A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Health‐Care Settings

In spite of increased attention to quality and efforts to provide safe medical care, adverse events (AEs) are still frequent in clinical practice. Reports from various sources indicate that a substantial number of hospitalized patients suffer treatment‐caused injuries while in the hospital. While risk cannot be entirely eliminated from health‐care activities, an important goal is to develop effective and durable mitigation strategies to render the system “safer.” In order to do this, though, we must develop models that comprehensively and realistically characterize the risk. In the health‐care domain, this can be extremely challenging due to the wide variability in the way that health‐care processes and interventions are executed and also due to the dynamic nature of risk in this particular domain. In this study, we have developed a generic methodology for evaluating dynamic changes in AE risk in acute care hospitals as a function of organizational and nonorganizational factors, using a combination of modeling formalisms. First, a system dynamics (SD) framework is used to demonstrate how organizational‐level and policy‐level contributions to risk evolve over time, and how policies and decisions may affect the general system‐level contribution to AE risk. It also captures the feedback of organizational factors and decisions over time and the nonlinearities in these feedback effects. SD is a popular approach to understanding the behavior of complex social and economic systems. It is a simulation‐based, differential equation modeling tool that is widely used in situations where the formal model is complex and an analytical solution is very difficult to obtain. Second, a Bayesian belief network (BBN) framework is used to represent patient‐level factors and also physician‐level decisions and factors in the management of an individual patient, which contribute to the risk of hospital‐acquired AE. BBNs are networks of probabilities that can capture probabilistic relations between variables and contain historical information about their relationship, and are powerful tools for modeling causes and effects in many domains. The model is intended to support hospital decisions with regard to staffing, length of stay, and investments in safety, which evolve dynamically over time. The methodology has been applied in modeling the two types of common AEs: pressure ulcers and vascular‐catheter‐associated infection, and the models have been validated with eight years of clinical data and use of expert opinion.     

A Knowledge Framework Underlying Process Management*

Organizations are increasingly implementing process‐improvement techniques like Six Sigma, total quality management, lean, and business process re‐engineering to improve organizational performance. These techniques are part of a process management system that includes the organizational infrastructure to support the improvement techniques. The knowledge‐based view of a firm argues that organizational knowledge is the source of competitive advantage. To the extent that the process management system enables knowledge creation it should be a source of competitive advantage. This study investigates the underlying framework and factors of a process management system that lead to organizational knowledge creation. Prior studies have considered knowledge creation in process improvement, but none have considered the role of the process management system. Specifically, the study uses the case study method to investigate multiple levels (organization level and project level) of two firms using Six Sigma as their chosen process management system. Analysis of the cases reveals that the leadership creates a supportive infrastructure enabling process‐improvement techniques to effectively create organizational knowledge. Interestingly, focusing on decision‐making tools and methods may not be effective without developing a supportive infrastructure. The proposed framework provides a basis for organizational leaders to think about how to design and implement a process management system to better enable knowledge creation in organizations.     

Making Sense of Risk—A Sociological Perspective on the Management of Risk

This article describes how risk has been conceptualized in the business and organizational literature through four distinct transformations: from the techno‐scientific perspective to the cognitive, the social‐cultural, and, finally, to the constructionist perspective. Each domain conceptualizes risk in different ways, as organizations have found it difficult to understand and mitigate using the risk management tools available. Conceptualizing risk as sensemaking becomes relevant due to the complexity of information available to the risk manager, and, coupled with time constraints, this means that risk managers increasingly rely on making sense of possible threats rather than on the accuracy of the information received. This shift presents four contributions to the current literature. First, it suggests that the role of risk management is shifting from being technical in nature to being about risk sensemaking, where the manager engages with the social and physical environment with the aim of acquiring cues that could indicate how future events will unfold. Second, a sensemaking perspective implies a shift in the use of risk management systems from being “containers” of knowledge about past risk events to lending legitimacy to the plausibility of the success of future decisions. Third, the role of the risk manager in managing individual risks changes and becomes one of managing everything using the social networks and systems available as indicators of future risk events. Finally, the risk manager and the systems he or she relies upon are regarded as a source of risk in themselves as both act as gatekeepers for organizational risk decision making.     

