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Hospital-based quality improvement (QI) programs are becoming increasingly common in developing countries as a sustainable method of strengthening health systems. The aim of this paper is to present the results and lessons learned from a QI program in a large, rural, district hospital in Lesotho, Southern Africa.

Over a 15-month period, a locally-relevant, hospital-wide QI program was developed and implemented. The QI program consisted of: planning meetings with district and hospitals staff; creation of multi-disciplinary QI teams; establishment of a QI steering committee; design and implementation of a locally appropriate QI curriculum; and monthly consultation from technical advisers. Initial QI programming was developed in three distinct areas: maternity care, out-patient care, and referral systems.

Partogram documentation in the maternity department increased by 78 percent, waiting time for critically ill patients in the out-patient department was reduced by 84 percent, and emergency referral times were reduced by 58 percent.

The design and early implementation of QI programs should focus on easily achievable, locally-relevant improvement projects. It was found that early successes helped to fuel further QI gains and the authors believe that the work building sustainable QI skill sets within hospital staff could be useful in the future when attempting to tackle larger national-level quality of care indicators. The findings add to the existing evidence suggesting that an increased use of locally-relevant quality improvement programming could help strengthen health care systems in low resource settings.

Digital platforms increase their function and scope by leveraging boundary resources and complementary add-on products from third-party developers to interact with external entities and producers. Application Programming Interfaces (APIs) are essential boundary resources developers use to connect applications, systems and platforms. This notwithstanding, previous API studies tend to focus more on the technical dimensions, with little on the social and cultural contexts underpinning API innovations. This study relies on the new (neo) institutional theory (focusing on regulative, normative and cultural-cognitive pillars) as an analytical lens to understand the institutional forces that affect API integration among digital firms.

The study adopts a qualitative case study methodology and relies on phone calls and a semi-structured in-depth interview approach of a Ghanaian digital music platform to uncover the institutional forces affecting API integration.

The findings reveal that regulative institutions such as excessive tax regimes mostly constrained API development and integration initiatives. However, other regulative institutions like the government digitalization agenda enabled API integration. Normative institutions, such as the growing use of e-payment options, enabled API integration in digital music platforms. Cultural-cognitive institutions like employee ego constrained the API integration process in music digital platforms.

This study primarily contributes to deepening understanding of the relevant literature by exploring the institutional forces that affect API integration among digital firms in a developing economy. The study also uncovered a new form of an institution known as motivational institution as an enabler for API development and integration in digital music platforms.

Company pressure for manufacturers is mounting from two angles: increasing pressure of global competition, and rapid advancements in technology such as additive manufacturing (AM) that are altering the way that goods are manufactured. The purpose of this paper is to explore the adoption process of AM within a manufacturing system and its business impact.

Research was conducted to collect empirical data at two manufacturing case companies in the North West England. Both cases are located in areas of industrial recovery using AM engineering innovation for value creation.

Early findings showed that the implementation of AM caused a shift in value propositions and the creation of additional value streams (VSs) for the case study companies. AM was shown to compliment and strengthen traditional manufacturing VSs rather than replacing them.

Limitations include the generalizability due to the number and location of case companies included in this research.

It is worthwhile to explore the opportunities that AM brings with the existing customer base as it has the potential to add unexplored and untapped value. However, managers need to be mindful of the capability and resources required to put the VS into practice.

Both cases resulted in skill retainment and development due to the implementation of AM. Hence, the innovation contributed to regional economic recovery and business survival.

This empirical research is one of the early field explorations focussing on the impact of AM on VS structures. Hence, this paper contributes to the area of technology enhanced manufacturing systems.

The purpose of this paper is to draw on previous work in multiple disciplines to establish a theoretical framework for clinical decision-making that incorporates non-medical factors, such as race/ethnicity, into the way physicians make decisions in the practice of medicine. The proposed Rapid Clinical Decision in Context (RCDC) model attempts to understand the influence of various contextual elements on physicians’ decision-making process. The RCDC model provides a basis for future studies to move beyond documentation of areas where disparities exist to understand the causes of the disparities and designing interventions to address those causes. The paper concludes with a discussion on possible studies to test the proposed model.

Using social relations theory, we argue that entrepreneurship ecosystems must also include relationships such as market pricing, equality matching, authority ranking and communal sharing to be successful and thrive.

We theorize using Fiske’s typology that a successful entrepreneurial system must have certain characteristics to be successful.

In doing so, we suggest an alternative perspective of the role of exchange relationships in ecosystems which considers both the geographic context and social relationships as equally important ecosystem components. Our contributions include (1) exposing social processes as the explanatory mechanism for exchanges instead of solely market forces, (2) illustrating the role of regional cultural differences in exchanges and (3) emphasizing how entrepreneurs can better realize ecosystem benefits through understanding the methods of exchange in these ecosystems.

Social relationships include a wide variety of different types of resources and exchange mechanisms, so by their inclusion into the entrepreneurship ecosystem literature, a more complete view of ecosystems is possible.

Purpose – The major question posed in this paper is whether public finance management (PFM) reforms undertaken by development partners (DPs) and the Ministry of Health (MOH) in Ghana were to find solutions to the many PFM challenges or it was merely a façade to pursue latent political interest?

Methodology – Study information was gathered via a desk review of major PFM policy documents, procedures, manuals, guidelines, and findings of commissioned studies covering the period under review. Information generated from the desk review was triangulated via extensive interviews with a sample of policy makers from MOH and DPs.

Findings – The findings suggest that MOH and DPs pursued reforms mostly to address the PFM challenges in the sector. Additionally, the study finds questionable the attitude and posture of the two actors and calls for further investigations to unearth what the said attitude and posture may imply in terms of intentions.

Originality/value – The findings raises fundamental question regarding public sector – DPs collaborations in executing reforms. This could open up new frontiers for further research to better understand DPs/public sector collaboration in the implementation of reforms.

Limitations – The sample used for this study may constrain generalization to other jurisdiction. This limitation does not in any case invalidate the conclusions arrived at.

The growing displacement of theory and other forms of wide-ranging knowledge of social phenomena by empirical research methods in economics is widely noted by economists and historians of economic knowledge. Less attention has been devoted, however, to understand the materialization of such changes in the scientific practices. This article studies the recent transformations in the epistemological practices at CEDE, a research center in Colombia. I use a machine learning technique called Topic Modeling, interviews to CEDE researchers, and exegesis of papers to characterize a shift in the production of knowledge in microeconometrics at CEDE during the years 2000 and 2018. I explain this shift by characterizing two sets of epistemological practices that implies a recent tendency to disdain research that cannot make a “strong” causal inference.