BackgroundThe concept of “mechanism” is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research. Our large, interdisciplinary research team has also experienced challenges in making the concept useful in our study of the implementation of models of integrated community-based primary health care (ICBPHC) in three international jurisdictions (Ontario and Quebec in Canada, and in New Zealand).MethodsIn this paper we summarize definitions of mechanism found in realist methodological literature, and report an empirical example of a realist analysis of the implementation ICBPHC.ResultsWe use our empirical example to illustrate two points. First, the distinction between contexts and mechanisms might ultimately be arbitrary, with more distally located mechanisms becoming contexts as research teams focus their analytic attention more proximally to the outcome of interest. Second, the relationships between mechanisms, human reasoning, and human agency need to be considered in greater detail to inform realist-informed analysis; understanding these relationships is fundamental to understanding the ways in which mechanisms operate through individuals and groups to effect the outcomes of complex health interventions.ConclusionsWe conclude our paper with reflections on human agency and outline the implications of our analysis for realist research and realist evaluation.
PurposeThe aim of this paper is to test a model of the relationship between organizational memory and empowerment. The model posited that organizational memory would be related to requests to share knowledge, psychological empowerment in the workplace (meaning, competence, self‐determination and impact), and organization‐based self‐esteem.Design/methodology/approachThe model was tested with 134 employees representing six companies using hierarchical regression analysis.FindingsSignificant relationships were found between organizational memory and requests to share knowledge, empowerment, and organization‐based self‐esteem. Findings indicated that a positive stereotype may exist towards older workers and the frequency they are requested to share knowledge, and that a halo‐type effect may operate, where knowledge of an organization's history is generalized to other knowledge domains.Research limitations/implicationsCausal implications cannot be made as this was correlational research. Some of the research measures while achieving acceptable to good reliability were in an early development stage. The study utilized a convenience sample that may limit how the results can be generalized.Practical implicationsThe paper indicates that organizations can emphasize positive outcomes for those who are knowledge repositories and mentors. It is also important to consider possible “positive stereotypes” which may be operating when organizational members evaluate older workers as knowledge repositories and mentors.Originality/valueThe paper addresses the assumptions in the human resources literature concerning the role of older workers as repositories of organizational memory and suitable mentors. The study introduces the “requests to share knowledge scale”.
BackgroundThe impact of long‐term conditions is the “healthcare equivalent to climate change.” People with long‐term conditions often feel they are a problem, a burden to themselves, their family and friends. Providers struggle to support patients to self‐manage. The Practical Reviews in Self‐Management Support (PRISMS) taxonomy lists what provider actions might support patient self‐management.ObjectiveTo offer providers advice on how to support patient self‐management.DesignSemi‐structured interviews with 40 patient‐participants.Setting and participantsThree case studies of primary health‐care organizations in New Zealand and Canada serving diverse populations. Participants were older adults with long‐term conditions who needed support to live in the community.Main outcome measuresQualitative description to classify patient narratives of self‐management support according to the PRISMS taxonomy with thematic analysis to explore how support was acceptable and effective.ResultsPatients identified a relationship‐in‐action as the mechanism, the how by which providers supported them to self‐manage. When providers acted upon knowledge of patient lives and priorities, these patients were often willing to try activities or medications they had resisted in the past. Effective self‐management support saw PRISMS components delivered in patient‐specific combinations by individual providers or teams.Discussion and conclusionsProviders who establish relationships with patients can support them to self‐manage and improve health outcomes. Delivery of taxonomy components, in the absence of a relationship, is unlikely to be either acceptable or effective. Providers need to be aware that social determinants of health can constrain patients’ options to self‐manage.
Purpose – The aim of this study is to develop a psychometrically sound self-report scale of organizational memory. The scale is planned for use in future research to test the relationship between what employees know and their attitudes to passing on their knowledge. Design/methodology/approach – A total of 72 organizational memory scale items representing six hypothesised dimensions of organizational memory were developed and tested with 143 participants using exploratory factor analysis. The resulting five-factor model was tested with a further sample of 288 employees using structural equation modelling, and the test-retest reliability was examined. Findings – Five factors of the organizational memory scale were identified. These were: socio-political knowledge, job knowledge, external network, history, and industry knowledge. The dimensions correlated with tenure variables often used as proxies for experience. Structural equation modelling confirmed the five-factor model and the scale achieved adequate test-retest reliability. Research limitations/implications – The five organizational memory factors are not an exhaustive list. While the scale enables employees to evaluate their own organizational memory, it may not necessarily be an accurate indicator of their knowledge. Practical implications – The scale can be used as a knowledge audit instrument for examining attitudes to mentoring and knowledge sharing, as well as for auditing knowledge that may potentially be lost when experienced employees leave organizations. Originality/value – The scale is a valid and reliable self-report measure of organizational memory. It is an innovative tool for examining employee attitudes to knowledge sharing initiatives. The scale also recognises the contribution made to organizational memory by those with industry knowledge outside the organization.
Purpose Training to improve health management and leadership competence is recommended. However, there is limited evidence showing the impact of training on competence. The purpose of this paper is to evaluate the evidence for the impact of training and professional development on health management and leadership competence. Design/methodology/approach A systematic review was conducted using a mixed-methods design. Studies using qualitative, quantitative or mixed-methods design were included. The following electronic databases were searched to October 2018: CENTRAL, CINAHL, EMBASE, ERIC, NEDLINE and PsycINFO. Study eligibility and methodological quality were assessed independently by two review authors. Data from qualitative studies were synthesised using thematic analysis. For quantitative studies, odds ratio (OR) or mean difference (MD) and 95% confidence interval (CI) were calculated for each intervention. Where appropriate, qualitative and quantitative data were integrated into a single synthesis using Bayesian methods. Findings In total, 19 studies were identified for inclusion in the review. Training and professional development interventions using flexible, multiple training techniques tailored to organisational contexts can improve individual competence and performance. Such training is typified by a leadership development programme. There was insufficient evidence to determine the effects of interventions on organisational performance. Originality/value This is the first systematic review evaluating the impact of training and professional development interventions on health management and leadership competence.
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