This study explored teamwork in two hospitals implementing Total Quality Management. Its objectives were to: document and describe the social process of constructing teamwork in the two hospitals and the patterns of interaction that emerged; to compare the experiences of teamwork in the hospitals to the conceptualization of teamwork prescribed by TQM and to compare the experiences of the two hospitals to each other; and to understand how teamwork is interpreted by members of TQM hospitals. A multi-site case design was used; data was collected through participant observation, interviews, and document analysis. Results suggested that quality improvement teams represent a means for creating teamwork in hospitals by providing a forum for members to understand each other's needs, work, and problems through which respect and cooperative relationships emerged. Team leaders played a key role in the construction of teamwork by managing the meaning of teamwork, guiding the work of teams, assuring equal participation and facilitating the establishment of meaningful ground rules and mutually shared objectives. Identified obstacles to teamwork included the lack of physician involvement in team efforts; managers and staff who would not cooperate with team recommendations; the time required to improve work processes; managers who attempted to control a team's work; and leaders who failed to provide clear direction and guidance. In exploring the practice of teamwork outside the boundaries of QIT's, the data revealed that barriers between departments still existed. Management efforts to forge teamwork across functional areas were fragmented. Department heads who promoted teamwork tended to be those who had been involved in QIT's. In both hospitals conflict, distrust and a lack of mutually shared objectives among senior managers was identified by middle managers as antithetical to TQM and an obstacle to building a sense of "all one team" hospital-wide. Recognizing that the hierarchical, departmental structure in hospitals prevents the construction of teamwork across departments and recognizing the ability of quality improvement teams to break down departmental barriers, this study recommends that organizational restructuring be explored for hospitals which might include the management of processes or systems vs. departments and incorporates the team structure.

This research examines how front line managers (FLMs) in a NHS Mental Health Trust responded when Electronic Rostering technology was introduced into their wards, with intentions of improving efficiency, transparency, fairness, skill matching, and safety, and potentially increasing control from above. The study applied a theoretical framework developed from previous research to investigate relationships between the organisational context and FLMs’ characteristics, change management processes and technology efficacy, and analyse their impact upon FLMs’ responses to E-Rostering adoption and consequent outcomes. The research questions focused upon the influences of organisational background and the change management process. The research strategy was an in-depth case study with data collection through semi-structured interviews with managers at ward, service/general, project and senior levels, observation of meetings and training, examination of system records and Trust documents. The theoretical framework was used to design interview guides to help researcher and subjects investigate perceptions of salient factors and FLMs’ responses, and help structure analysis. Cross referencing of data supported reliability and validity of interpretations. The FLMs were ward managers perceiving themselves as professional clinical leaders and operational managers, running wards semi-autonomously. Control of deployment was vital to their authority. They showed power to resist pressures to adopt technology which threatened their control and to resist changes not congruent with their priorities. They negotiated with the project team and adapted practices to produce locally acceptable rosters. Although electronic staff records helped administration, automatic rostering was not efficacious. Rosters needed considerable manual adjustment, meaning ward managers recovered control of deployment and maintained local customs. The study confirms the importance of organisational structure and culture and of political and change management processes, in explaining responses to IT innovation. Change leaders should investigate operational practices, unit cultures and contexts to prepare for technology adoption because these factors will strongly influence FLMs’ responses.

Thesis (Ph. D.)--Oregon State University, 2001. / Typescript (photocopy). Includes bibliographical references. Also available on the World Wide Web.

Thesis (Ph. D.)--Lehigh University, 1997. / Includes vita. Bibliography: leaves 179-195.

<p> Participation in youth sports is increasingly popular with estimates of 35&ndash;40 million U.S. children playing an organized sport each year. Current concussion education has not been shown to be consistently effective. The risk of concussion exposure is present in a number of youth sports. Much of the research surrounding concussion reporting has targeted older adolescents. A better understanding of the reporting process among younger athletes is needed. </p><p> <b>Purpose of the Study:</b> The purpose of this study was to generate a grounded theory that explained concussion reporting in youth sports from the perspective of the young athletes. </p><p> <b>Design and Methods:</b> A grounded theory approach was used to gather and analyze data from semi-structured interviews with soccer players ages 5 to 12. The sample consisted of eleven athletes (8 male, 3 female) from non-elite soccer leagues in two counties; Maricopa, Arizona and Santa Barbara, California. </p><p> <b>Results:</b> Data analysis induced four conceptual categories; trusted environment, self-monitoring, being a player and incentive structure. The resultant theoretical model explains injury reporting from the perspective of young athletes. This study suggests that there is an incentive structure related to injury reporting, that young athletes have a good understanding of the incentives in relation to their perception of self as a player. Athletes demonstrate self-agency in terms of self-monitoring, however important adult others provide a trusted environment that makes children feel safe with their decisions. </p><p> <i>Implications:</i> This study suggests that a better understanding of the incentive structure embedded in the reporting process is needed to design effective prevention and education strategies. Important other adults such as parents and coaches may play a pivotal role in injury reporting among younger athletes when compared to adolescents.</p><p>

Thesis (M.S.)--University of Michigan, 1999. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 27-29).

Thesis (M.S.)--University of Michigan, 1999. / Includes bibliographical references (leaves 27-29).

