Expectations and perceptions of expectations for the role of Head Nurse were investigated in four teaching hospitals of McGill University, Montreal, Canada. Head Nurses, nurses, Directors of Nursing, and doctors were respondents. The study examined three questions: What are the expectations held for the Head Nurse within groups? Are there differences in expectations held for the Head Nurse across groups? Are there differences between expectations of nurses and doctors for the Head Nurse, and Head Nurse perceptions of expectations of nurses and doctors? / Factor analysis was performed on responses of Head Nurses, nurses, and doctors separately. Expectations within groups were determined by frequencies, means, and standard deviations. Differences in expectations between groups were tested by chi-squares. / Conceptualizations of the Head Nurse as manager, clinician, patient care co-ordinator, and teacher were supported. Five factors, identified as doctor's helper, clinical leader, communication link, determiner of quality of care, and manager, accounted for 67 to 82% of variance in all groups. All groups agreed that the Head Nurse should be a determiner of quality of care given. Significant differences in expectations between groups were found in regard to the Head Nurse as doctor's helper, and clinical leader, and in regard to other activities related to patients, staff, and the unit. Head Nurses tended to overestimate nurse expectations for the Head Nurse, and underestimate doctor expectations for the Head Nurse.

The purpose of this exploratory study was to investigate whether there is any relationship between the strength of the culture in a hospital work group and the job involvement, upward striving, organizational commitment and job satisfaction of the employees within that work group. The conceptual framework for this study is the symbolic frame of reference for understanding organizational behaviour. The concept is described by Bolman and Deal (1984). Two hospitals participated in the study, which provided two data sets. Subjects were employees of certain departments within each of the hospitals. Each subject completed a four-part questionnaire. The first part collected demographic data, part two contained questions on job involvement, upward striving, and organizational commitment, part three focussed on job satisfaction, and part four was the culture strength scale. The culture strength scales were developed separately at each hospital and, therefore, contained items which were relevant to a specific facility. There were two major findings from the study. First, there is a positive relationship between job satisfaction and culture strength. Results at both hospitals were consistent in this regard. No relationships were found between job involvement, upward striving, and/or organizational commitment with culture strength. The second finding was that at the larger hospital there was a significant difference in culture strength scores among some work units, while at the smaller hospital this was not the case. This finding supports the idea that size of an organization is a factor in the predisposition to subculture formation. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

M.A. (Business Management) / With the raise of competition in the Gabonese health industry and increased costs, most health service providers in Gabon have become under pressure to deliver good service quality. This also relates to the military hospital in Libreville in Gabon striving to provide adequate health services to its patients. The cost for hospitals to attract patients through several means such as providing good service quality has become crucial. Patient loyalty and retention can have an important financial advantage for a hospital, thus it has become essential for hospitals to create a sustaining relationship with their patients. The question of assessing service quality presents itself. This study investigated service quality at a military hospital in Libreville in Gabon. It was the objective of this study to establish if there is a difference in how patients rate doctors and nurses on the service quality dimensions. This research was quantitative and descriptive in nature. Theory relating to service quality and patient satisfaction was provided. The population for the study consisted of patients who were at least 18 years old, males and females, who have experienced medical services and stayed over at the military hospital for at least one night. A self administered questionnaire was designed based on the theoretical literature illustrated in the study. The questionnaire assessed various elements that were identified through the literature review. The questionnaire was based on a set of statements linked to the literature theory, and a 7-point Likert scale which enabled respondents to choose from seven different alternatives ranging from strongly disagree to strongly agree. A number of statistical analysis techniques were undertaken to achieve the objectives of the study, such as factor analysis. The conclusion and findings of the research assisted in explaining the objectives of the study and the results of the statistical analysis were found to reject the hypotheses that there is no significant difference in how patients rate the reliability, responsiveness, assurance and empathy of doctors and nurses and to reject the hypothesis that patients do not have a positive perception of the tangible aspects of a military hospital in Libreville, Gabon. In terms of the doctors’ services, patients felt a need for more privacy in terms of the confidentiality of their treatment, a need for more individual attention, a need to be heard, and to trust doctors. Therefore such needs could be addressed through improved compassion, communication and understanding of doctors during the diagnosis of the problem. The feeling expressed was that doctors should pay more attention to patients’ problems and share with them their experience. Doctors at the military hospital should develop more work ethic where patients’ records and cases should never be discussed with anyone without patients’ permission. The military hospital should employ highly trained and qualified doctors to address the trust issue with patients. Lastly, consultation time may need to be reviewed to add some extra time to better address patients’ needs during their consultation with doctors. In terms of the services delivered by nurses towards patients, the latter were of the opinion that there was a need for more individual attention from nurses. Such individual attention could include greater information sharing when a patient is treated, friendlier communication to install greater trust and respect. Such needs could be addressed through improved patience, compassion and understanding by nurses during their dealings with patients. Nurses should also develop more work ethic regarding patients’ records, and cases should never be discussed with anyone without their permission. Officials in the hospital should hire highly trained and qualified nurses to address the issue of trust in patients and consultation time may need to be reviewed to add some extra time to better address patients’ needs during their dealings with nurses.

