Implementation research to assess a health workers performance-based management system in Nepal.

AIM: To test and refine a performance-based management system to improve health worker performance in Nepal. METHODS: A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes. RESULTS: Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. CONCLUSION: The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.

Effects of job resources factors on nurses job performance (mediating role of work engagement).

PURPOSE: The purpose of this paper is to examine the mediating role of work engagement (vigor and dedication) between job resources (job characteristics, supervisor and co-worker support, participation in decision making and job security) and job performance (task and contextual) rated by the supervisor. DESIGN/METHODOLOGY/APPROACH: A sample of 364 nurses and their supervisors was used. Structural equation modeling with Amos 17 was used to obtain a model fit with path significance of work engagement as the mediator between job resources and job performance. FINDINGS: The results found support for the proposed conceptual claim and confirm that work engagement with a two-factor model (vigor and dedication) mediates the relationship between job resources (job characteristics, supervisor and co-worker support, participation in decision making and job security) and with a multidimensional construct of job performance (task and contextual performance) rated by the supervisor. PRACTICAL IMPLICATIONS: The findings of this research will help human resource managers and professionals to further develop the working environment, provide job security and opportunities for employees to participate in decision making in a way that enhances employee work engagement, which, ultimately, improves employee job performance. ORIGINALITY/VALUE: Past studies have not previously tested the two-factor model of work engagement (vigor and dedication) as the mediating variable between job resources (job characteristics, supervisor and co-worker support, participation in decision making and job security) and job performance rated by the supervisor.

The impact of a human resource management intervention on the capacity of supervisors to support and supervise their staff at health facility level.

BACKGROUND: A systematic and structured approach to the support and supervision of health workers can strengthen the human resource management function at the district and health facility levels and may help address the current crisis in human resources for health in sub-Saharan Africa by improving health workers' motivation and retention. METHODS: A supportive supervision programme including (a) a workshop, (b) intensive training and (c) action learning sets was designed to improve human resource management in districts and health facilities in Tanzania. We conducted a randomised experimental design to evaluate the impact of the intervention. Data on the same measures were collected pre and post the intervention in order to identify any changes that occurred (between baseline and end of project) in the capacity of supervisors in intervention a + b and intervention a + b + c to support and supervise their staff. These were compared to supervisors in a control group in each of Tanga, Iringa and Tabora regions (n = 9). A quantitative survey of 95 and 108 supervisors and 196 and 187 health workers sampled at baseline and end-line, respectively, also contained open-ended responses which were analysed separately. RESULTS: Supervisors assessed their own competency levels pre- and post-intervention. End-line samples generally scored higher compared to the corresponding baseline in both intervention groups for competence activities. Significant differences between baseline and end-line were observed in the total scores on 'maintaining high levels of performance', 'dealing with performance problems', 'counselling a troubled employee' and 'time management' in intervention a + b. In contrast, for intervention a + b + c, a significant difference in distribution of scores was only found on 'counselling a troubled employee', although the end-line mean scores were higher than their corresponding baseline mean scores in all cases. Similar trends to those in the supervisors' reports are seen in health workers data in terms of more efficient supervision processes, although the increases are not as marked. CONCLUSION: A number of different indicators were measured to assess the impact of the supportive supervision intervention on the a + b and a + b + c intervention sites. The average frequency of supervision visits and the supervisors' competency levels across the facilities increased in both intervention types. This would suggest that the intervention proved effective in raising awareness of the importance of supervision and this understanding led to action in the form of more supportive supervision.

The impact of a supportive supervision intervention on health workers in Niassa, Mozambique: a cluster-controlled trial.

