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Open Access
Article
Publication date: 24 August 2021

Maureen Alice Flynn and Niamh M. Brennan

The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction…

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Abstract

Purpose

The paper examines interviewee insights into accountability for clinical governance in high-consequence, life-and-death hospital settings. The analysis draws on the distinction between formal “imposed accountability” and front-line “felt accountability”. From these insights, the paper introduces an emergent concept, “grounded accountability”.

Design/methodology/approach

Interviews are conducted with 41 clinicians, managers and governors in two large academic hospitals. The authors ask interviewees to recall a critical clinical incident as a focus for elucidating their experiences of and observation on the practice of accountability.

Findings

Accountability emerges from the front-line, on-the-ground. Together, clinicians, managers and governors co-construct accountability. Less attention is paid to cost, blame, legal processes or personal reputation. Money and other accountability assumptions in business do not always apply in a hospital setting.

Originality/value

The authors propose the concept of co-constructed “grounded accountability” comprising interrelationships between the concept’s three constituent themes of front-line staff’s felt accountability, along with grounded engagement by managers/governors, supported by a culture of openness.

Details

Journal of Health Organization and Management, vol. 35 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 24 June 2020

Oliver Nnamdi Okafor, Festus A. Adebisi, Michael Opara and Chidinma Blessing Okafor

This paper investigates the challenges and opportunities for the deployment of whistleblowing as an accountability mechanism to curb corruption and fraud in a developing country…

8470

Abstract

Purpose

This paper investigates the challenges and opportunities for the deployment of whistleblowing as an accountability mechanism to curb corruption and fraud in a developing country. Nigeria is the institutional setting for the study.

Design/methodology/approach

Adopting an institutional theory perspective and a survey protocol of urban residents in the country, the study presents evidence on the whistleblowing program introduced in 2016. Nigeria’s whistleblowing initiative targets all types of corruption, including corporate fraud.

Findings

This study finds that, even in the context of a developing country, whistleblowing is supported as an accountability mechanism, but the intervention lacks awareness, presents a high risk to whistleblowers and regulators, including the risk of physical elimination, and is fraught with institutional and operational challenges. In effect, awareness of whistleblowing laws, operational challenges and an institutional environment conducive to venality undermine the efficacy of whistleblowing in Nigeria.

Originality/value

The study presents a model of challenges and opportunities for whistleblowing in a developing democracy. The authors argue that the existence of a weak and complex institutional environment and the failure of program institutionalization explain those challenges and opportunities. The authors also argue that a culturally anchored and institutionalized whistleblowing program encourages positive civic behavior by incentivizing citizens to act as custodians of their resources, and it gives voice to the voiceless who have endured decades of severe hardship and loss of dignity due to corruption.

Details

Accounting, Auditing & Accountability Journal, vol. 33 no. 6
Type: Research Article
ISSN: 0951-3574

Keywords

Open Access
Article
Publication date: 19 August 2022

Giacomo Pigatto, Lino Cinquini, John Dumay and Andrea Tenucci

This study aims to provide a critical assessment of developments in the field of voluntary corporate non-financial and sustainability reporting and disclosure (VRD). The…

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Abstract

Purpose

This study aims to provide a critical assessment of developments in the field of voluntary corporate non-financial and sustainability reporting and disclosure (VRD). The assessment is grounded in the empirical material of a three-year research project on integrated reporting (IR).

Design/methodology/approach

Alvesson and Deetz’s (2021) critical management framework structures the arguments in this paper. By investigating local phenomena and the extant literature, the authors glean insights that they later critique, drawing on the empirical evidence collected during the research project. Transformative redefinitions are then proposed that point to future opportunities for research on voluntary organisational disclosures.

Findings

The authors argue that the mainstream approaches to VRD, namely, incremental information and legitimacy theories, present shortcomings in addressing why and how organisations voluntarily disclose information. First, the authors find that companies adopting the International IR Council’s (IIRC, 2021) IR framework tend to comply with the framework only in an informal, rather than a substantial way. Second, the authors find that, at times, organisations serendipitously chance upon VRD practices such as IR instead of rationally recognising the potential ability of such practices to provide useful information for decision-making by investors. Also, powerful groups in organisations may use VRD practices to establish, maintain or restore power balances in their favour.

Research limitations/implications

The paper’s limitations stem directly from its aim to be a critical reflection. Even when grounded on empirics, a reflection is mainly a subjective effort. Therefore, different researchers could come to different conclusions and offer different lessons from the two case studies.

Practical implications

The different rationales the authors found for VRD should make a case for reporting institutions to tone down any investor-centric rhetoric in favour of more substantial disclosures. The findings imply that reporting organisations should approach the different frameworks with a critical eye and read between the lines of these frameworks to determine whether the purported normative arguments are achievable practice.

Originality/value

The authors reflect on timely and relevant issues linked to recent developments in the VRD landscape. Further, the authors offer possible ways forward for critical research that may rely on different methodological choices, such as interventionist and post-structuralist research.