Antecedents of Innovativeness in Technology‐Based Services (TBS): Peering into the Black Box of Entrepreneurial Orientation

Innovativeness is the organization's capability for developing and introducing innovations. We argue that new combinations and recombinations of prior and new knowledge (by way of creating, assembling, and transforming knowledge) result in innovativeness in an organization. We further assert that a knowledge‐based focus on innovativeness is particularly important for firms that are technology‐based. The majority of studies focusing on innovativeness are in the entrepreneurship arena, and a large number of studies consider innovativeness as one of three dimensions of the entrepreneurial orientation (EO) construct, the other two dimensions being proactiveness and risk‐taking. However, recent research has suggested peering into the black box of EO by disaggregating the EO construct and examining the interrelationships among its three components. Hence, using the knowledge‐based view and drawing from multiple disciplines, our study conceptualizes innovativeness as a criterion variable and investigates the antecedent role of proactiveness and risk‐taking propensity on innovativeness in the context of technology‐based services (TBS). We hypothesize that both proactiveness and risk‐taking propensity exhibit a curvilinear relationship with innovativeness and introduce organizational structure formality as a moderator to further explicate these relationships. Our results show that proactiveness has a curvilinear (inverted U relationship) with innovativeness, and that this relationship is attenuated by organizational structure formality. Additional analysis indicates that in TBS firms, risk‐taking propensity has a positive linear relationship with innovativeness, and this relationship is accentuated by organizational structure formality. Finally, we discuss important conceptual and practical implications of our study and provide suggestions for future research.     

Addressing Climate Change as an Emerging Risk to Infrastructure Systems

The consequences that climate change could have on infrastructure systems are potentially severe but highly uncertain. This should make risk analysis a natural framework for climate adaptation in infrastructure systems. However, many aspects of climate change, such as weak background knowledge and societal controversy, make it an emerging risk where traditional approaches for risk assessment and management cannot be confidently employed. A number of research developments aimed at addressing these issues have emerged in recent years, such as the development of probabilistic climate projections, climate services, and robust decision frameworks. However, additional research is needed to improve the suitability of these methods for infrastructure planning. In this perspective, we outline some of the challenges in addressing climate change risks to infrastructure and summarize new developments aimed at meeting these challenges. We end by highlighting needs for future research, many of which could be well‐served by expertise within the risk analysis community.     

Realizing the Need for Rework: From Task Interdependence to Social Networks

Design rework is a core phenomenon in new product development (NPD). Yet carrying out design rework presupposes recognizing the need for it. I characterize the types of interpersonal knowledge transfer that help developers realize the need for design rework in NPD. As predicted by the NPD literature, I find that individuals who interact frequently with colleagues to address their task interdependences are more likely to realize the need for rework. I also learn that interacting with colleagues who have different expertise in process‐related knowledge (as opposed to product‐related knowledge) facilitates realizing the need for rework. However, to develop a deeper understanding of how individuals recognize the need for rework when interacting with others, we must expand our views beyond task interdependence and expertise‐related factors. In particular, organizational variables—both formal and informal—play a significant role. With respect to formal hierarchical structures, actors of superior rank are less likely to realize the need for rework regardless of whether or not their interacting partner is of superior rank; however, actors of superior rank are more likely to trigger realizing the need for rework when interacting with partners of subordinate rank. By examining an organization's informal structure, I discover that the social “embeddedness” of developers (i.e., the energy and attention invested in a dyadic relationship) significantly influences their propensity to realize the need for rework. Several hypotheses are tested in a sociometric study conducted within the development department of a software company, and I discuss the implications for behavioral operations in NPD.     

Corporate risk management and pension investment policy

In this paper, we study whether firms manage their pension risk exposures within an integrated corporate risk management framework or they manage their pension and firm risk exposures independently following the adoption of fair value pension reporting regulation (IAS 19). Controlling for known factors affecting the risk-taking in pension plan investments, we document a robust negative association both at the cross-section and over time between pension risk and firm systematic risk and operating asset risk during the post-IAS 19 adoption period. The findings suggest that firms manage pension risk as an integral part of firm risk, consistent with a coordinated risk management explanation. Overall, our evidence highlights that pension investment strategy is a dynamic process that is ultimately determined by sponsoring firms' strategic corporate risk management considerations and the important role that changing pension reporting regulation plays in shaping these dynamics. Our conclusions have potential wider implications for ongoing reforms in financial reporting and disclosure policy settings.     