BACKGROUND: Regular supportive supervision is critical to retaining and motivating staff in resource-constrained settings. Previous studies have shown the particular contribution that supportive supervision can make to improving job satisfaction amongst over-stretched health workers in such settings. METHODS: The Support, Train and Empower Managers (STEM) study designed and implemented a supportive supervision intervention and measured its' impact on health workers using a controlled trial design with a three-arm pre- and post-study in Niassa Province in Mozambique. Post-intervention interviews with a small sample of health workers were also conducted. RESULTS: The quantitative measurements of job satisfaction, emotional exhaustion and work engagement showed no statistically significant differences between end-line and baseline. The qualitative data collected from health workers post the intervention showed many positive impacts on health workers not captured by this quantitative survey. CONCLUSIONS: Health workers perceived an improvement in their performance and attributed this to the supportive supervision they had received from their supervisors following the intervention. Reports of increased motivation were also common. An unexpected, yet important consequence of the intervention, which participants directly attributed to the supervision intervention, was the increase in participation and voice amongst health workers in intervention facilities.

Trouble in transit: Organizational barriers to workers' health.

BACKGROUND: Valuable insights on the health and behavior of transit workers can be obtained from qualitative research that considers the social environment, which affects job performance and determines levels of perceived stress. METHODS: Using a grounded theory approach, semi-structured interviews were conducted with American transit workers (n = 32). Recorded interviews were transcribed and analyzed using a constant comparative method. RESULTS: Participants described categories related to entrenched organizational practices, particularly managements' leadership style, which created an atmosphere of distrust. High demanding work schedules, as a result of technological advances, were discussed in relation to diminished breaks, fatigue, and unhealthy diets. Transit workers also attributed increased work demands and irregular working hours to compromised time with family and friends. CONCLUSIONS: The described barriers to positive health behaviors and social support underscore the need for interventions that ensure adequate breaks and recovery between shifts and increase safety for transit passengers. Am. J. Ind. Med. 60:350-367, 2017. © 2017 Wiley Periodicals, Inc.

Job design, employment practices and well-being: a systematic review of intervention studies.

There is inconsistent evidence that deliberate attempts to improve job design realise improvements in well-being. We investigated the role of other employment practices, either as instruments for job redesign or as instruments that augment job redesign. Our primary outcome was well-being. Where studies also assessed performance, we considered performance as an outcome. We reviewed 33 intervention studies. We found that well-being and performance may be improved by: training workers to improve their own jobs; training coupled with job redesign; and system wide approaches that simultaneously enhance job design and a range of other employment practices. We found insufficient evidence to make any firm conclusions concerning the effects of training managers in job redesign and that participatory approaches to improving job design have mixed effects. Successful implementation of interventions was associated with worker involvement and engagement with interventions, managerial commitment to interventions and integration of interventions with other organisational systems. Practitioner Summary: Improvements in well-being and performance may be associated with system-wide approaches that simultaneously enhance job design, introduce a range of other employment practices and focus on worker welfare. Training may have a role in initiating job redesign or augmenting the effects of job design on well-being.

Encounter Preparedness, Satisfaction, and Performance Effects of Influence in Assertive Community Treatment (ACT) Teams.

Assertive community treatment (ACT) teams are linked to high quality outcomes for individuals with severe mental illness. This paper tests arguments that influence shared between team members is associated with better encounter preparedness, higher work satisfaction, and improved performance in ACT teams. Influence is conceptualized in three ways: the average level according to team members, the team's evaluation of the dispersion of team member influence, and as the person-organization fit of individual perception of empowerment. The study design is a retrospective observational design using survey data from a longitudinal study of 26 ACT teams (approximately 275 team members total) over 18 months. This study finds that average team influence and person-organization fit are positively correlated with encounter preparedness and satisfaction. Dispersion of influence was not significantly correlated with study outcomes. Influence in ACT teams has multiple dimensions, each with differential effects on team outcomes. These findings provide guidance as to how one might encourage equal and substantive contribution from ACT team members.

The Influence of the Practice Environment on Nurse Managers' Job Satisfaction and Intent to Leave.

