Background: Healthcare workers (HCWs) will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic.

BackgroundIf UK healthcare services are to respond effectively to pandemic influenza, levels of absenteeism amongst healthcare workers (HCWs) must be minimised. Current estimates of the likelihood that HCWs will continue to attend work during a pandemic are subject to scientific and predictive uncertainty, yet an informed evidence base is needed if contingency plans addressing the issues of HCW absenteeism are to be prepared.MethodsThis paper reports the findings of a self-completed survey of randomly selected HCWs across three purposively sampled healthcare trusts in the West Midlands. The survey aimed to identify the factors positively or negatively associated with willingness to work during an influenza pandemic, and to evaluate the acceptability of potential interventions or changes to working practice to promote the continued presence at work of those otherwise unwilling or unable to attend. 'Likelihood' and 'persuadability' scores were calculated for each respondent according to indications of whether or not they were likely to work under different circumstances. Binary logistic regression was used to compute bivariate and multivariate odds ratios to evaluate the association of demographic variables and other respondent characteristics with the self-described likelihood of reporting to work.ResultsThe survey response rate was 34.4% (n = 1032). Results suggest absenteeism may be as high as 85% at any point during a pandemic, with potential absence particularly concentrated amongst nursing and ancillary workers (OR 0.3; 95% CI 0.1 to 0.7 and 0.5; 95% CI 0.2 to 0.9 respectively).ConclusionLevels of absenteeism amongst HCWs may be considerably higher than official estimates, with potential absence concentrated amongst certain groups of employees. Although interventions designed to minimise absenteeism should target HCWs with a low stated likelihood of working, members of these groups may also be the least receptive to such interventions. Changes to working conditions which reduce barriers to the ability to work may not address barriers linked to willingness to work, and may fail to overcome HCWs' reluctance to work in the face of what may still be deemed unacceptable risk to self and/or family.

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This paper explores the links between management and non-management attitudes to the environment and organizational responses within SMEs. It identifies the scope for, and means by which, personal attitudes can be harnessed to motivate, activate and help operationalize business responses.The paper identifies strong personal attitudes about the environment. In some more proactive companies it identifies some of the elements of organizational learning which may assist in translating attitudes into effective behaviour-including supportive management structures, training and two-way communication. However, it also identifies organizational limits in this regard. It draws parallels with management systems in relation to health and safety.

This paper reports some of the findings of an ESRC Global Environmental Change Programme project which considered the attitudes of individuals (management and non‐management) in small and medium‐sized enterprises (SMEs) to the environment and environmental compliance. The focus on individuals and an understanding of the relationship between attitudes and behaviour within businesses is essential to implementation of effective sustainable development and self‐regulation policies. The research revealed that the environment is important to individuals and that environmental compliance is regarded as ‘the right thing to do’. However, the influence of the regulatory domain on businesses is revealed as considerably more complex than suggested by some other surveys. In particular the positive culture amongst individuals in businesses to the importance of compliance appears to differ from the operational climate of many SMEs; i.e. their capacity and feasibility to act. The research suggests that SMEs in general are ‘vulnerably compliant’ due to a mismatch between climate and culture. Copyright © 1999 John Wiley & Sons, Ltd and ERP Environment.