Experiential and Informational Knowledge,Architectural Marketing Capabilities,and the Adaptive Performance of Export Ventures: A Cross‐National Study

Knowledge‐based view (KBV) theory posits that the acquisition and use of relevant knowledge is key to understanding organizational performance. However, there is relatively little empirical evidence to support or refute several important propositions underlying KBV theory explanations of organizational performance. In particular, the extant literature has focused on individual technical and scientific components of the knowledge bases of firms in dynamic industries, and largely ignored both different levels of informational and experiential knowledge relevant to the market environment, and the increasingly important context of exporting. Our study addresses these knowledge gaps by developing a framework for export venture knowledge management and empirically examining relationships between different types of individual‐level and organizational‐level knowledge relevant to the market environment, architectural marketing capabilities, and the adaptive performance of export ventures. Using primary data collected in the United Kingdom and China, our study indicates that export ventures' organizational‐level experiential and informational knowledge, and individual‐level experiential knowledge relevant to the market environment, is positively associated with export ventures' architectural marketing capabilities, which are in turn associated with the adaptive performance of export ventures.     

External Knowledge Sourcing and Firm Innovation Efficiency

This study examines the relationship between external knowledge sourcing and firm innovation efficiency. We build on the organizational learning theory to propose that this relationship follows an inverted U‐shape: as the level of external knowledge sourcing increases from low to moderate, firm innovation efficiency increases; as the level of external knowledge sourcing increases from moderate to high, firm innovation efficiency declines. Further, we explore the moderating role of different contextual factors and contend that this inverted U‐shaped relationship is flattened in firms that operate in high‐tech sectors and in firms that face high internal constraints for innovation. Our empirical analysis is based on a sample of 3,204 Spanish firms over the period 2004–2015, and our results provide support for these contentions. We used data envelopment analysis methodology to estimate firm innovation efficiency relative to industry best performers, and truncated regression models for panel data with bootstrapped confidence intervals to test our hypotheses.     

Factors Motivating Individuals to Take Precautionary Action for an Expected Earthquake in Istanbul

Istanbul is expected to experience an earthquake in the near future, but individuals show limited interest in preparing for it. This study aims to identify the factors associated with taking action to prepare for an earthquake and mitigate its effects at the individual level. A field survey was carried out in 2007 in two districts of Istanbul with different levels of earthquake risk. Within these districts, three socioeconomic levels were considered. A total of 1,123 people were interviewed face to face. Analysis indicated that the educational level of the respondents was the leading factor associated with taking at least three measures, followed by living in a higher earthquake risk area, having participated in rescue and solidarity activities in previous earthquakes, a higher level of knowledge about earthquakes, home ownership, a higher score for action‐stimulating attitudes, being younger, and a higher general safety score, in that order. The findings pointed to the role of knowledge about earthquakes and possible mitigation/preparedness measures, and thus the importance of developing effective awareness programs. Such programs should also consider the characteristics of different groups in the population. Motivated individuals, such as those who have participated in rescue and solidarity activities in previous earthquakes, could be involved in reaching other people.     

Multiple Interacting Risk Factors: On Methods for Allocating Risk Factor Interactions

A persistent problem in health risk analysis where it is known that a disease may occur as a consequence of multiple risk factors with interactions is allocating the total risk of the disease among the individual risk factors. This problem, referred to here as risk apportionment, arises in various venues, including: (i) public health management, (ii) government programs for compensating injured individuals, and (iii) litigation. Two methods have been described in the risk analysis and epidemiology literature for allocating total risk among individual risk factors. One method uses weights to allocate interactions among the individual risk factors. The other method is based on risk accounting axioms and finding an optimal and unique allocation that satisfies the axioms using a procedure borrowed from game theory. Where relative risk or attributable risk is the risk measure, we find that the game‐theory‐determined allocation is the same as the allocation where risk factor interactions are apportioned to individual risk factors using equal weights. Therefore, the apportionment problem becomes one of selecting a meaningful set of weights for allocating interactions among the individual risk factors. Equal weights and weights proportional to the risks of the individual risk factors are discussed.     