OBJECTIVE: The aim of this study was to explore the influence of the practice environment on nurse managers' (NMs') job satisfaction and intent to leave. BACKGROUND: Nurse managers are a ready pool of talent to fill impending strategic leadership vacancies. Job satisfaction as an NM is a deciding factor for senior leadership aspirations. METHODS: This study used a secondary analysis of 2012 survey data of 355 NMs. The Nurse Manager Practice Environment Scale was used to identify organizational features that influence NMs' job satisfaction and intent to leave. RESULTS: Mean (SD) job satisfaction was 4.5 (1.1) on a 6-point scale. Mean (SD) intent to leave was 5.0 (2.1) on a scale ranging from 3 to 9. The Nurse Manager Practice Environment Scale was a significant predictor of both job satisfaction and intent to leave. CONCLUSIONS: Features of the organizational context can be modified to improve job satisfaction and reduce intent to leave among NMs.

The Genesis of a Trauma Performance Improvement Plan.

The purpose of this article is to assist the trauma medical and program director with developing a performance improvement and patients safety plan (PIPS), which is a required component of a successful trauma verification process by the American College of Surgeons. This article will review trauma quality standards and will describe in detail the required elements of a successful trauma center's performance improvement plan including a written comprehensive plan that outlines the mission and vision of the PIPS Program, authority of the PIPS Program, PIPS Program Committee reporting structure to the other hospital committees, list of required PIPS multidisciplinary team members, the operational components of the utilized data management system (trauma registry), list of indicators/audit filters, levels of review, peer determinations, corrective action plan with implementation, event resolution, and reevaluation. Strategies to develop a successful trauma performance improvement plan are presented.

Adapting to change: How has COVID-19 affected people's work and personal goals?

COVID-19 has had a devastating impact on the global economy and affected millions of people's work and personal lives across the world. The purpose of the present study was to better understand how individuals' work and personal goals have been affected by the pandemic and how they have adapted to these changes. We conducted qualitative semi-structured interviews (n = 48) and surveyed participants (n = 200) weekly for 5 weeks. Both methods revealed similar themes regarding the adaptation and pursuit of goals (social support, handling unpredictable situations, logistics, solving problems creatively, goal postponement, and no changes). Survey responses also showed that most individuals experienced their goals as more difficult (79%; 13% easier; 9% no change) and found that many had had to adapt or postpone their work and personal goals, often due to logistical difficulties. Businesses and governments should do more to help individuals adapt their goals to the new circumstances.

Impact of agile management on project performance: Evidence from I.T sector of Pakistan.

Over the past several years, global project management teams have been facing dynamic challenges that continue to grow exponentially with the increasing number of complexities associated with the undertaken tasks. The ever-evolving organizational challenges demand project managers to adapt novel management practices to accomplish organizational goals rather than following traditional management practices. Considering which, the current study aims to explain the effect of agile management practices upon project performance directly as well as while being mediated through project complexity. Furthermore, the aforementioned mediatory relationship is evaluated in terms of the moderating effect of leadership competencies. The current study utilized the survey approach to collect the data from registered I.T firms deployed in the potential metropolitans of each province of Pakistan including, Peshawar, Islamabad, Lahore, Sialkot, Faisalabad, Hyderabad, Sukkur, and Karachi. A total of 176 responses were utilized for statistical evaluations. As result, it was observed that the negative influence anticipated by project complexity on project performance was compensated by the agile management practices. Further, the leadership competencies played a pivotal role in managing project complexity while implementing agile management practices and therefore enhancing project performance. The current study abridges the potential knowledge gap conceptually by evaluating the direct impact of agile management upon project performance while considering all of its aspects, exploring the mediatory role of project performance and evaluating the moderating role of leadership competencies in attaining optimum project performance. In contextual terms, the current study fills the knowledge gap by gauging the implications of agile management practices within the I.T sector of Pakistan. The results of the current study can be a potential guide for both the academicians and the industry professionals.

Workspace preferences and non-preferences in Activity-based Flexible Offices: Two case studies.