Details

Journal of Accounting & Organizational Change, vol. 19 no. 2
Type: Research Article
ISSN: 1832-5912

Keywords

Open Access
Article
Publication date: 14 March 2023

Jennifer Martin, Zuneera Khurshid, Gemma Moore, Michael Carton, John J. Fitzsimons, Colm Henry and Maureen A. Flynn

This paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a…

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Abstract

Purpose

This paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a qualitative experience of patients and frontline staff. It demonstrates the application of the “Picture-Understanding-Action” approach and shares the lessons learnt.

Design/methodology/approach

Using co-design and applying the “Picture-Understanding-Action” approach, the project team supported the directors of the Irish health system to identify and test a qualitative and quantitative picture of the quality of care across the health system. A “Quality Profile” consisting of quantitative indicators, analysed using SPC methods was used to provide an overview of the “critical few” indicators across health and social care. Patient and front-line staff experiences added depth and context to the data. These methods were tested and evolved over the course of six meetings, leading to quality of care being prioritised and interrogated at board level.

Findings

This project resulted in the integration of quality as a substantive and prioritised agenda item. Using best practice SPC methods with associated training produced better understanding of performance of the system. In addition, bringing patient and staff experiences of quality to the forefront “people-ised” the data.

Originality/value

The application of the “Picture-Understanding-Action” approach facilitated the development of a co-designed quality agenda item. This is a novel process that shifted the focus from “providing” information to co-designing fit-for-purpose information at board level.

Details

International Journal of Health Governance, vol. 28 no. 1
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 4 December 2017

Peter O’Meara, Gary Wingrove and Michael Nolan

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a…

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Abstract

Purpose

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

Design/methodology/approach

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Findings

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

Originality/value

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

Details

International Journal of Health Governance, vol. 22 no. 4
Type: Research Article
ISSN: 2059-4631

Keywords

Open Access
Article
Publication date: 26 July 2018

Peter O’Meara, Gary Wingrove and Michael McKeage

The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of…

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Abstract

Purpose

The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.

Design/methodology/approach

A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.

Findings

Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession.

Originality/value

In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

Open Access
Article
Publication date: 16 October 2017

Abhijeet Ghadge, Merilena Kaklamanou, Sonal Choudhary and Michael Bourlakis

Food supply chain (FSC) in Greece is dominated by small and medium-sized enterprises (SMEs), who face several challenges in adopting green practices. The purpose of this paper is…

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Abstract

Purpose

Food supply chain (FSC) in Greece is dominated by small and medium-sized enterprises (SMEs), who face several challenges in adopting green practices. The purpose of this paper is to identify the key drivers and barriers influencing the environmental performance of SMEs within the Greek dairy supply chain (SC).

Design/methodology/approach

Descriptive research methodology attempts to prioritize the drivers and barriers for improving the environmental sustainability performance. Analytical hierarchy process and sensitivity analysis are used to understand the complex nature of the influencing factors.

Findings

The analysis identifies five barriers and six drivers for the implementation of green practices within the dairy SC. While external drivers significantly influence the market structure and logistics network, government, competitors and customers are the driving factors for improving environmental performance.

Research limitations/implications

The study contributes to filling the literature gap on key factors influencing the implementation of green practices within the FSC. The identified influential factors will contribute toward building a framework for improving sustainability performance within the Greek dairy SC.

Practical implications

The study is expected to benefit the Greek and European SMEs by driving their environmental practices within the perishable SC network.

Originality/value

The paper provides directions for researchers, practitioners and policy makers in understanding the challenges for implementing green practices in the dairy SC. The holistic approach followed in this paper is a building block for a conceptual framework on implementing environmental sustainability within the FSC. Apart from contributing to the current literature by extending the research horizon to SMEs’ green adoption capability, this study also provides better understanding of the pivotal role of internal and external key factors in influencing sustainability performance.

Details

Industrial Management & Data Systems, vol. 117 no. 9
Type: Research Article
ISSN: 0263-5577

Keywords

Open Access
Article
Publication date: 3 April 2017

Gareth James Brennan and MaryBeth Gallagher

Occupational choice describes the process that leads to occupational engagement as a result of intrinsic and extrinsic influences. There has been a considerable amount of research…

8742

Abstract

Purpose

Occupational choice describes the process that leads to occupational engagement as a result of intrinsic and extrinsic influences. There has been a considerable amount of research concerning occupational choice, gender and adolescence. However, this has largely focused on the areas of career choice and engagement in risky health behaviours. This paper aims to expand on the literature by providing a broader scope of occupation more aligned with the concept associated with occupational science. Furthering this, the researcher aims to examine the influence of gender as an extrinsic influence on occupational choice. The researcher aims to explore how contextual influences inform gendered occupational choice.

