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The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported.To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia.Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505).46 U.S. and Canadian hospitals.Patients aged 50 years or older undergoing hip fracture surgery.Spinal or general anesthesia.Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care.A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups.Missing outcome data and multiple outcomes assessed.Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia.Patient-Centered Outcomes Research Institute

Summary Engaging patients—defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them—as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process.

Following the 2007 Gibbons review and the subsequent repeal of the statutory grievance and disciplinary procedures in April 2009, the resolution of workplace conflict through alternative dispute resolution (ADR) continues to be a topical issue in the UK. Using a qualitative case study methodology, this paper examines the approaches to dispute resolution adopted by owners and managers in small businesses and the operational realities that shape their handling of individual disputes. The findings reveal a support for early and informal conflict resolution, but also a lack of knowledge about ADR and what it can offer. The conclusion is that, whilst ADR offers real benefits to small business employers and their employees, the dominant concern of these parties appears to be their ability to defend decisions they have taken in the event of litigation.

Despite the general awareness that working in retailing is unattractive to many workers, relatively little is known about which aspects of retailing are actually disliked, or how that varies across groups within the workforce, employers, or types of store. Initial analyses from an extensive survey of UK retail employees show that statistically significant variations exist in terms of dislike of retail employment and particular aspects of that employment. Exploratory factor analysis shows that while a general dimension of discontent is identifiable, there are also specific concerns, such as among more senior staff who are particularly concerned about long hours, and younger employees frustrated at a perceived lack of career progression. However, there is also a dimension of relative contentment with work circumstances among large numbers of female part-time workers and older staff.

PurposePublic sector reforms and external performance review has meant that the HR function in UK local government is not only expected to continuously review working practices but is also facing major changes in its role and its own service delivery. This paper explores how changes driven by the pursuit of efficiency and cost cutting may impact on the function's ability to fulfil the employee champion role that Ulrich identifies as essential to it making a valuable strategic contribution.Design/methodology/approachThe findings are drawn from interviews, focus groups and desk research conducted in three large local authoritiesFindingsThe emergent concerns, tensions and dilemmas across the case study organisations suggest that changes, both planned and actual, to HR's role and services will impact on the function's ability to act as an “employee champion” due to reduced employee contact and more fragmented HR roles.Research limitations/implicationsThe findings are based on three case studies, so there is an issue of their wider application – and they provided rather more insights into the views of HR staff and line managers than of other employee groups.Practical implicationsThe devolved, decentralised, outsourced and self service models of HR service provision require careful internal evaluation as this study's findings indicate they may well have hidden costs in terms of promoting employee commitment in large public sector organisations.Originality/valueA qualitative study of how changes to the HR function's role and service delivery can impact on the HR's responsibilities for employee relations rather than the more usual considerations of cost effectiveness and efficiency.

PurposeTo examine how an external performance review process introduced as part of the public sector modernisation agenda in England and Wales has impacted on HR service provision and processes in local government and the extent to which it has acted as a catalyst for the development of more integrative and innovative HR practices to support organisational performance.Design/methodology/approachA case study analysis of the Best Value Review (BVR) process of HR services at two county and two unitary authorities generated data from multiple sources including interviews, focus groups, consultative meetings as well as internal documentation. This approach was adopted to offer perspectives from different stakeholders in the employment relationship.FindingsThere was found to be a frequent lack of synergy between organisational goals, departmental plans and the performance objectives of individuals combined with an absence of shared understandings about human resourcing priorities or commitment to the processes needed to strategically integrate HR policies.Research limitations/implicationsWhilst providing insights into the Best Value (BV) approach to public sector modernisation, a wider generalisation of the findings cannot be drawn from four case studies.Practical implicationsLine management and the HR function need to share better understandings concerning the HR practices needed to support the modernisation agenda and their respective HR responsibilities.Originality/valueThis paper reveals that the BV performance regime was not encouraging, and even limiting, a corporate approach to the HR policies and practices required to develop longer term organisational capability.

This article examines how operational managers are interpreting the management of diversity in practice. It is explicitly concerned with the way in which managing diversity was understood and applied in one large, long-established British retailing company. The findings suggest that while the business benefits attributed to diversity management are appealing to employers, it is a concept that lacks clarity for line managers both in terms of what it is and how it should be implemented within the anti-discrimination legal framework. Line managers, familiar with the value of demonstrating a common approach in their decision-making as the key means of defence against claims of discriminatory treatment, regarded a diversity management agenda concerned with recognising and responding to individual differences as more likely to lead to feelings of unfairness and claims of unequal treatment. It will be argued that, in the implementation of organisational diversity initiatives, employers need to take greater account of the tensions facing line managers, their interpretation of diversity management and perceptions of fair treatment as well as the operational context.

The U.K.’s public sector modernization agenda has significant implications for human resource (HR) practices and how they contribute to organizational performance. Through 4 case studies of large, local authorities, this article considers how the externally imposed performance assessment process of best value review is affecting HR practices in local government and to what extent these are being developed to support the high-performance model reflected in central government performance interventions. It also explores whether these are helping or hindering approaches to the organizational development required to build the internal capability necessary for delivering local authorities’ future improvement plans.