Activity-based Flexible Offices (AFOs) are innovations in workspace design that are being increasingly implemented in organisations. While most studies investigate satisfaction and perceived work support in AFOs, employees' workspace preferences are not addressed in the literature. The aims of this study were to (i) identify workspace preferences and non-preferences in AFOs, and (ii) investigate whether employees' workstation choices support their activities and align with their preferences. Two Swedish municipalities participated in the study. Data collection involved 27 semi-structured interviews and annotations on architectural drawings. The results showed that the interviewees preferred workstations that were both desirable and functional, and avoided workstations that were undesirable. This was due to functional, social, emotional and symbolic aspects of the workspaces as well as their physical structure and stimuli. The approach used in this paper can be adopted for improving the design of AFOs, thereby mitigating the stress of finding a suitable workstation.

Impact of supervisory behavior on sustainable employee performance: Mediation of conflict management strategies using PLS-SEM.

This study investigates the relationship between supervisory behavior, conflict management strategies, and sustainable employee performance and inquires the mediating effect of conflict management strategies. Data were collected from the SMEs of the manufacturing industry of Pakistan. The significance of the model was assessed using the PLS-SEM (structural equation modeling). The findings of the study revealed a positive and significant relationship between supervisory behavior and sustainable employee behavior. Similarly, conflict management strategies had a positive effect on the relationship between supervisory behavior and sustainable employee behavior. This study adds in the current literature of supervisory behavior as a critical predictor of sustainable employee performance in two ways. Firstly, this study validates Conflict management strategies as an influential mediator between the relationship of supervisory behavior and sustainable employee performance. Secondly, this study provides substantial practical implications for managers at SMEs to enhance sustainable employee performance through supervisory behavior, stimulated by conflict management strategies. This study is based on cross-sectional data; more longitudinal studies can further strengthen the generalizability of relationships between the constructs. The study adds in the current literature of PLS-SEM as an assessment model for direct and mediation relationships.

Poor work design begets poor work design: Capacity and willingness antecedents of individual work design behavior.

Few studies have systematically considered how individuals design work. In a replication study (N = 211, Study 1), we showed that students naturally tend to develop simplified, low variety work. In 2 further simulation studies, we quantitatively assessed participants' work design behaviors via 2 new measures ("enriching task allocation" and "enriching work strategy selection"). As a comparison measure, we assessed individuals' tendency to choose individualistic rather than work design strategies ("person-focused strategy selection"). We then investigated how work design behaviors are affected by capacity (professional expertise, explicit knowledge, job autonomy) and willingness (life values). For a sample of human service professionals (N = 218, Study 2), participants scored higher on enriching task allocation and enriching work strategy selection if they had expertise as an industrial/organizational psychologist and if they had high autonomy in their own job. Explicit knowledge about work design predicted lower scores on person-focused strategy selection, and mediated the effects of professional expertise on this outcome. Individuals high in openness values scored higher on enriching work strategy selection, and those high in conservation values scored lower on enriching task allocation. These findings were replicated in Study 3 among working professionals (N = 602). We then showed that openness to change values predicted enriching work strategy selection via the more proximal processes of valence (valuing intrinsic work characteristics) and affect (positive affect when enriching others' work). This article opens up a new area of inquiry: how and why individuals design work for others in the way they do. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The longitudinal study for the work-related factors to job performance among nurses in emergency department.

To explore the relationship between baseline information, personal factors, working characteristics and job performance among nurses in emergency department in northern Taiwan.Two-hundred twenty-two nursing staff were interviewed repeated with structured questionnaires for data collection in 3 time points (From August to September, 2008, from February to March, 2009, and from November to December, 2009). The generalized estimating equation (GEE) is used to test the relationship between the domains of independent variables (baseline information, personal factors, working characteristics) and dependent variables (task performance, contextual performance).The mean age of participants is 30.1 ±â€Š5.1 years. 50.0% are junior college or bachelor degrees. From the GEE model, biological protection (ß = 0.17, P value = .002) and safety climate (ß = 0.24, P value < .001) are significantly related to task performance. Contextual performance is strongly affected by safety climate (ß = 0.15, P value < .001).To improve the job performance among nurses in emergency department, it should consider personal psychological and environmental factors.

