Health services management research : an official journal of the Association of University Programs in Health Administration
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Health Serv Manage Res · Nov 1994
Comparative StudyJob stress, ill health and job satisfaction among health service employees.
The study examined the effects of occupational stressors, perceived locus of control, Type A behaviour pattern and use of coping strategies on well-being and job satisfaction of 1,176 health service employees. Several stressors were identified as having a negative impact on health and job satisfaction although these differed between the various occupational groups included in the study. The interactionist model of stress used in the study, and the diagnostic tool used (the Occupational Stress Indicator) proved to be useful in suggesting means of intervening to reduce ill health and increase job satisfaction among health service employees.
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Health Serv Manage Res · Feb 1994
Comparative StudyDo formal controls always achieve control? The case of triage in accident and emergency departments.
Triage is the term used to describe the formal process of assigning urgency categories to patients arriving in a hospital accident and emergency department. This paper uses insights from literature on management control, medical sociology and nursing to illuminate the results of a research study comparing formal triage with an informal prioritisation process carried out by nurses. Topics discussed include whether triage is a bureaucratic process, whether it allows nurses' intuition to be expressed, whether it masks the urgency of the condition of the small number of seriously injured or ill patients, and whether responsibility for decisions on urgency should be separated from responsibility to act on those decisions. It is concluded that managers must consider these questions in the light of arrangements in their own hospital; departmental layout as well as the nursing staff's experience and commitment need to be taken into account.
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Health Serv Manage Res · Feb 1993
The impact of advertising on price and practice volume. A case study of dental markets.
Advertising is often considered a catalyst which stimulates competition by communicating the important attributes (information) of goods and services to consumers. Theoretically, advertising makes demand responsive to strategic price differences. This advertisement-induced price elasticity puts competitive pressure on the providers' pricing strategy. ⋯ This study investigates the impact that the advertising of services has on the price and demand behaviour in the dental care market. The sampling frame includes 1,326 dentists, 558 (44.3%) of whom have advertised their services. The statistical results seem to dispute the claim that advertising lowers the consumer's price and increases the advertising dentist's market share.
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Health Serv Manage Res · Feb 1993
RMI (Resource Management Initiative) and quality--getting the climate right.
The literature on the Resource Management Initiative (RMI) identifies an improvement in the quality of patient care as one of its principal aims. Successful implementation of RMI requires a change in behaviour. The mechanism or process by which this is to be achieved is not clear. ⋯ We suggest that an understanding of the mechanisms through which an acute hospital can influence quality is best viewed from the perspective of organisational climate. The paper suggests a normative model for exploring climate and quality linkages through the operation of six key organisational levers. The applicability of the model is discussed throughout with reference to a RM acute hospital.
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The proposal for self-governing hospital trusts within the NHS, announced in the White Paper Working for Patients on 31 January 1989 and enacted through passage of the National Health Service and Community Care Act 1990 last July, introduces free market incentives to NHS hospitals. Hospitals applying for self-governing status must first demonstrate that they have an information system appropriate to support decision making in the new context. An overall information systems flow and an approach to information systems development are recommended based upon the Freeman Hospital model. The Freeman Hospital is a national pilot site selected by the NHS Management Executive for development of information systems for NHS hospitals.