Thesis (Ph. D.)--Catholic University of America, 1924. / Vita. "Select bibliography": p. ix-xi.

The rate of injury and death inadvertently caused by medical treatment is too high and exacts enormous human and financial costs. Each year in Britain and the United States alone, hundreds of thousands of patients are injured, ten of thousands are killed and billions of dollars are spent on additional health care due to iatrogenic harm. Health care organisations remain predominately human-centred in their approach to safety-that is, methods of avoiding error rely primarily on the resolve and vigilance of individual clinicians to avoid bad outcomes. However, this approach is becoming increasingly inadequate in the face of the steadily rising complexity of modern health care and the increasing number of procedures carried out each year. In other high-reliability organisations such as aviation and nuclear power generation, safety results not from the sheer effort of “operators”, but from in-depth analysis of problems and the removal and redesign of dangerous aspects of systems-the so-called systems approach. Here I present an evaluation of the integrated drug administration system (IDAS) as an example of the systems approach, intended to reorganise the way in which anaesthetists give drugs to improve performance and facilitate safe practice. The problem of drug error in anaesthesia is an important subset of iatrogenic harm in medicine. From the prospective study of 10806 conventional anaesthetics I define the rate of drug error in anaesthesia as one error in every 133 anaesthetics conducted-a rate five times higher than anything previously reported. In addition, anaesthetists rated the risk of harming a patient through drug error in the course of their career as high. I discuss the principles of safe system design, the psychology of error, and advanced systems safety concepts with respect to the design of the IDAS and the future of safety in medicine. In clinical use, the IDAS saved time before and during anaesthesia, and was rated by anaesthetists as significantly safer and more useable than conventional methods of drug administration. This work supports the hypothesis that error in anaesthesia can be reduced through the systematic analysis of its causes and the implementation of appropriate countermeasure strategies. / Subscription resource available via Digital Dissertations only.

Considering the increasing levels of unemployment and underemployment, and the limited evidence concerning the impact of underemployment on health, my study examines the relations between subjective, objective, and time-related underemployment and employees’ health-related quality of life, as manifested through self-rated health, activity limitations and work-related stress. The study compares an expanded model of work-health relations that, along with the factors addressed by control-demand, and social capital theories, includes characteristics of the physical work environment, and employees’ economic class. In addition to the commonly examined factors related to employment and health (control-demand and social capital), my study explores the impact of the work environment (hazards, discomfort and physical demands) and economic class to determine the specific effects of underemployment on an employee’s health-related quality of life. My main argument is that underemployment, in conjunction with lower economic class, higher exposure to a harmful work environment, lack of control over work, and lower social capital, contributes to increased work-related stress and diminishes health-related quality of life. The study applies a mixed methodological approach based on data from the Canadian Work and Lifelong Learning Survey and the US General Social Survey, and qualitative analysis of interviews from the Ontario Survey on Education-Job Requirements Matching. Evidence based on cross-sectional and qualitative data analysis provides consistent findings and confirms the main assumption that high levels of underemployment have a significant effect on employees’ health-related quality of life. The study shows that employees’ economic class, characteristics of work environment and control over work carry the highest associations with health-related quality of life, while underemployment has a significant additive association with health-related quality of life, most importantly with work-related stress.

Over the past decade, mental illness in the workplace has become a key issue in the health and business communities, fueled in part by recognition of the high prevalence rates and significant costs for individuals and organizations. Although research in the field is starting to emerge, there are significant gaps in what is known, particularly with respect to the workplace context and its impact on workers. The overall objective of this study was to characterize, from a sociological perspective, the experiences of healthcare workers with mental health issues, and to account for how their experiences were shaped by the social relations of work. A qualitative approach, based on principles of institutional ethnography, guided exploration of the interactional, structural and discursive dimensions of work within a large mental health and addictions treatment facility. Data collection included in-depth interviews with twenty employees regarding their personal experiences with mental health issues, interviews with twelve workplace stakeholders regarding their interactions with workers, and a review of organizational texts related to health, illness and productivity. Analysis of the transcripts and texts was based on an institutional ethnography approach to mapping social processes; examining connections between local sites of experience and the social organization of work. The study findings revealed a critical disjuncture between the public mandate of advocacy, open dialogue, and support regarding mental health issues, and the private experience of workers which was characterized by silence, secrecy and inaction. Practices of silence were adopted by workers and workplace stakeholders across the organization, and were shaped by discursive forces related to stigma, staff-client boundaries, and responsibility to act. The silence had both positive and negative implications for the mental health of workers, as well as for relationships and productivity in the workplace. In accounting for the practices and production of silence, I argue that silence is complex, multi-dimensional, and embedded within the social relations of healthcare work. It serves to maintain institutional order. This conceptualization of silence challenges current beliefs and practices related to stigma, disclosure, early identification, support, and return to work for employees with mental health issues.