Thesis: M.S., Massachusetts Institute of Technology, Sloan School of Management, 1980 / Bibliography: leaves 110-111. / by Katherine Ann Overskei. / M.S. / M.S. Massachusetts Institute of Technology, Sloan School of Management

Service systems such as call centers and hospital inpatient wards typically feature multiple classes of customers and multiple types of servers. Not all customer-server pairs are compatible, and some types of servers may be more efficient at serving some classes of customers than others. In the queueing literature, the problem of matching customers and servers is known as skills-based routing. This thesis consists of two works I have done in this area. The first work, which is done jointly with Jing Dong and Pengyi Shi, considers the routing problem in the face of a demand surge such as a pandemic. It shows how future arrival rate information, which is often available through demand forecast models, can be used to route near-optimally, even when there may be prediction errors. The methods used involve fluid approximations and optimal control theory, and the policies obtained are intuitive and easy to implement. The second work, which is done jointly with Jing Dong, incorporates a staffing element in addition to routing. Asymptotically optimal staffing and scheduling policies are derived for an M-model, both with and without demand uncertainty. The methods used involve diffusion approximations and stochastic-fluid approximations.

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Occupations involve regular contacts and associations with stigmatized or degraded people (e.g, policemen, nurses, social workers) are referred to as socially dirty work (Hughes, 1951; Ashforth & Kreiner, 1999; 2014).Socially dirty workers dealing with clients who are stigmatized by the society may encounter identity threat and negative societal perceptions towards their work (Kreiner, Ashforth & Sluss, 2006). Though the clients are stigmatized by the society, professional trainings of socially dirty workers advocate treating the clients as equal and respectable individuals. Hence, socially dirty workers face a big challenge to handle conflicting perceptions towards their clients– taking the professional side or the societal side. / Drawing on the conservation of resource (COR) framework (Hobfoll, 1989; 1990), I examined the effect of work dirtiness on socially dirty worker’s job outcomes and investigated the effects of two contextual factors. In particular, I proposed a construct called the intensity of social work dirtiness (ISWD) –the extent to which clients are stigmatized by society: when the clients are more stigmatized by the society, socially dirty workers are more likely to experience resource loss and job strain. I also proposed employees’ work orientations (calling / job orientation) and professional-client relationship quality, would moderate the effect of intensity of social work dirtiness on employees’ stressful experience and work outcomes. / Data were collected at three time points from 16 hospitals in Mainland China. Results showed that the intensity of social work dirtiness was positively related to job strain and further affected employees’ job satisfaction, turnover intentions and psychological wellbeing. The moderating effects of work orientations and relationship quality were also supported in the analysis. / 现代社会有许多职业需要经常接触污名化的客户 （如警察、护士、社工），这类职业被定义为社会型厌恶性工作(Hughes, 1951; Ashforth & Kreiner, 1999; 2014)。 社会型厌恶性工作者往往会遇到自我身份认同的难题和承受社会对他们的负面印象(Kreiner, Ashforth & Sluss, 2006)。 另一方面，这类型的工作者通常都接受了职业价值观的训练:要平等对待和尊重他们的客户。因此，社会型厌恶性工作者常常面临挑战：如何看待工作中接触的污名化客户 -- 是跟随社会大众的看法还是保持职业的看法。根据资源保存理论 (Hobfoll,1989)。当客户的污名化程度越严重，这类型工作者越可能承受更大的压力。 / 我提出员工的工作导向以及员工与污名化客户的关系会调节客户污名化程度对员工压力的影响。 / 我在中国内地的医院和香港的社工组织中收集了数据并作了详细分析，模型中的部分假设得到了验证和支持。 / Wen, Shanshan. / Thesis Ph.D. Chinese University of Hong Kong 2015. / Includes bibliographical references (leaves 101-117). / Abstracts also in Chinese; appendix includes Chinese. / Title from PDF title page (viewed on 06, October, 2016). / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only.

