Developing Initial Middle Range Theories in Realist Evaluation: A Case of an Organisational Intervention

(1) Background: Realist evaluation is a promising approach for evaluating organisational interventions. Crucial to realist evaluation is the development and testing of middle range theories (MRTs). MRTs are programme theories that outline how the intervention mechanisms work in a specific context to bring about certain outcomes. To the best of our knowledge, no organisational intervention study has yet developed initial MRTs. This study aimed to develop initial MRTs based on qualitative evidence from the development phase of an organisational intervention in a large multi-national organisation, the US food service industry. (2) Methods: Data were collected through 20 semi-structured interviews with the organisation′s managers, five focus groups with a total of 30 employees, and five worksite observations. Template analysis was used to analyse data. (3) Results: Four initial MRTs were developed based on four mechanisms of participation, leadership commitment, communication, and tailoring the intervention to fit the organisational context to formulate ‘what may work for whom in which circumstances?’ in organisational interventions; (4) Conclusions: Our findings provide insights into ‘how’ and ‘which’ initial MRTs can be developed in organisational interventions.

Workplace cyber abuse: challenges and implications for management

PurposeThis paper offers a synopsis of workplace cyber abuse, identifying patterns of and responses to cyber abuse, as well as barriers to reporting and successful organisational intervention.Design/methodology/approachUsing a pragmatic research paradigm, quantitative and qualitative survey data were collected from 205 targets of cyber abuse in New Zealand.FindingsNearly half of all respondents experienced more than one form of cyber abuse, with gendered patterns emerging. Workplace cyber abuse also frequently went unreported for varying reasons. Based on the descriptive analyses, four key challenges for the management of cyber abuse are identified: (1) multiple and gendered patterns of cyber abuse, (2) cyber abuse across organisational boundaries, (3) non-reporting and underreporting and (4) ineffective (or lack of) organisational interventions.Practical implicationsImplications for human resource management (HRM) and line managers include adopting a preventative approach to workplace cyber abuse by implementing clear policies, guidelines and resources to deal with cyber abuse, clarifying the boundaries of “workplace” cyber abuse and considering organisational protection measures for non-standard and vulnerable workers.Social implicationsUnique challenges with workplace cyber abuse emphasise the need for a coordinated, multilevel intervention approach involving organisations, policymakers, online platforms and academics.Originality/valueThis study provides an important overview of existing approaches to the management of workplace cyber abuse as well as a foundation upon which to base further research exploring good practice in its prevention and intervention and much-needed theoretical development.

Managing occupational stress: should we consider the sociodemographic groups of health workers?

Background An essential part of occupational stress management is identifying target groups and developing a wellbeing program that tailors organisational interventions to the specific needs of the target groups. The study aimed to explore whether psychosocial risk determinants and organisational intervention objects differ across employees' groups based on sociodemographic factors in a public healthcare institution. Methods Using a cross-sectional study design, paper questionnaires were delivered to all health workers (n = 690) of the Lithuanian primary healthcare institution; the response rate 68%. The questionnaire contained items related to sociodemographic groups (gender, age, job seniority, education, occupational status), 14 psychosocial risk determinants, and 10 organisational intervention objects. Nonparametric tests for comparisons of the groups were used. Results The results showed that differences by gender were not statistically significant except for one organisational intervention object. Only 3 organisational intervention objects had mean rank scores differing statistically across age and job seniority groups; 5 objects - across education groups and almost all objects - across occupational groups. Regarding psychosocial risk determinants, one determinant had mean rank scores differing statistically across age and job seniority groups; 4 and 6 determinants - across education and occupational groups respectively. Statistical significance was considered with p-value < 0.05 and 95% confidence interval. Conclusions The findings showed that different psychosocial risk determinants and organisational intervention objects were emphasized by different sociodemographic groups of health workers in the institution, but they did not impact groups in the same measure. Therefore, it is crucial to start by determining the risk group's specific needs before developing and implementing stress management programs. Key messages The study contributes to bridging the gap between theoretical knowledge and practical solutions in occupational stress management at public primary healthcare settings. The study has proposed a way of diagnosing psychosocial risks and of tailoring interventions to all health workers of the public primary healthcare institution by using a simple and robust tool.