The U.K. government is seeking to transform the quality of the National Health Service (NHS) through a process ofmodernization. It is generally thought by government and managers within the service that improving the job satisfaction of employees is an important mechanism for delivering modernization. On the basis of job satisfaction surveys carried out within 2 NHS hospitals, this article suggests that instead of being a driver for improvement, employee perception of job satisfactionmay be acting as a barrier tomodernization. The article then discusses the possibility that there may be structural tensions between the imperatives of modernization and the wish to improve job satisfaction.

As home‐based teleworking grows in the UK, more evidence is needed of how working from home shapes the employment relationship and the implications this may have for those line managers responsible for a home‐based workforce. The reported experiences of a sales team and their line managers at one large international drinks manufacturing company of teleworking during its first year of operation revealed the importance of developing understanding of the complex interface between the domains of work and home life. The findings suggest individual circumstances require close attention before implementing home‐based working with line managers recalibrating perceptions of the boundaries between home and work for positive employee relationships to develop within a new paradigm of “home‐work” relations.

Examines the impact of employment regulation on owner‐manager approaches to the employment relationship at the level of the individual firm. While there was no reported principled opposition to extending employment rights as suggested by a number of earlier studies, the cumulative effect of recent legislation was perceived by owner‐managers to be reducing their competitiveness by placing costly and time‐consuming demands on the smaller business. The case study companies were increasingly formalising their employment processes largely to defend their decisions against potential litigation. Despite certain acknowledged benefits, this increasing proceduralisation was held to be detrimental to the informality and flexibility viewed as essential to effective working relationships in the smaller enterprise. Continuing recruitment difficulties combined with the costs associated with expanding regulation led the majority of the case study companies to identify an investment in automation and labour‐saving equipment as a preferable long‐term option to the expansion of the workforce.

This article examines the reallocation of human resource management responsibilities from HR specialists to line managers in UK public sector organisations in an increasingly regulated working environment. It uses evidence about the extent and scope of HR devolution in a large unitary city council, the British Library and a county probationary service. Based on the perceptions of senior managers, middle managers, HR specialists and the trade union representatives, it specifically explores: the issues devolution raises about the HR responsibilities of line managers; the experience of HR devolution in the public sector; and the impact of a more externally regulated and litigious workplace on continuing devolution.

This paper explores how the contribution of specialist HR services is being evaluated in the context of best value performance reviews in local government. It examines the perceptions that HRM and line managers have of their respective HR responsibilities and of the contribution made by the specialist function. Dilemmas involved in measuring a function whose contribution is mediated through the work of others are identified. The extent to which the best value review process will promote continuous improvement in HR practices and its value as a mechanism for identifying good HR practices and establishing criteria for measuring their effectiveness is discussed. Copyright © 2002 John Wiley & Sons, Ltd.

The recent expansion of employment law and the growth of work place litigation in the UK is likely to intensify the preoccupation of Human Resource (HR) specialists and line managers with demonstrating procedural fairness in their human resourcing practices. The agenda is increasingly becoming one of "showing that justice has been done" in employment decisions. This paper's central claim is that regulation and escalating litigation can encourage an employee relations environment where HR practitioners and line managers alike place the emphasis on adhering to processes developed to demonstrate moral neutrality as a means of defending managerial decision making. I will argue that this results in a heavily "proceduralised" approach which can be at the cost of investing in interpersonal relationships that are more conducive to positive employment relationships and individual feelings of fair treatment. Issues of fairness in HR processes will be explored from the perspectives of line managers, HR specialists and, to a lesser extent, of individuals at the receiving end. I will draw upon findings from two case studies of human resourcing policies and practice within two large public sector organizations?a large City Council and the British Library. The discussion will focus on two particular issues

This article explores managerial perceptions of the effectiveness and fairness of individual performance related pay schemes. It draws upon findings from a two part study of middle managers' interpretation and application of performance related pay processes in a variety of organisational contexts. The analysis reveals that middle managers all too often do not share the principles or the stated objectives of the schemes they are required to operationalise. It concludes that the importance of managerial values and beliefs about rewarding individual contribution has been an overlooked and underestimated dimension in the design and application of individual performance related pay schemes (IPRP) despite the significance of the manager 's role in their organisational effectiveness.

As the volume and complexity of employment legislation increases, small and medium‐sized enterprises (SMEs) without access to internal human resource expertise are increasingly vulnerable to litigation and its associated costs. The disproportionate impact of employment regulation on the small firm has long been a concern of SME owner‐managers and is expected to increase as a result of the recent rapid expansion of labour law in the UK. This paper will consider evidence from a recent survey of small businesses, which examined their main employment concerns and the sources of advice they use on employment relations matters. The survey’s findings illustrate the particular challenge increased employment rights presents to the smaller organisation. It identifies a need for more intensive support tailored to the specific circumstances of individual firms in developing proactive approaches to human resourcing which not only comply with but also reflect the spirit of the legislation.

