public office. In the light of the evidence of the potential benefits of using more than one approach, it is suggested that a combination of AC methodology and panel interviews be used in making public sector appointments. Practical implications – The evidence presented supports the decision of the Appointment Commission to use AC methodology in the selection for positions in public office, and points to ways in which the process could be improved. Originality/value – The paper provides empirical evidence of the reliability and validity of two methodologies used in selection to posts.