Beyond Planning:: Strategies for Successfully Implementing Strategic Decisions

This article brings strategy back to managers and their organizations. It argues and demonstrates empirically that what managers do, and the kind of organization they lead, matter in terms of achieving stated objectives. Managerial action involves a set of activities from assessing the problem to prioritising action, and takes place within an organizational context which has two important elements for decision-making. First, organizations have an accumulated stock of experience, and the more managers can access and utilise this experience base the better. Secondly, the culture and structure of an organization may exhibit more or less readiness for the changes that decisions bring about, and contexts less ready for change pose problems for managers in the implementation of decisions.This long-term study of 55 decisions in UK firms shows that careful managerial planning does not of itself guarantee successful outcomes: the organizational context is crucial in framing actions and influencing achievement, and decisions may send a firm on a trajectory beyond the point at which it can plan with confidence. Where experience and readiness are strong, decisions achieve stated objectives—where both are lacking, decisions tend to fail. But, as examination of two illustrative cases indicates, strength in either domain may be enough: sound experience may win out in comparatively unreceptive situations, and decisions may still succeed where experience is lacking but the organization is ready for change. The article closes with some implications for managers.     

Žumberak: A Sixteenth-Century Refugee Settlement Zone

This article examines the movement of Orthodox Christian refugees from Bosnia to the Habsburg Monarchy in the 1530s and their settlement in a district called ?umberak. The movement of these Uskoks has never been examined in the context of refugee studies. This study of a refugee movement and settlement over a five-century period offers the possibility of reaching a better understanding of the long-term outcome of refugee movements. Ultimately, this article suggests that the refugees affected the land they settled as much as the settlement zone affected them, and that, in this case, the refugees were able to define their own outcome.     

Why social status matters for understanding the interrelationships between testosterone,economic risk‐taking,and gender

We conduct an extensive review of the literature on testosterone and economic risk‐taking behavior. In sum, there is evidence of a positive association between testosterone and economic risk taking, although it is unlikely to be a strong association given the abundance of null results. However, we argue that the existing literature may overstate the causal effects of testosterone on economic risk taking (or even report a spurious correlation) because this research has not considered the potentially confounding role of social status. Status could concurrently influence both testosterone and economic risk taking, given that testosterone is a social hormone with a reciprocal relationship with social status, and social status has been found to drive risk‐taking behavior. We also argue against using findings from this literature to make gender essentialist claims, primarily because social phenomena influence the size—and existence—of gender differences in economic risk‐taking behavior. We conclude with suggestions for future research.     

Data envelopment analysis in the presence of measurement error: case study from the National Database of Nursing Quality Indicators® (NDNQI®)

Data envelopment analysis (DEA) is the most commonly used approach for evaluating healthcare efficiency [B. Hollingsworth, The measurement of efficiency and productivity of health care delivery. Health Economics 17(10) (2008), pp. 1107–1128], but a long-standing concern is that DEA assumes that data are measured without error. This is quite unlikely, and DEA and other efficiency analysis techniques may yield biased efficiency estimates if it is not realized [B.J. Gajewski, R. Lee, M. Bott, U. Piamjariyakul, and R.L. Taunton, On estimating the distribution of data envelopment analysis efficiency scores: an application to nursing homes’ care planning process. Journal of Applied Statistics 36(9) (2009), pp. 933–944; J. Ruggiero, Data envelopment analysis with stochastic data. Journal of the Operational Research Society 55 (2004), pp. 1008–1012]. We propose to address measurement error systematically using a Bayesian method (Bayesian DEA). We will apply Bayesian DEA to data from the National Database of Nursing Quality Indicators^® to estimate nursing units’ efficiency. Several external reliability studies inform the posterior distribution of the measurement error on the DEA variables. We will discuss the case of generalizing the approach to situations where an external reliability study is not feasible.     

Cash Transfers and Children's Education and Labour among Malawi's Poor

This article examines the impact on children's education and labour of monthly cash grants targeted on ultra‐poor households and designed to reduce poverty and enable families to invest in human development. It conducts a randomised community trial, with baseline and endline surveys of intervention and control households; verifies school enrolment; and completes key‐informant interviews and focus‐group discussions. Compared with non‐beneficiaries, intervention children experienced a 5 percentage point difference in enrolment, higher educational expenditures, fewer absences, and a 10 percentage point decrease in labour outside the home. Qualitative data confirm the quantitative findings. Transfers to poor households had a positive impact. However, the Malawian educational system needs to be improved for short‐term impacts to lead to long‐term development in human capital.     

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.     

College students with congenital heart disease: A critical time for transition

As medical and surgical advances improve, more young adults with congenital heart disease (CHD) are attending college. This case study illustrates some of the issues that these young adults may face as they attend college and discusses the role that college health practitioners can play in easing that transition. Participants: A case of a male with CHD presenting to the college health clinic with a new onset headache. Methods: The authors discuss some of the unique challenges that college health practitioners may face when caring for students with CHD. In addition, they make recommendations on how best to care for these patients and how best to coordinate care with CHD students other care providers. Results: This student with a history of coarctation of the aorta presented with new onset headaches and was found to have high blood pressure. He was diagnosed with recurrent coarctation, underwent percutaneous treatment with stenting and quickly resumed classes. Conclusions: As more students with CHD enter college, college health providers will need to understand some of the health risks that CHD students face. In addition, understanding some of the optimal ways to coordinate care with CHD providers can ease the transition that CHD students face as they enter college.     

The Inability of Self-affirmations to Decrease Defensive Bias Toward an Alcohol-Related Risk Message Among High-Risk College Students

Abstract

Objective: To examine the efficacy of a self-affirmation task in deterring college alcohol misuse and the importance of preexisting beliefs in predicting subsequent behavior change. Participants: Heavy-drinking undergraduates (N = 110) participated during the 2011–2012 academic year. Methods: Participants were randomized to complete an affirmation or control task before reading an alcohol risk message. Alcohol-related beliefs and behaviors were assessed. Participants completed a 2-week online follow-up assessing alcohol-related behaviors. Results: Both groups reported increased perceived problem importance, but neither group displayed changes in personal risk. Follow-up assessment revealed similar, significant declines in peak consumption in both groups, with no significant between-group differences. Preexisting beliefs accounted for 5% to 10% of variance in drinking outcomes. Conclusions: An affirmation task does not seem to decrease defensive processing or alter high-risk drinking behaviors among college students and should not be utilized in lieu of more effective strategies.