Developing Stress Management Programs in a Public Primary Healthcare Institution: Should We Consider Health Workers’ Sociodemographic Groups?

Background and Objectives: An essential part of occupational stress management is identifying target groups and developing a wellbeing program that tailors interventions to the specific needs of the target groups. This study aims to explore whether psychosocial risk determinants and organizational intervention objects differ across employees’ groups based on sociodemographic factors in a Lithuanian public primary healthcare institution. Methods: All 690 health workers of the institution were invited to participate (response rate 68%) in a cross-sectional survey between February and March 2017. The questionnaire contained items related to sociodemographic factors (gender, age, job seniority, education, and occupation), 14 psychosocial risk determinants, and 10 organisational intervention objects. Results: The results of the study showed that differences by gender were not statistically significant except for one organisational intervention object (work–life balance). Only a few organisational intervention objects (justice of reward, matching to the job demand, and variety of tasks) had mean rank scores differing statistically across age and job seniority groups. Five organisational intervention objects (work–life balance, variety of tasks, communication, manager feedback, and stress management training) had mean rank scores differing statistically across education groups, and all organisational intervention objects (except stress management training) had mean rank scores differing statistically across occupational groups. Regarding psychosocial risk determinants, excessive work pace had mean rank scores differing statistically across age and job seniority groups. Four (overtime, unclear role, conflicting roles, and being under-skilled) and six psychosocial risk determinants (work overload, overtime, tight deadlines, unclear role, being under-skilled, and responsibility) had mean scores differing statistically across education and occupational groups, respectively. Statistical significance was considered with p-value < 0.05 and 95% confidence interval. Conclusions: The findings showed that different psychosocial risk determinants and organizational interventional objects were emphasized by different sociodemographic groups in the institution, but they did not impact groups in the same measure. Therefore, it is crucial to start by determining the risk group’s specific needs before developing and implementing stress management programs.

Making soft intelligence hard: a multi-site qualitative study of challenges relating to voice about safety concerns

BackgroundHealthcare organisations often fail to harvest and make use of the ‘soft intelligence’ about safety and quality concerns held by their own personnel. We aimed to examine the role of formal channels in encouraging or inhibiting employee voice about concerns.MethodsQualitative study involving personnel from three academic hospitals in two countries. Interviews were conducted with 165 participants from a wide range of occupational and professional backgrounds, including senior leaders and those from the sharp end of care. Data analysis was based on the constant comparative method.ResultsLeaders reported that they valued employee voice; they identified formal organisational channels as a key route for the expression of concerns by employees. Formal channels and processes were designed to ensure fairness, account for all available evidence and achieve appropriate resolution. When processed through these formal systems, concerns were destined to become evidenced, formal and tractable to organisational intervention. But the way these systems operated meant that some concerns were never voiced. Participants were anxious about having to process their suspicions and concerns into hard evidentiary facts, and they feared being drawn into official procedures designed to allocate consequence. Anxiety about evidence and process was particularly relevant when the intelligence was especially ‘soft’—feelings or intuitions that were difficult to resolve into a coherent, compelling reconstruction of an incident or concern. Efforts to make soft intelligence hard thus risked creating ‘forbidden knowledge’: dangerous to know or share.ConclusionsThe legal and bureaucratic considerations that govern formal channels for the voicing of concerns may, perversely, inhibit staff from speaking up. Leaders responsible for quality and safety should consider complementing formal mechanisms with alternative, informal opportunities for listening to concerns.

Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before–after pilot study

ObjectiveProvision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before–after observational study design.SettingAcute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a ‘top-ranked’ hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers.ParticipantsHospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack.InterventionA four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning.Primary and secondary outcome measuresThree discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3 months before the intervention (preintervention), 3 months postintervention and at 12 months (sustainability).ResultsData from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p<0.001); discharge planning (72%vs94%, p<0.001); composite outcome (73%vs89%, p<0.001). There was an insignificant decay effect over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08).ConclusionDischarge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale.