How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Dynamic capabilities and high-tech entrepreneurial ventures’ performance in the aftermath of an environmental jolt

This paper contributes to studies on dynamic capabilities (DCs) by showing that a neglected environmental contingency – i.e. the occurrence of a jolt – shapes the DCs–performance relationship. We focus on high-tech entrepreneurial ventures because these are the firms that jolts affect most; in so doing, we also advance the understanding of DCs in the entrepreneurship field. We argue that, in the aftermath of an environmental jolt, the high-tech entrepreneurial ventures that use internationalization and new product development capabilities to modify their resource configuration and regain environmental fit enjoy better performance. Econometric estimates on a sample of 340 Italian high-tech entrepreneurial ventures confronting the consequences of the global economic crisis that began in 2008 confirm that separately using these two DCs has a positive performance effect. This effect is stronger for relatively smaller ventures. Interestingly, despite synergies should arise from the combined use of the two DCs, we do not detect any superadditive effects.     

A Literature Review of Organizational Behavior Management Interventions in Human Service Settings from 1990 to 2016

We reviewed the Journal of Applied Behavior Analysis (JABA), Journal of Organizational Behavior Management (JOBM), and Behavior Analysis in Practice (BAP) from 1990 to 2016, to identify articles that evaluated organizational behavior management interventions in a human service setting. Of those articles, 75 articles met the inclusion criteria for the review, 44 from JABA (1990 to 2016), 22 from JOBM (1990 to 2016), and 7 from BAP (2008 to 2016). We categorized each selected article by setting, employee population, client population, assessment, dependent variable, independent variable, and outcome measures. Results from the review are discussed for all three journals. Recommendations are made to broaden the scope of population and dependent variable targets, include more assessments, and include outcome data when applicable.     

Perceptions of participants and staff of implementing a physical activity program in rural primary care

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention utilizing a Fitbit to increase PA behavior in inactive rural adults recruited from a primary care clinic. Semi-structured interviews were conducted with study participants (n=10) and a focus group was held with nurses (n=7) from the primary care clinic. Data were analyzed using the process of immersion/crystallization. Participants and nurses both felt the program had a positive impact on PA and that the program was needed in the community. Study participants most often reported their favorite part of the study was being able to track their activity as well as the goal setting. However, study participants reported barriers to continued participation in PA related to a lack of time and ability to be active in cold weather. Further, nursing staff reported barriers in regard to a lack of resources (staffing and money) These barriers need to be examined further and addressed in order to implement a sustainable PA program that can be maintained through a primary care clinic.     

Clarifying the role of belief-motive explanations in multi-stakeholder realist evaluation

In realist evaluation, where researchers aim to make program theories explicit, they can encounter competing explanations as to how programs work. Managing explanatory tensions from different sources of evidence in multi-stakeholder projects can challenge external evaluators, especially when access to pertinent data, like client records, is mediated by program stakeholders. In this article, we consider two central questions: how can program stakeholder motives shape a realist evaluation project; and how might realist evaluators respond to stakeholders’ belief-motive explanations, including those about program effectiveness, based on factors such as supererogatory commitment or trying together in good faith? Drawing on our realist evaluation of a service reform initiative involving multiple agencies, we describe stakeholder motives at key phases, highlighting a need for tactics and skills that help to manage explanatory tensions. In conclusion, the relevance of stakeholders’ belief-motive explanations (‘we believe the program works’) in realist evaluation is clarified and discussed.     