Enriching Absorptive Capacity through Social Interaction

Absorptive capacity is frequently highlighted as a key determinant of knowledge transfer within multinational enterprises. But how individual behaviour translates into absorptive capacity at the subsidiary level, and how this is contingent on subsidiaries' social context, remains under‐addressed. This not only limits our understanding of the relationship between individual‐ and organizational‐level absorptive capacity, but also hampers further research on potentially relevant managerial and organizational antecedents, and limits the implications we can draw for practitioners who seek to increase their organization's capacity to put new knowledge to use. To address this shortcoming we conduct an in‐depth comparative case study of a headquarters‐initiated knowledge transfer at two subsidiaries of the same multinational enterprise. The findings demonstrate that social interaction is a prerequisite for subsidiary absorptive capacity as it enables employees to participate in the transformation of new knowledge to the local context and the development of local applications. The findings also illustrate how organizational conditions at the subsidiary level can impact subsidiary absorptive capacity by enabling or constraining local interaction patterns. These insights contribute to the absorptive capacity literature by demonstrating the scale and scope of social interaction as a key link between individual‐ and organizational‐level absorptive capacity.     

Understanding the Antecedents of Effective Knowledge Management: The Importance of a Knowledge‐Centered Culture*

Within the context of knowledge management, little research has been conducted that identifies the antecedents of a knowledge‐centered culture—those organizational qualities that encourage knowledge creation and dissemination. In this study, the existing literature on organizational climate, job characteristics, and organizational learning (in the form of cooperative learning theory) are linked with the current thinking and research findings related to knowledge management to develop a theoretical model explaining the relationships among organizational climate, the level of cooperative learning that takes place between knowledge workers, and the resulting level of knowledge created and disseminated as measured by team performance and individual satisfaction levels. The study goes on to empirically test the proposed research model by investigating the climate of organizations, and seeks to understand the linkage between a set of organizational and individual characteristics and knowledge‐related activities found in cooperative learning groups and the resulting work outcomes. The hypothesized research model is tested using LISREL with data collected from 203 information systems (IS) professionals engaged in systems development activities. The paper concludes with a discussion of the implications the results have for future research and managerial practice.     

An Empirical Study of the Effect of Knowledge Management Processes at Individual,Group, and Organizational Levels*

To enhance our understanding of knowledge management, this paper focuses on a specific question: How do knowledge management processes influence perceived knowledge management effectiveness? Prior literature is used to develop the research model, including hypotheses about the effects of four knowledge management processes (internalization, externalization, socialization, and combination) on perceived individual‐level, group‐level, and organizational‐level knowledge management effectiveness. The study was conducted at the John F. Kennedy Space Center of the National Aeronautics and Space Administration using a survey of 159 individuals and two rounds of personal interviews. Structural equation modeling was performed to test measurement and structural models using the survey data. The emergent model suggests that internalization and externalization impact perceived effectiveness of individual‐level knowledge management. Socialization and combination influence perceived effectiveness of knowledge management at group and organizational levels, respectively. The results also support the expected upward impact in perceived effectiveness of knowledge management, from individual to group level, as well as from group level to organizational level. The study's limitations and implications for practice and future research are described.     

Using Prior Risk‐Related Knowledge to Support Risk Management Decisions: Lessons Learnt from a Tunneling Project