Over the past decade, mental illness in the workplace has become a key issue in the health and business communities, fueled in part by recognition of the high prevalence rates and significant costs for individuals and organizations. Although research in the field is starting to emerge, there are significant gaps in what is known, particularly with respect to the workplace context and its impact on workers. The overall objective of this study was to characterize, from a sociological perspective, the experiences of healthcare workers with mental health issues, and to account for how their experiences were shaped by the social relations of work. A qualitative approach, based on principles of institutional ethnography, guided exploration of the interactional, structural and discursive dimensions of work within a large mental health and addictions treatment facility. Data collection included in-depth interviews with twenty employees regarding their personal experiences with mental health issues, interviews with twelve workplace stakeholders regarding their interactions with workers, and a review of organizational texts related to health, illness and productivity. Analysis of the transcripts and texts was based on an institutional ethnography approach to mapping social processes; examining connections between local sites of experience and the social organization of work. The study findings revealed a critical disjuncture between the public mandate of advocacy, open dialogue, and support regarding mental health issues, and the private experience of workers which was characterized by silence, secrecy and inaction. Practices of silence were adopted by workers and workplace stakeholders across the organization, and were shaped by discursive forces related to stigma, staff-client boundaries, and responsibility to act. The silence had both positive and negative implications for the mental health of workers, as well as for relationships and productivity in the workplace. In accounting for the practices and production of silence, I argue that silence is complex, multi-dimensional, and embedded within the social relations of healthcare work. It serves to maintain institutional order. This conceptualization of silence challenges current beliefs and practices related to stigma, disclosure, early identification, support, and return to work for employees with mental health issues.

Habilitationsschrift : Philosophie : Tübingen, Eberhard-Karls-Universität : 1998. / Bibliographie : p. 325-335.

Reproduction de : Thèse de doctorat : Sciences de l'éducation : Lyon 2 : 2003. / Titre provenant de l'écran-titre. Bibliogr.

Thesis (doctoral), Technische Universität Carolo-Wilhelmina zu Braunschweig, 1985. / Bibliographie : p. 137-145.

Considering the increasing levels of unemployment and underemployment, and the limited evidence concerning the impact of underemployment on health, my study examines the relations between subjective, objective, and time-related underemployment and employees’ health-related quality of life, as manifested through self-rated health, activity limitations and work-related stress. The study compares an expanded model of work-health relations that, along with the factors addressed by control-demand, and social capital theories, includes characteristics of the physical work environment, and employees’ economic class. In addition to the commonly examined factors related to employment and health (control-demand and social capital), my study explores the impact of the work environment (hazards, discomfort and physical demands) and economic class to determine the specific effects of underemployment on an employee’s health-related quality of life. My main argument is that underemployment, in conjunction with lower economic class, higher exposure to a harmful work environment, lack of control over work, and lower social capital, contributes to increased work-related stress and diminishes health-related quality of life. The study applies a mixed methodological approach based on data from the Canadian Work and Lifelong Learning Survey and the US General Social Survey, and qualitative analysis of interviews from the Ontario Survey on Education-Job Requirements Matching. Evidence based on cross-sectional and qualitative data analysis provides consistent findings and confirms the main assumption that high levels of underemployment have a significant effect on employees’ health-related quality of life. The study shows that employees’ economic class, characteristics of work environment and control over work carry the highest associations with health-related quality of life, while underemployment has a significant additive association with health-related quality of life, most importantly with work-related stress.

Giessen, Phil. Diss. v. 22. Aug. 1919, Ref. Kahle. / Vollst. als : Veröffentlichungen d. staatl. Forschungsinstituts f. vergl. Religionsgesch. an d. Univ. Leipzig. Nr 3. [Geb. 2. Nov. 93 Darmstadt ; Wohnort : Darmstadt ; Staatsangeh. : Hessen ; Vorbildung : RG. Darmstadt Reife 12, Erg. Ludwig-Georgs-G. Darmstadt 12 ; Studium : Giessen 3, Tübingen 2, Giessen 2 S. ; Rig. 19. Nov. 18.].