Case studies that examine how firms coordinate economic activity in the face of asymmetric information—information not equally available to all parties—are the focus of this volume. In an ideal ...world, the market would be the optimal provider of coordination, but in the real world of incomplete information, some activities are better coordinated in other ways. Divided into three parts, this book addresses coordination within firms, at the borders of firms, and outside firms, providing a picture of the overall incidence and logic of economic coordination. The case studies—drawn from the late nineteenth and early twentieth century, when the modern business enterprise was evolving, address such issues as the relationship between coordination mechanisms and production techniques, the logic of coordination in industrial districts, and the consequences of regulation for coordination. Continuing the work on information and organization presented in the influential Inside the Business Enterprise, this book provides material for business historians and economists who want to study the development of the dissemination of information and the coordination of economic activity within and between firms.
Aims and objectives
To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care ...framework.
Background
The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high‐quality, person‐centred care, it is important to understand how these factors affect patients' experiences and care needs.
Design
A focused ethnographic approach.
Method
A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis.
Results
The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high‐tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety.
Conclusion
Patients with acute abdominal pain were cared for in the high‐tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery.
Relevance to Clinical Practice
Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well‐being and recovery.
In a recent article in this journal, Ahrne, Brunsson, and Seidl (2016) suggest a definition of organization as a ‘decided social order’ composed of five elements (membership, rules, hierarchies, ...monitoring, and sanctions) which rest on decisions. ‘Partial organization’ uses only one or a few of these decidable elements while ‘complete organization’ uses them all. Such decided orders may also occur outside formal organizations, as the authors observe. Although we appreciate the idea of improving our understanding of organization(s) in modern society, we believe that Ahrne, Brunsson, and Seidl's suggestion jeopardizes the concept of organization by blurring its specific meaning. As the authors already draw on the work of Niklas Luhmann, we propose taking this exploration a step further and the potential of systems theory more seriously. Organizational analysis would then be able to retain a distinctive notion of formal organization on the one hand while benefiting from an encompassing theory of modern society on the other. With this extended conceptual framework, we would expect to gain a deeper understanding of how organizations implement and shape different societal realms as well as mediate between their particular logics, and, not least, how they are related to non-organizational social forms (e.g. families).
Despite advances in treatment, the increasing and ageing population makes heart failure an important cause of morbidity and death worldwide. It is associated with high healthcare costs, partly driven ...by frequent hospital readmissions. Disease management interventions may help to manage people with heart failure in a more proactive, preventative way than drug therapy alone. This is the second update of a review published in 2005 and updated in 2012.
To compare the effects of different disease management interventions for heart failure (which are not purely educational in focus), with usual care, in terms of death, hospital readmissions, quality of life and cost-related outcomes.
We searched CENTRAL, MEDLINE, Embase and CINAHL for this review update on 9 January 2018 and two clinical trials registries on 4 July 2018. We applied no language restrictions.
We included randomised controlled trials (RCTs) with at least six months' follow-up, comparing disease management interventions to usual care for adults who had been admitted to hospital at least once with a diagnosis of heart failure. There were three main types of intervention: case management; clinic-based interventions; multidisciplinary interventions.
We used standard methodological procedures expected by Cochrane. Outcomes of interest were mortality due to heart failure, mortality due to any cause, hospital readmission for heart failure, hospital readmission for any cause, adverse effects, quality of life, costs and cost-effectiveness.
We found 22 new RCTs, so now include 47 RCTs (10,869 participants). Twenty-eight were case management interventions, seven were clinic-based models, nine were multidisciplinary interventions, and three could not be categorised as any of these. The included studies were predominantly in an older population, with most studies reporting a mean age of between 67 and 80 years. Seven RCTs were in upper-middle-income countries, the rest were in high-income countries.Only two multidisciplinary-intervention RCTs reported mortality due to heart failure. Pooled analysis gave a risk ratio (RR) of 0.46 (95% confidence interval (CI) 0.23 to 0.95), but the very low-quality evidence means we are uncertain of the effect on mortality due to heart failure. Based on this limited evidence, the number needed to treat for an additional beneficial outcome (NNTB) is 12 (95% CI 9 to 126).Twenty-six case management RCTs reported all-cause mortality, with low-quality evidence indicating that these may reduce all-cause mortality (RR 0.78, 95% CI 0.68 to 0.90; NNTB 25, 95% CI 17 to 54). We pooled all seven clinic-based studies, with low-quality evidence suggesting they may make little to no difference to all-cause mortality. Pooled analysis of eight multidisciplinary studies gave moderate-quality evidence that these probably reduce all-cause mortality (RR 0.67, 95% CI 0.54 to 0.83; NNTB 17, 95% CI 12 to 32).We pooled data on heart failure readmissions from 12 case management studies. Moderate-quality evidence suggests that they probably reduce heart failure readmissions (RR 0.64, 95% CI 0.53 to 0.78; NNTB 8, 95% CI 6 to 13). We were able to pool only two clinic-based studies, and the moderate-quality evidence suggested that there is probably little or no difference in heart failure readmissions between clinic-based interventions and usual care (RR 1.01, 95% CI 0.87 to 1.18). Pooled analysis of five multidisciplinary interventions gave low-quality evidence that these may reduce the risk of heart failure readmissions (RR 0.68, 95% CI 0.50 to 0.92; NNTB 11, 95% CI 7 to 44).Meta-analysis of 14 RCTs gave moderate-quality evidence that case management probably slightly reduces all-cause readmissions (RR 0.92, 95% CI 0.83 to 1.01); a decrease from 491 to 451 in 1000 people (95% CI 407 to 495). Pooling four clinic-based RCTs gave low-quality and somewhat heterogeneous evidence that these may result in little or no difference in all-cause readmissions (RR 0.90, 95% CI 0.72 to 1.12). Low-quality evidence from five RCTs indicated that multidisciplinary interventions may slightly reduce all-cause readmissions (RR 0.85, 95% CI 0.71 to 1.01); a decrease from 450 to 383 in 1000 people (95% CI 320 to 455).Neither case management nor clinic-based intervention RCTs reported adverse effects. Two multidisciplinary interventions reported that no adverse events occurred. GRADE assessment of moderate quality suggested that there may be little or no difference in adverse effects between multidisciplinary interventions and usual care.Quality of life was generally poorly reported, with high attrition. Low-quality evidence means we are uncertain about the effect of case management and multidisciplinary interventions on quality of life. Four clinic-based studies reported quality of life but we could not pool them due to differences in reporting. Low-quality evidence indicates that clinic-based interventions may result in little or no difference in quality of life.Four case management programmes had cost-effectiveness analyses, and seven reported cost data. Low-quality evidence indicates that these may reduce costs and may be cost-effective. Two clinic-based studies reported cost savings. Low-quality evidence indicates that clinic-based interventions may reduce costs slightly. Low-quality data from one multidisciplinary intervention suggested this may be cost-effective from a societal perspective but less so from a health-services perspective.