Evaluating the effectiveness of performance management: A 30-year integrative conceptual review.

This integrative conceptual review is based on a critical need in the area of performance management (PM), where there remain important unanswered questions about the effectiveness of PM that affect both research and practice. In response, we create a theoretically grounded, comprehensive, and integrative model for understanding and measuring PM effectiveness, comprising multiple categories of evaluative criteria and the underlying mechanisms that link them. We then review more than 30 years (1984-2018) of empirical PM research vis-à-vis this model, leading to conclusions about what the literature has studied and what we do and do not know about PM effectiveness as a result. The final section of this article further elucidates the key "value chains" or mediational paths that explain how and why PM can add value to organizations, framed around three pressing questions with both theoretical and practical importance (How do individual-level outcomes of PM emerge to become unit-level outcomes? How essential are positive reactions to the overall effectiveness of PM? and What is the value of a performance rating?). This discussion culminates in specific propositions for future research and implications for practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Nurses' knowledge and practices in the face of the challenge of using the systematization of nursing care as an instrument of assistance in a first aid in Brazil.

OBJECTIVE: To analyze the performance of nurses in the implementation of nursing care systematization (NCS). This study is a descriptive research developed from a qualitative approach. The content analysis (CA) must be developed through 3 chronological poles allowing the researcher to construct an analysis structure that corresponds to the needs of the research and the objectives of the proposed research; The chronological poles of CA are described as: Phase 1-preanalysis, phase 2-exploration of the material: phase 3-treatment of the results obtained and interpretation. Only a semistructured interview will be conducted with the research subjects who meet the inclusion criteria of the study, preserving the identity of the individuals and guaranteeing the right to quit the research at any time during the interview. The Research Ethics Committee of Hospital of the clinics of Acre, Brazil (Amazon region) under the opinion no. 1.460.960 approved this protocol. The clinical protocol was registered in the "Brazilian Registry of Clinical Trials" validated by the World Health Organization, and received clinical trials "RBR-882rg2."

Effective Implementation of Peri-operative Local Guidelines for Metabolic Surgery in Patients with Diabetes Mellitus in a Tier 4 Setting Demonstrate Improved Work Efficiency and Resource Allocation.

BACKGROUND: Dynamic changes in glycaemia predominate peri-operatively in patients with type 2 diabetes mellitus (T2DM) undergoing metabolic surgery. There is a lack of consensus and clear guidance on effective glycaemic management of such patients. The aim of this study was to design, pilot, and implement a proforma to improve consistency of glycaemic management and clarity of communication with healthcare professionals following metabolic surgery in patients with T2DM, thereby reducing unnecessary diabetes specialist nurse (DSN) referrals. METHODS: A proforma was designed and piloted for 12 months to guide healthcare professionals on managing glycaemic therapies for T2DM patients undergoing metabolic surgery. Glycaemic control (HbA1c) and glycaemic therapies were reviewed 3 weeks pre-operatively and a proforma was completed accordingly. RESULTS: Of the patients with T2DM (n = 34) who underwent metabolic surgery prior to the new proforma being implemented, 71% (n = 24) had a DSN referral. Half of these referrals were deemed unnecessary by the DSNs. Of the patients with T2DM (n = 33) who underwent metabolic surgery following implementation of the proforma, 21% (n = 7) had a DSN referral. Only 10% of these were deemed unnecessary. Despite the reduced DSN input, no diabetes-related complications were reported. CONCLUSION: Implementation of our proforma effectively halved the proportion of patients with T2DM requiring a DSN referral. Additionally, there was a 40% absolute reduction in the proportion of unnecessary DSN referrals. The proforma improved clarity of communication and guidance for healthcare professionals in the glycaemic management of patients. This also facilitated improved work efficiency and resource allocation.