Search results

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations.

Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust.

Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.

Based on an exploratory case-based approach, the purpose of this paper is to open the KM black box and examine the relationships that link knowledge management (KM) inputs (i.e. knowledge resources and KM practices) via knowledge processes to KM performance. This paper aims to identify the underlying mechanisms and explain how KM performance is enabled.

This in-depth case study conducted at a medium-sized consultancy in the supply chain management industry empirically examines knowledge flows to uncover the relationships between KM inputs, knowledge processes and KM performance. We adopt the viable system model (VSM) as a theoretical lens to identify KM mechanisms.

By identifying six KM mechanisms, we contribute to the theoretical understanding of how KM inputs are interconnected and lead to KM performance via knowledge processes.

Based on the insights gained, we provide propositions that organizations should consider in designing viable KM. Our findings help organizations in understanding their KM with the help of knowledge flow analysis and identifying how critical KM elements are interconnected.

In the early to mid-twentieth century, psychiatrist-led occupational therapy departments emerged in Irish psychiatric hospitals. This marked a transition towards establishing rehabilitative services in institutional settings. This paper aims to examine the development of occupational therapy in Grangegorman Mental Hospital and its auxiliary hospital, Portrane Mental Hospital from 1934-1954.

Historical documentary research methods were used to analyse primary source data from Grangegorman Committee Minutes, Inspector of Mental Hospital Reports, Boroughs of Mental Hospitals, Department of Foreign Affairs documents and newspaper archives. The archival data was analysed using both a chronological and thematic approach.

The main key event emerged in 1935 when four Grangegorman nursing staff were sent to Cardiff Mental Hospital to undergo a six month training course in occupational therapy. The following themes emerged – “establishing occupational therapy in Grangegorman and Portrane”; “the role of short-course trained nursing staff in providing occupational therapy services” and “therapeutic rationales vs hospital management rationales”.

This study throws light on the early practitioners of occupational therapy in Grangegorman and highlights the complexities of occupational therapy’s role origins in mid-twentieth century Ireland. In line with contemporaneous psychiatric hospitals, the occupational therapy activities promoted in Grangegorman were mainly handicraft or productivity based. The absence of patients’ voices means there are limitations to determining the therapeutic nature of this early occupational therapy service.

Commonly used rent indices are based on average developments or expert opinions. Such indices often suffer from compositional biases or low data coverage. The purpose of this paper is to overcome these challenges using the authors' approach.

The authors construct a quality-adjusted rent index for the office market in Oslo using detailed data from 14,171 rental contracts.

The authors show that compositional biases can have a large impact on rental price developments. By adding building-fixed effects to a standard hedonic regression model, the authors show that the explanatory power increases considerably. Furthermore, indices excluding location-specific information, or which include less granular location controls than at the building level, portray quite a different picture of rent developments than indices that do take this into account. The authors also exploit information on contract signature date and find that a more timely detection of turning points can be achieved by using the signature date instead of the more typically used start date of the lease.

The study is confined to Norwegian data, and an avenue for future research would be to explore if similar results are obtained for other countries. A weakness with the paper is that authors' do not observe quality changes over time, such as renovation. Controlling for time-varying and unit-specific attributes in hedonic models for the commercial real estate (CRE) market would be useful to purge indices further for compositional effects and unobserved heterogeneity. While the authors do control for building-fixed effects, there are additional variations within a building (floor, view, sunlight, etc.) that the authors do not capture. Studies that could control for this would certainly be welcome, both in order to estimate the value of such amenities and to see how it affects estimated rent developments. Another promising avenue for future research is to link data on rental contracts in the CRE market with firm-specific information in order to explore how firm profitability and liquidity may affect rental contracts.

The authors show that the hedonic index yields a sharper fall in rents after the global financial crisis and more muted developments in the period between 2013 and 2015 than the average rent index. The results show that rents have followed their estimated equilibrium closely and have re-adjusted quickly in periods of deviation. From a financial stability perspective, the risk of a sharp fall in rents is reduced because rents often are in line with their fundamentals.

The authors find that a more timely detection of turning points can be achieved by using information on the signature date. This is an important finding. The financial system is heavily exposed toward CRE, and timely detection of turning points is critical for policymakers.

The financial system is heavily exposed toward the commercial real estate market and timely detection of turning points is of major importance to policymakers. Finally, the authors use our quality-adjusted rent index as the dependent variable in an error correction model. The authors find that employment and stock of offices are important explanatory variables. Moreover, the results show that rents have followed their estimated equilibrium path.