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The purpose of this study is to present a quality improvement approach titled “Picture-Understanding-Action” used in Ireland to enhance the role of healthcare boards in the oversight of healthcare quality and its improvement.

The novel and practical “Picture-Understanding-Action” approach was implemented using the Model for Improvement to iteratively introduce changes across three quality improvement projects. This approach outlines the concepts and activities used at each step to support planning and implementation of processes that allow a board to effectively achieve its role in overseeing and improving quality. This approach matured over three quality improvement projects.

The “Picture” included quantitative and qualitative aspects. The quantitative “Picture” consisted of a quality dashboard/profile of board selected outcome indicators representative of the health system using statistical process control (SPC) charts to focus discussion on real signals of change. The qualitative picture was based on the experience of people who use and work in health services which “people-ised” the numbers. Probing this “Picture” with collective grounding, curiosity and expert training/facilitation developed a shared “Understanding”. This led to “Action(s)” from board members to improve the “Picture” and “Understanding” (feedback action), to ask better questions and make better decisions and recommendations to the executive (feed-forward action). The Model for Improvement, Plan-Do-Study-Act cycles and a co-design approach in design and implementation were key to success.

To the authors’ knowledge, this is the first time a board has undertaken a quality improvement (QI) project to enhance its own processes. It addresses a gap in research by outlining actions that boards can take to improve their oversight of quality of care.

This article examines the links between average city size, fiscal decentralisation, and national economic growth in 33 Organisation for Economic Co-operation and Development (OECD) countries.

The data in this paper comprise an unbalanced panel dataset which contains economic growth indicators, average city size, fiscal decentralisation indicators and control variables in 33 OECD member countries from 1975 to 2015 in five-year intervals. Fixed-effects (FE) estimators are used for the analysis.

This research finds i) countries with larger weighted average city sizes have higher economic growth, ii) countries with greater fiscal decentralisation have higher economic growth, but iii) countries with larger weighted average city sizes with greater decentralisation have lower rates of economic growth.

The research highlights the importance of agglomerations and decentralised governance and management for economic growth. While the findings are consistent with previous evidence that larger city sizes and fiscal decentralisation are separately associated with higher rates of economic growth, the authors find countries which have larger cities and greater fiscal decentralisation experience lower rates of economic growth highlighting a need for caution on decentralisation agendas in such cases. The implications of this suggest policymakers should proceed with caution on decentralisation agendas in countries with large cities.

Skilled migrants' careers are heterogeneous, with existing theories capturing only some of their diversity and dynamic development over time and circumstance. This paper aims to draw out the multilevel (macro, meso and micro levels) influences impacting skilled migrants' careers by using the lens of the intelligent career framework. Furthermore, structuration theory captures the agency of skilled migrants facing different social structures at and across levels and explains the idiosyncratic nature of skilled migrants' careers.

Following an abductive approach, this paper examines the career influences for a sample of 41 skilled migrants in three different host countries. Individual career stories were collected through qualitative interviews. Important career influences from these narratives are categorised across the intelligent career competencies (knowing why, how and whom) at the macro, meso and micro levels.

Findings illustrate the lived reality for skilled migrants of these interrelated multilevel career influences and go some way in elucidating the heterogeneity of skilled migrants' careers and outcomes. The interplay of individual agency in responding to both facilitating and challenging social structures across the multilevels further explains the idiosyncratic nature of skilled migrants' careers and how/whether they achieve satisfying career outcomes. Some potential policy implications and options arising from these findings are suggested.

By considering multilevel themes that influence skilled migrants' career capital, the authors were able to better explain the complex, relational and idiosyncratic shaping of their individual careers. As such, the framework informs and guides individuals, practitioners and organisations seeking to facilitate skilled migrants' careers.

The purpose of this paper is to examine the relationship between an individual's social capital context and entrepreneurship using a multi-level modelling framework.

This paper uses data from 87,007 individual level observations across 428 regions in 37 countries. The data comes from the 2010 and 2016 Life in Transition Surveys. The paper uses a principal component analysis to identify the different dimensions of an individual's social capital context. Subsequently, a multi-level model is employed examining the relationship between the components of an individual's social capital context and entrepreneurship (which is proxied by an individual's attempt to set up a business), whilst controlling for both country and regional effects.

Greater levels of networking, informal connections and tolerance of others have a significant positive relationship with entrepreneurial activity. Trust of institutions and others have a negative relationship with entrepreneurial activity. Regional and country differences are also important for entrepreneurship, demonstrating the importance of the multi-level and social contextual environment for business development.

Firstly, the authors present a broad, but comprehensive social contextual framework incorporating many measures of social capital when examining the importance of social capital for business development. Secondly, the work provides interesting results on the “bright and dark sides of trust” for entrepreneurship, answering calls for improved understandings on the positive and negative relationships between social capital and entrepreneurial activity. Thirdly, the paper extends the burgeoning but limited number of studies that examine the multi-level contextual environment of entrepreneurial activities.