Search results

New public management (NPM) has transformed the public sector auditing context, although in quite different ways. Further, investigations into NPM’s impact on public sector auditors and audit institutions have been largely unconnected, with the exception of the critical examination of performance audits. We investigate the question of how public sector auditors’ roles and activities have changed as a result of NPM and later reforms.

We examine and synthesise public sector audit research examining reforms since the year 2000. The research presented considers changes to external and internal public sector audits as well as the development of public sector audit institutions – known as supreme audit institutions (SAIs).

Considerable changes have occurred. Many were influenced by NPM, but others have evolved from the eco-system of accounting, auditing and public sector management. External auditors have responded to an increase in demand for accountability. Additional management and governance techniques have been introduced from the private sector, such as internal auditing and audit committees. NPM has also led to conflicting trends, particularly when governments introduced competition to public sector auditing by contracting out but then chose to centralise to improve accountability. There is also greater international influence now through bodies like the International Organisation of Supreme Audit Institutions (INTOSAI) and similar regional bodies.

NPM reforms and the eco-system have impacted public sector auditing. Sustainability reporting is emerging as an area requiring more auditing attention; auditors also need to continue to develop better ways to communicate with citizens. Further, research into auditing in non-Western nations and emerging technologies is also required, especially where it provides learnings around more valuable audit practices. Empirical evidence is required of the strengths and weaknesses of SAIs’ structural variety.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

This chapter aims to contribute to the literature on sustainability in the public sector by discussing how human resource and human resource management can help to integrate environmental management into organizations and improve environmental performance. Public sector scholars have neglected the study of Green Human Resource Management (GHRM) until now. Nevertheless, implementing such practices could lead to positive outcomes regarding awareness of environmental issues, organizational reputation and attractiveness, job satisfaction and organizational performance. The authors discuss the relevance and the necessity of developing a field of research on GHRM in public organizations. Starting from a conceptual review of the main literature on GHRM, this chapter provided some directions for future research.

There are significantly fewer women than men in managerial positions, mainly project management. This problem is noticeable in the construction and engineering sectors, traditionally male-dominated industries with leadership much dependent on masculine qualities. This study examines the obstacles to the career progression of professional female project managers (PFPMs) in the Ghanaian construction industry.

Twenty potential obstacles to women's career progression in the construction industry were identified from a comprehensive review of the literature. A questionnaire was prepared and administered among eighty project managers who work in large construction firms in Ghana. Data obtained were analysed using one sample t-test, Kendall's concordance test, Chi-square test and exploratory factor analysis.

The findings suggest the significance of all the twenty factors as potential obstacles to the career progression of PFPMs. The exploratory factor analysis identified five underlying grouped obstacles: “leadership and human capital related issues”, “issues related to discrimination of all forms”, “career aspiration and planning issues”, “female related role conflicts”, and “recruitment and selection issues”.

The subjective nature of the views of the respondents could influence the evaluation of the obstacles. With this study only exploring the dimensions underlying the significant obstacles, future studies could examine the interrelationships between the various obstacles and move on to determine their impacts on the career progression of professional female PMs as well.

Having an in-depth understanding of these obstacles, stakeholders and other industry practitioners in Ghana could make informed decisions on measures to put in place to address some of these critical issues to raise the standard of professional female PMs in the construction industry. Policymakers and gender advocates in Ghana could also take up some of the critical obstacles identified and provide suitable strategies to educate and create the needed awareness of the industry on those obstacles. Practically, the findings from this study can be valuable for informing decision-making at different management levels in the construction industry.

With country-specific (Ghana) obstacles identified, the findings significantly contribute to the literature on the career advancement of females in the construction sector.

Climate change places significant pressure on the tourism sector by altering environmental and socio-economic conditions that influence tourist behaviour and the attractiveness of destinations. Rising temperatures, changing precipitation patterns and the increasing frequency and severity of extreme weather events affect tourism supply and demand. On the supply side, climate change threatens tourism infrastructure, natural attractions, recreational opportunities and accessibility of destinations. Coastal destinations are particularly vulnerable to sea-level rise and coastal flooding, which can damage tourism assets. On the demand side, changing climatic conditions alter visitor comfort levels, health risks and the seasonality of destinations, influencing tourists' choice of destinations. In addition, small island destinations face unnecessary risks due to their economic dependence on climate-sensitive activities such as beach and nature tourism. Adapting the tourism sector to climate change requires reducing vulnerability through diversification, green infrastructure, ecosystem conservation, community-based adaptation and policy support. Mitigating tourism's contribution to climate change requires minimising energy use, switching to renewable energy, improving efficiency, reducing long-haul flights and promoting sustainable consumption and production. Collective and concerted efforts by all stakeholders are needed to transition to a climate-resilient and low-carbon tourism sector that continues to provide socio-economic benefits while minimising its environmental footprint.

The internationalisation of industries has spilled over to academia, whereby institutions of higher learning (IHL) increasingly compete in the graduate quality and applied graduate knowledge capabilities that they can offer. With increasing global competition for students, combined with the evolving need for lifelong learning in dynamic industries impacted by digital knowledge management, there is an opportunity for IHLs to be able to evolve to ensure their business models enable services and service delivery to cater to and help shape industry demands. This chapter will look at micro-credentialing (MC) and how the provision of MCs has changed along with the evolving IHL education environment. The demands of students, employers and ecosystem considerations will be addressed through a review of the current landscape, pathways to MC and how MC may be operationalised. The Bersteinian approach to pedagogic classification, which identifies the framework of knowledge as being communicable via three axes of singularism, regionalism and a wider generalist approach is referenced as a framework. The resultant recommendations that draw upon these foundations will conclude the chapter.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.