Measuring servitization progress and outcome: the case of ‘advanced services’

The purpose of this paper is to establish a framework for assessing the progress and outcome of a manufacturer’s transformation towards becoming a provider of ‘advanced services’ – a complex bundling of products and services, whereby manufacturers offer capabilities and outcomes instead of products alone. ‘Advanced services’ represent the most complex offering in the current servitization trend amongst manufacturers. However, current performance measures lack the breadth and focus to assess progress or outcomes, and so support research and practice of organisational transformation efforts required. To address this gap the paper investigates how a manufacturer’s efforts to become an ‘advanced services’ provider can be comprehensively measured, and develops a framework for assessing the transformation journey towards becoming an ‘advanced services’ provider. The research method is based on (1) a systematic literature review process to create a comprehensive set of service-related performance measures that are available to assess a manufacturer’s servitization efforts, followed by (2) an engagement with an expert panel to synthesise the identified measures and create a set of ‘advanced services’ performance measures. The proposed framework is presented as a scorecard that can be used in practice to assess the progress and outcome of a manufacturer’s transformation towards becoming a provider of ‘advanced services’.     

An empirical assessment of the operational performance through internal benchmarking: a case of a global logistics firm

This article solves an operational performance measurement problem of a global logistics firm through an internal benchmarking tool. The intended impact is to enable logistics firms to form a deeper understanding of their own internal processes and metrics. The methodology of this in-depth action research involves a sequential approach with a series of interviews, questionnaire-based surveys, operations data collated through observations and process mapping yielding real-world data. A series of statistical tests are conducted to analyse the collated data. Strategic priorities of the firm are integrated with the firm’s operational performance to ascertain the effective performance by considering both the tangible and intangible measures. The outcomes inform both practitioners and academics how the firm could improve its freight forwarding business’s profitability by ensuring that its operations meet the prioritised criteria. The ‘best practice’ derived from internal benchmarking forms an intermediate step towards external benchmarking. The outcomes facilitate investigating the current business strategy, the standard operating procedures and the scope of improving those.     

Performance management practices in lean manufacturing organizations: a systematic review of research evidence

This paper provides the first systematic look into the existing research on performance management (PM) practices employed in lean manufacturing organisations (LMOs). It adopts a systematic review method to examine the evidence generated in the period 2004 – 2015 and uses a comprehensive PM framework to synthesise the findings. The results suggest that PM practices that have the most prominent role in LMOs are those that, firstly, are located closest to front-line actions and, secondly, explicitly address operational realities. This calls into question the primacy of accounting-driven controls in LMOs, suggesting that operational controls may be more effective than top-down accounting-based PM practices. The results also confirm the bias towards operational-level issues but suggest that LMOs may integrate the operational and the strategic levels by using PM practices that drive organisational learning through employee involvement and engagement.     

Integrating risk and performance management in quality management systems for the development of complex bespoke systems (CBSs)

Abstract

Risk and performance management are at the core of complex bespoke systems (CBSs). CBSs are developed to customer–specified requirements in terms of structure, functionality and conformance. This article examines how risk and performance management are integrated as essential systems in the successful development of projects across multi-organizational functions in complex bespoke system (CBS) organizations. The article argues for the development of a quality management system that consists of two sub-processes: quality control and quality development. Using three case studies from engineering companies, we provide evidence and insights of the way change control, quality development and quality performance are developed in innovating business solutions.     

Regulatory Institutional Distance and MNCs' Subsidiary Performance: Climbing up Vs. Climbing Down the Institutional Ladder

We investigate the possibility of regulatory institutional distance exerting an asymmetric effect on multinational corporations' (MNCs') subsidiary performance depending on the direction of institutional distance. We use the term ‘institutional ladder’ to differentiate between upward distance, referred to as when the subsidiary is operating in a relatively stronger institutional environment than its parent-firm's home country, and downward distance for vice versa. Combining institutional theory with organisational imprinting and learning perspectives, we argue that the implications of regulatory institutional distance on subsidiary performance are relatively more positive (or less negative) when MNCs are climbing down the institutional ladder as compared to when MNCs are climbing up the institutional ladder. We also argue that subsidiary ownership strategy – i.e. the choice of a wholly owned subsidiary (WOS) versus joint venture (JV) – moderates the above-mentioned implications of institutional distance on subsidiary performance. We test these hypotheses based on a panel data-set of 1936 foreign subsidiaries representing 70 host countries and 66 home countries and spanning the 12-year period: 2002–2013.