The authors of this article have developed six probabilistic causal models for critical risks in tunnel works. The details of the models' development and evaluation were reported in two earlier publications of this journal. Accordingly, as a remaining step, this article is focused on the investigation into the use of these models in a real case study project. The use of the models is challenging given the need to provide information on risks that usually are both project and context dependent. The latter is of particular concern in underground construction projects. Tunnel risks are the consequences of interactions between site‐ and project‐ specific factors. Large variations and uncertainties in ground conditions as well as project singularities give rise to particular risk factors with very specific impacts. These circumstances mean that existing risk information, gathered from previous projects, is extremely difficult to use in other projects. This article considers these issues and addresses the extent to which prior risk‐related knowledge, in the form of causal models, as the models developed for the investigation, can be used to provide useful risk information for the case study project. The identification and characterization of the causes and conditions that lead to failures and their interactions as well as their associated probabilistic information is assumed to be risk‐related knowledge in this article. It is shown that, irrespective of existing constraints on using information and knowledge from past experiences, construction risk‐related knowledge can be transferred and used from project to project in the form of comprehensive models based on probabilistic‐causal relationships. The article also shows that the developed models provide guidance as to the use of specific remedial measures by means of the identification of critical risk factors, and therefore they support risk management decisions. Similarly, a number of limitations of the models are discussed.     

Trust‐Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem‐focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution‐focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational‐level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.     

The Determinants of Trust and Credibility in Environmental Risk Communication: An Empirical Study

This study examines a key component of environmental risk communication; trust and credibility. The study was conducted in two parts. In the first part, six hypotheses regarding the perceptions and determinants of trust and credibility were tested against survey data. The hypotheses were supported by the data. The most important hypothesis was that perceptions of trust and credibility are dependent on three factors: perceptions of knowledge and expertise; perceptions of openness and honesty; and perceptions of concern and care. In the second part, models were constructed with perceptions of trust and credibility as the dependent variable. The goal was to examine the data for findings with direct policy implications. One such finding was that defying a negative stereotype is key to improving perceptions of trust and credibility.     

The Practice of Scenario Planning: An Analysis of Inter‐ and Intra‐organizational Strategizing

Strategic activity is often punctuated through the application of strategy tools. Despite widespread use, a lack of understanding exists regarding the impact such tools and their practices have on an organization's strategy process. Of the growing body of research tackling the phenomenon, none appears to extend beyond an intra‐organizational setting. Acknowledging the importance of multi‐organizational partnerships, particularly in the public sector, in this paper an attempt is made to help fill this void through examining the application and effect of a scenario planning process at an inter‐organizational level. Conceptualizing scenario planning as a practice of simplexity, where complexity of thought combines with simplicity of action, an in‐depth, longitudinal case study is used to demonstrate the importance and interaction of sensemaking, storytelling and organizing in creating meaning within strategizing activities at the inter‐organizational level. However, also demonstrated is the relative weakness of the output of the scenario planning process ? the stories ? as a boundary object capable of transferring knowledge and meaning to the intra‐organizational level. Through empirical and theoretical integration a model is developed presenting the flow of practices and artefacts used in sensemaking within inter‐ and intra‐organizational strategizing.     

企业跨部门心理安全、知识分享与组织绩效间关系的实证研究

知识分享是组织学习研究领域中的一个热点话题,本研究旨在探讨跨部门心理安全对组织内部知识分享以及组织绩效的影响机制。本文实证研究发现,组织跨部门心理安全与组织知识分享、组织绩效之间均存在"倒U"关系,而知识分享会对组织绩效的提升产生正向影响,知识分享在跨部门心理安全对组织绩效的作用中扮演中介角色。研究发现有助于加深我们对跨部门心理安全与组织知识分享、组织绩效间作用关系的深入了解,为企业管理实践提供有益的借鉴和启示。     

Cooperation and Knowledge Transfer within Buyer–Supplier Relationships: The Moderating Properties of Trust,Relationship Duration and Supplier Performance*

This paper examines the effect of relational factors on knowledge transfer within strategic buyer–supplier exchange. Prior research examining inter‐firm knowledge transfer has focused almost exclusively on horizontal forms of governance such as strategic alliances and joint ventures, whilst research on vertical forms, such as buyer–supplier relationships, is limited. We test the effect of four important relational properties: cooperation, trust, relationship duration and supplier performance. Quantitative data, gathered from 104 UK manufacturing firms in eight industry sectors, are used to analyse the hypothesized relationships through a moderated hierarchical regression model. Our study provides support for the importance of considering relational factors in the transfer of knowledge at the inter‐organizational level. In particular, the results indicate that knowledge transfer is positively influenced by the extent of cooperation, but that this relationship is moderated by the level of trust and the performance of the supplier firm. Managerial implications for these findings and future directions for research are then offered.