Demonstrating procedural justice through a focus on the psychometric job-related approach to selection continues to be the most effective means for employers to meet legal requirements and potential claims of unfair treatment. A study of selection practice in a large local UK City Council reports how a structured, highly ‘job-focused’ approach can result in negative perceptions about the fairness of the process, its outcomes and effectiveness. Its findings reveal an organizational dilemma – how to develop selection systems that are sufficiently robust in terms of demonstrating maximum procedural fairness and objectivity to withstand potential litigation but are sufficiently flexible to accommodate those other factors which influence individual perceptions of fairness. It considers the future of the highly structured approach in the light of pressures to develop selection processes which can meet the needs of rapidly changing organizational structures as well the expansion of anti-discrimination legislation and litigation.

Since the 1980s local government recruitment practices have been characterised by the development of procedures designed to promote fairness in employee selection. This article examines recruitment practice in one local authority in terms of its effectiveness in providing fairness in selection and questions its ability to meet the changing demands being placed on recruitment processes. A central argument is that an emphasis on developing recruitment procedures to demonstrate equality of treatment can overlook important social psychological factors. It concludes that although a highly structured approach to employee selection has real advantages in meeting the requirements of equal opportunities it can, paradoxically, result in negative perceptions about its fairness and effectiveness.

Small firms are a major and growing provider of employment and are playing a vital role in economic regeneration. The contribution of contemporary, relevant and focused management techniques to enhance competitive advantage is crucial, especially in performance management and reward systems. The performance management systems of large organizations simply cannot be scaled down to fit the smaller enterprise which often exhibits a radically different management process and operating context. The skills and abilities of managers are fundamental to the success of any performance management system. Consistency and clarity in both design and implementation are essential features. Smaller enterprises need to be aware of the paradox of formalized performance management systems which may erode the flexibility, innovation and team working required for long-term success and strategic health.

Questions that concern the new Stanford-Binet Intelligence Scale: 4th Edition (SB-4) have been raised with respect to the correspondence between the underlying theory and the hypothesized factor structure of the scale. Contrary to the Thorndike, Hagen, and Sattler (1986b) four-factor model, evidence exists that there are fewer factors and that factor structure changes with age. The present study obtained data from 3-year-old children to explore the factor structure and the correspondence between SB-4 verbal scores and verbal scores from the McCarthy. Both EFA and CFA results identify only verbal and nonverbal factors and replicate the findings of others, including R. M. Thorndike (1990b). Stanford-Binet verbal scores derived from models constructed from the factor analyses correlate strongly with McCarthy verbal scores.

Securing the commitment of employees can generate a number of organisational benefits, such as reducing recruitment costs and improving interactions between customers and employees. For retailers, a loyal workforce can therefore represent a source of differentiation and competitive advantage. Despite this, few retail studies have explored employee loyalty and have instead focused upon the loyalty of customers. This quantitative and qualitative exploratory study of store employees in three UK retailers aims to explore how employee loyalty manifests itself in a retail context. It proposes that employee loyalty in this industry is multi-faceted and can be understood in relation to commitment to the retailing industry, the retailer and the store. The findings also suggest that, due to their domestic circumstances, female general assistants are more likely to be loyal to their store than men.

PurposeThe purpose of the paper is to show that a defining characteristic of the UK retail sector is the high number of women it employs but there remains an enduring under‐representation of women in its management positions. The majority of women in the industry work part‐time and this paper aims to explore the factors that impact upon the career progression.Design/methodology/approachIn the paper, 1,000 questionnaires were completed by store staff in three leading retailers, supported by interviews with store staff and SME retailers in the UK's East Midlands region.FindingsThe paper finds continuing barriers to career progression for women working part‐time in retailing. Despite family friendly employment policies becoming an increasingly important feature of modern work organisations, career progression was informed by a traditional concept of a career based on full‐time working.Research limitations/implicationsThe paper was limited to one sector. There is a need for further studies into women's career progression in other sectors reliant on female employment.Practical implicationsThe findings in the paper have implications for promotion policies, training and development provision and line management practices if retailers are to maximise the potential of the women they employ.Originality/valueThe paper suggests that retailing is an industry where a significant number of women are working below their potential despite organisational policies supportive of diversity and equality of opportunity.

PurposeThe aim of this paper is to highlight the factors that limit and support female career progression in the retail industry.Design/methodology/approachThe research used a combination of quantitative and qualitative research methods. Data were collected from employees and managers working in 31 stores belonging to national stores operating in the East Midlands as well as ten SME independent retailers based in the region.FindingsThe women in this study can be categorised into those women who are not interested in pursuing a career in retail, those that seek promotion but have difficulties balancing the demands of their work and domestic circumstances and those who have actively pursued a career in the industry. Despite these categorisations, the study suggests that the career progression of all female staff is helped and hindered by a number of interrelating factors, such as whether they have a role model, are loyal to the store they work in or have children.Practical implicationsIt is proposed that career initiatives in retailing need to be more adaptable so that they take account of the different development needs of these three types of women.Originality/valueThis is a large‐scale study that uses a mixed method approach and considers the opinions of store staff working in a range of roles.