This study concerns the general question, "What has been the impact of collective bargaining representation elections on nonprofit hospitals in Texas?" The means of answering this question involved a study of wages and attitudes of nonprofessional employees in both hospitals where such elections occurred and hospitals where no such elections had occurred in the State of Texas. An overview of the development of hospitals and the union movement in hospitals are presented as background information for this study. Further, a brief discourse on attitude development and attitude measurement is provided as theoretical foundational material. A researcher-constructed questionnaire was devised, tested, and administered to employees of the subject hospitals. There were 176 useable returns from employees where no union representation election occurred and 176 useable returns from employees where union representation elections occurred.

The study used a pre-/post-test design within a secondary analysis of existing de identified data obtained from a major Northeastern hospital for use by permission, in order to evaluate the impact of a communication cultural competency training of hospital registration personnel focused on teaching the collection of gender identity and sexual orientation data (SOGI). The study’s convenience sample (N=240) was diverse, given 34.6% (N=83) identified as White/Caucasian, 28.3% (N=68) as Hispanic/Latino, 27.1% (N=65) as Black /African American, and 10.0% (N=24) as Asian. For gender identity, 74.6% (N=179) identified as female, and 15.8% (N=37) as male. Those who identified their sexual orientation as heterosexual comprised 79.6% (N=191) of the sample. The mean time in current role for the sample was 3.97 years (Min = 1-1 to 6 months, Max = 6-over 10 years, SD = 1.547). For example, 18.3% (N=44) indicated being in their current role for between 5-10 years. Some 74.2% (N=178) indicated that they know someone who is LGBTQ+. Of note, 16.7% (N=38) indicated that they had other training in the last three months. Cronbach’s Alphas ranged from .858-.978 for the 11 new study scales, as very good to excellent internal consistency. As main study findings, paired t-tests for all five global scale scores (knowledge, self-efficacy, skill/ability level, and personal preparation for collecting SOGI data—and engagement in recommended SOGI data collection behavior) demonstrated significant differences from pre- to post- training in this sample (p˂.000; Bonferroni Significance level, p<.007). This suggested that participation in the training was associated with statistically significant improvements from pre- to post-training for knowledge, self-efficacy, skill/ability level, personal, and engagement in recommended SOGI data collection behavior. Through backward stepwise regression, having higher post-training self-efficacy was significantly predicted by: higher pre-training personal skill/ability (B=.589, SEB=.468, p=.000); and, higher post-training overall evaluation (B=.244, SEB=.305, p=.000). The adjusted R-squared value for this model was 0.346, meaning that 34.6% of the variance for higher post-training self-efficacy for collecting for collecting patients’ sexual orientation and gender identity data was explained by this model. Findings suggest the need for further dissemination, implementation and evaluation of the new communication cultural competence training.

This study reviewed the methods of teaching orthopedics to family practice residents. It explored the areas of how, when, and to what end. Questionaires were sent to all family practice residency programs in the United States. The complied results showed that most residents are taught during a block assignment for four weeks in the second year of residency. The results showed preceptorships being utilized most frequently and for at least 50% of the teaching time. Lectures were used next most frequently and usually for 20% or less of the teaching time. Nearly all of the respondants felt their residents were qualified to initially manage athletic injuries, simple fractures, and low back pain. On the management of infant foot problems, 63% felt their residents were qualified and 36% felt they were not. This difference was felt to be due to a difference in content and not process. Suggestions for future research were put forth.Ball State UniversityMuncie, IN 47306