Although equine charities’ presence in developing countries is assumed to improve working equine health, little scientifically substantiated information is available on the impact of such projects in targeted communities or about communities’ horse health priorities. This work aims to (i) evaluate and quantify the impact of World Horse Welfare training in farriery, saddlery and nutrition-related interventions on health of Lesotho’s working horses (ii) elicit community priority horse health topics using participatory methods for comparison with topics identified using epidemiological techniques. A baseline cross-sectional survey was conducted before World Horse Welfare’s first training course, with two follow-up surveys 9 and 20 months after first year course completion. Each followed a standardised clinical examination protocol for horses and administered a structured questionnaire on equine husbandry/primary health care knowledge and practices with study horses’ owners. Standardised data on tack used on horses was also collected. Data was analysed quantitatively to assess changes in equine health and tack parameters and owners’ knowledge and practices over the intervening period. Following impact evaluation, owner discussion groups were convened, employing participatory facilitation techniques to elicit owner-specified key horse health-associated issues and their priority order. Limited changes in farriery-related parameters were identified, but few saddlery-related improvements resulted; problems including high prevalence of poor tack and tack-associated injuries persisted. High prevalence of suboptimal body condition score, sharp enamel teeth points, parasite infestation, overgrown hooves and adverse clinical pathology parameters persisted throughout the study. Owners’ basic husbandry knowledge and application remained variable. Community-specified horse health priorities were mouthcare, nutrition, disease management, feet and husbandry. Engaging horse owners to understand country-specific issues and elicit community priorities is essential before designing interventions to improve equine health. A complex change process involving owner knowledge, attitudes and behaviour, underpinned by community support and bespoke step-wise interventions is required to achieve sustainable equine health improvements.

In developing countries healthcare reforms are increasingly advocated and implemented in association with global developmental agendas. This thesis analyses the process of health sector reforms in Punjab by looking at the reform drivers, strategies and implementation and examines the elite motivation to reform. Responding to the empirical gap, one underlying objective is to map health sector reforms in Punjab at the primary and secondary level health facilities with respect to drivers, content, design and implementation. Bureaucrats and administrative elite hold a central role in the design and implementation of public management reforms, but in the context of developing countries with political instability and chronic budget deficits; it evaluates how the bureaucratic elites adopt, design and implement reforms. An abductive research approach is used, to investigate Punjab as a case study of health sector reforms at the primary and secondary level health facilities. The organisational context of the study enables the investigation of seven health reform programmes in Punjab, managed and implemented at the provincial and district level. The central argument of the thesis is that the process of reforms in developing countries is a political one. Administrative elites, central to the design and implementation of reforms tend to focus more on the reform trajectory and “what” to implement, and underemphasise implementation. Using data from an in-depth case study of Punjab with two embedded subunits of Lahore and Kasur selected on the basis of urban and rural demographics, this research triangulates between different datasets (bureaucracy, professionals, staff and service users) and documentary sources such as reports, documents, legislation etc. in addition to locating findings and arguments in public management, as a field of literature. The study provides evidence that devolution and the United Nations Millennium Development Goals largely drive health care reform in Punjab. Both reform and development agendas are funded by financial assistance from international financial institutions and donor organisations, and the implementation is top-down with little or no engagement with professionals, staff and service users. There is lack of motivational engagement with professionals and staff, who have no input in decision-making. The reform process lacks citizen engagement (ignorant service user) and accountability from the citizens. The adoption of reform agenda is highly driven by the fact that reforms consistent with global development agendas like UNMDGs bring in funds and resources in economically unstable environment faced by the country in general. Findings suggest that the reform process in developing countries needs to be understood in a much broader context and needs to incorporate the role international organisations play in determining the reform agenda. Reform adoption is highly dependent on the political activity and motivations of the administrative elites. Firstly, the existing models of reform are inadequate and focus on the institutional forces, rather than the individual motivations of the policy makers. Secondly, developing countries facing fiscal and economic stresses as well as unstable political institutions suffer from a skewed power imbalance where the power is concentrated in elites that results in a self-serving bureaucracy. This study contributed to the literature on reform process in developing countries by suggesting implications for research on reforms in the developing world, which includes the political and tactical motivation of the key actors in the reform process.

This qualitative study describes the experience of eight men with fibromyalgia (FM). Data from repeated semi-structured interviews was analysed using the constant comparative method, in order to generate a grounded theory. The specific aims were to explore how individuals perceived and made sense of their condition, and to discover the impact of FM upon their sense of identity and intimate relationships. Two core categories emerged from data analysis - loss and limited understanding. Losses pertained to the men's capabilities and activities; role and identity; work; and relationships. Limited understanding was described in relation to three levels of experience: limited understanding by the individual sufferer; by other people; and by health care professionals. Various intervening and contextual variables were identified for each phenomenon. Analysis suggested that loss is more likely to be pronounced where pain is severe and constant; the degree of incapacity is high; and there is a complete cessation of work. Intervening conditions likely to reduce the sense of loss included role expectations consistent with capabilities; absence of young dependants; a flexible work environment; living with a partner; favourable social comparisons; high self-efficacy and accepting attitude towards illness. Limited understanding was likely to be more pronounced where the individual perceived no rational link between the triggering event and symptoms of FM, and where new difficulties were encountered. The individual was more likely to perceive that others misunderstood their situation if they were not using a mobility aid themselves. Individuals were more likely to perceive limited understanding by the medical profession where the GP had not been especially supportive, and where contact with the specialist was unsatisfactory. Limited understanding was exacerbated by intervening variables including lack of contact with other FM sufferers and a treatment history focusing on 'fixing' the problem. Men with FM struggled to find meaning in their experience. Some individuals were able to locate possible causes, but all the men were unable to fully understand their condition. The analysis suggested that the experience of FM varies for different men. The study reveals that FM is a complex experience characterised by loss, which sufferers and health care professionals struggle to understand. Implications for health care practice and further research are discussed. This study will help FM sufferers understand their condition more fully. Moreover, it should enrich the understanding of health care professionals - thereby facilitating encounters characterised by greater support and empathy for men with FM.