We found limited evidence for the effect of disease management programmes on mortality due to heart failure, with few studies reporting this outcome. Case management may reduce all-cause mortality, and multidisciplinary interventions probably also reduce all-cause mortality, but clinic-based interventions had little or no effect on all-cause mortality. Readmissions due to heart failure or any cause were probably reduced by case-management interventions. Clinic-based interventions probably make little or no difference to heart failure readmissions and may result in little or no difference in readmissions for any cause. Multidisciplinary interventions may reduce the risk of readmission for heart failure or for any cause. There was a lack of evidence for adverse effects, and conclusions on quality of life remain uncertain due to poor-quality data. Variations in study location and time of occurrence hamper attempts to review costs and cost-effectiveness.The potential to improve quality of life is an important consideration but remains poorly reported. Improved reporting in future trials would strengthen the evidence for this patient-relevant outcome.
Providing aid in times of increasing humanitarian need, limited budgets, and mounting security risks is challenging. This paper explores in what organisational circumstances evaluators judge, ...positively and negatively, the performance of international non‐governmental organisations (INGOs) in response to disasters triggered by natural hazards. It assesses whether and how, as perceived by expert evaluators, CARE and Oxfam successfully met multiple institutional requirements concerning beneficiary needs and organisational demands. It utilises the Competing Values Framework to analyse evaluator statements about project performance and organisational control and flexibility issues, using seven CARE and four Oxfam evaluation reports from 2005–11. The reports are compared using fuzzy‐set Qualitative Comparative Analysis. The resulting configurations show that positive evaluations of an INGO's internal and external flexibility relate to satisfying beneficiary needs and organisational demands, whereas negative evaluations of external flexibility pertain to not meeting beneficiary needs and negative statements about internal control concerning not fulfilling organisational demands.
This article addresses a significant gap in the literature on legitimacy in global governance, exploring whether, in what ways, and to what extent institutional qualities of international ...organisations (IOs) matter for popular legitimacy beliefs towards these bodies. The study assesses the causal significance of procedure and performance as sources of legitimacy, unpacks these dimensions into specific institutional qualities, and offers a comparative analysis across IOs in three issue areas of global governance. Theoretically, the article disaggregates institutional sources of legitimacy to consider democratic, technocratic, and fair qualities of procedure and performance. Empirically, it examines the effects of these institutional qualities through a population-based survey experiment in four countries in different world regions with respect to IOs in economic, security, and climate governance. The findings demonstrate that both procedure- and performance-related aspects of IO policymaking matter for popular legitimacy beliefs. This result holds across democratic, technocratic, and fair qualities of IO procedure and performance. Disaggregating the results by issue area indicates that a broader scope of institutional qualities are important for legitimacy beliefs in economic governance compared to security governance and, especially, climate governance. These findings suggest that propositions to reduce the institutional sources of IO legitimacy to single specific qualities would be misguided.
Steer your organization away from burnout while boosting all-around performance
The Happy, Healthy Nonprofit presents realistic strategies for leaders looking to optimize organizational achievement ...while avoiding the common nonprofit burnout. With a uniquely holistic approach to nonprofit leadership strategy, this book functions as a handbook to help leaders examine their existing organization, identify trouble spots, and resolve issues with attention to all aspects of operations and culture. The expert author team walks you through the process of building a happier, healthier organization from the ground up, with a balanced approach that considers more than just quantitative results. Employee wellbeing takes a front seat next to organizational performance, with clear guidance on establishing optimal systems and processes that bring about better results while allowing a healthier work-life balance. By improving attitudes and personal habits at all levels, you′ll implement a positive cultural change with sustainable impact.
Nonprofits are driven to do more, more, more, often with fewer and fewer resources; there comes a breaking point where passion dwindles under the weight of pressure, and the mission suffers as a result. This book shows you how to revamp your organization to do more and do it better, by putting cultural considerations at the heart of strategy.
Find and relieve cultural and behavioral pain points
Achieve better results with attention to well-being
Redefine your organizational culture to avoid burnout
Establish systems and processes that enable sustainable change
At its core, a nonprofit is driven by passion. What begins as a personal investment in the organization′s mission can quickly become the driver of stress and overwork that leads to overall lackluster performance. Executing a cultural about-face can be the lifeline your organization needs to thrive. The Happy, Healthy Nonprofit provides a blueprint for sustainable change, with a holistic approach to improving organizational outlook.
PDF