Design/methodology/approach

An exploratory qualitative approach was used in the current study. Incorporating photographs as a means of elucidating conversation during the interview process, photo-elicitation interview techniques were used as part of the data collection. This involved using a collection of photographs to prompt participants to discuss their interpretations of various occupations. Six adolescent boys and girls aged 11-14 years participated in the study. Participants were recruited from mixed-gendered sports clubs in the West of Ireland. Thematic analysis was used to analyse the data. An occupational justice perspective was used to interpret the data.

Findings

Responses suggest that gender informs occupational choice through different mechanisms. These included social systems, physical and institutional opportunities as well as expectations participants held of themselves and others they considered to be within their social grouping. Social systems included groups such as friends and family. The ease of access to physical and institutional resources was another factor that informed choice. Participants projected views of expectations they perceived others held for them informed how the participants made their choices. These factors varied across gender. Despite opportunities being available to both sexes, choices were often restricted to particular occupations.

Originality/value

The findings suggest that factors informing the occupational choices of adolescents included a combination of intrinsic factors such as gender and perspectives, as well as external factors including peers, family and opportunities in the local community. Practical applications of this involve acknowledging and further understanding the contextually situated nature of choice to provide more equitable practice. The results of the study may provide more insight into the factors that enable and inhibit occupation. A further understanding of these influences can redirect how we view adolescent occupations in a way that promotes health.

Details

Irish Journal of Occupational Therapy, vol. 45 no. 1
Type: Research Article
ISSN: 2398-8819

Keywords

Open Access
Article
Publication date: 11 July 2017

Jennifer Anna Stark and Erich Kirchler

The purpose of this paper is to investigate the relationship of inheritance tax behavior with normative value principles and factors found relevant for income tax compliance…

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Abstract

Purpose

The purpose of this paper is to investigate the relationship of inheritance tax behavior with normative value principles and factors found relevant for income tax compliance. Also, it examines the influence of affectedness and earmarking on inheritance tax compliance. Furthermore, it compares two countries similar in tax morale, tax culture as well as dominant normative value principles, Austria and Germany, of which one – Germany – levies inheritance taxes and the other – Austria – is debating its reintroduction.

Design/methodology/approach

A two (affected vs nonaffected) by two (Austria vs Germany) by two (inheritance tax vs stock profit tax) by three (no earmarking vs social justice earmarking vs equality of opportunity earmarking) experimental online questionnaire was conducted with 296 Austrians and 230 Germans.

Findings

Normative value principles and other socio-psychological variables play an important role concerning inheritance tax behavior. Affectedness does not influence inheritance tax compliance. Earmarking inheritance tax to projects corresponding to these value principles increases inheritance tax compliance in the Austrian sample and could represent a measure to increase inheritance tax compliance in countries implementing inheritance tax or increasing inheritance tax.

Originality/value

This study draws a comprehensive picture of the socio-psychological variables relevant to inheritance tax behavior and tests the effect of earmarking as a policy measure to increase inheritance tax compliance.

Details

International Journal of Sociology and Social Policy, vol. 37 no. 7/8
Type: Research Article
ISSN: 0144-333X

Keywords

Open Access
Article
Publication date: 17 January 2022

Stephanie Brick

Service members of the US Department of Defense (DoD) have alarmingly high rates of depression, anxiety, probable stress disorders and suicidality, all of which are negative…

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Abstract

Purpose

Service members of the US Department of Defense (DoD) have alarmingly high rates of depression, anxiety, probable stress disorders and suicidality, all of which are negative health conditions exacerbated by various external stressors. High-stress work conditions – to include shift work, hazardous territories, high-stakes mission sets and generally disconnected sites – require a work environment that facilitates, rather than inhibits, stress reduction and mental well-being. This paper aims to present “salutogenic design” as an innovative approach: Salutogenic design offers demonstrated architectural solutions that improve health and well-being.

Design/methodology/approach

This paper describes salutogenic design strategies beginning with the need for such an approach, the call to action to implement strategic and tactical solutions and the challenges and financial impacts of such a broad and innovative strategy to improve workplace health, well-being and performance in the DoD and beyond. Examples of these strategies, via biophilic design solutions, are presented in the central Table 1 as an easy-to-reference tool and supported by the voluminous literature as referenced, in part, through this research paper.

Findings

Salutogenic design strategies offer innovative, financially viable solutions to help mitigate stress and improve workforce well-being while maintaining the highest level of building security requirements in access-controlled spaces and disconnected sites, such as military installations and government compounds.

Research limitations/implications

Issues of mental and physical health are complex and multi-faceted, and they require complex and multi-faceted solutions. Salutogenic design is presented as one facet of that solution: a tangible solution to an often-intangible issue. Further, as a novel approach to address a critical DoD issue, Table 1 bridges the common gap between high-concept design theory and practical construction-application solutions, with positive value to the health, performance, quality-of-life and well-being of service members.

Originality/value

To the best of the author’s knowledge, this paper is the first to approach the DoD’s imperative to reduce service members’ mental stress with “salutogenic design.”

Details

Facilities , vol. 40 no. 15/16
Type: Research Article
ISSN: 0263-2772

Keywords

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