Search results

This chapter reports on how teachers engage with research evidence in New Zealand (NZ). NZ is classified as a mixture of egalitarian and individualist ways, as it has low social regulation but is ‘centre right’ on social cohesion according to Hood’s (1998) matrix. That is to say, as it is self-governing school system, it has low social regulation with fewer hierarchical accountability systems, but there is evidence of both high and low social cohesion in the system. While the system values and promotes research engagement and establishes initiatives that require it, such engagement is not yet as fully embedded as the related policies and initiatives would hope. Many teachers are unlikely to engage with research without sufficient support, conducive conditions and adequate resourcing that support that aspiration. Enablers include: a research-derived and research-promoting model of pedagogy in the national curriculum, and initiatives that promote connections between practitioners and research/researchers. Barriers include: limited system-wide mechanisms to ensure that the policy mechanisms are working as intended, the ‘translation’ of research to practice, and research accessibility. We discuss three lessons from the NZ case: systematic and system-wide efforts to ensure high-quality tools and capability-building initiatives, the potential of research-practice partnerships to build research engagement capability, and how enquiry can support appropriate use of research evidence.

This article explores the symbolic aspects of change agency on a learning platform designed to facilitate system-wide transformation in cancer care. A sensemaking–sensegiving perspective is adopted to analyze the construction of meaning in interaction between the leader of a regional cancer center, senior physicians, and an action research team in relation to patient-centered care. The analysis suggests that the physicians, as change agents, made sense of the vision from three quite distinct discourses in relation to the development effort. We argue that although meanings reconstructed in development initiatives may well be far from shared, this by no means implies that they are dysfunctional.

Purpose – The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context?

Design/methodology – We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal: to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services; (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy.

Findings – The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT.

Originality/value – There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

Most academic work on sustainability has been focused on the organizational level, reflecting the popular “business case for sustainability” idea. However, organizations are certainly not the only locus of entrepreneurial action for sustainability, nor are they the most ideal. This chapter reports on a six-year study of the Sustainability Consortium, a collaboration started in 1999 between large companies that were seeking to lead their industry through innovative initiatives for sustainability. The findings, based on 60 interviews and many other sources of data, identify eight “ecologies of entrepreneurial action,” all of which were critical for driving change. These ecologies are: Individual Aspiration; Network Affiliation; Process Optimization; Entrepreneurial Innovation; Value Chain Collaboration; Industry/Sector Coordination; System-Wide Integration; and Social Transformation. As shown by complexity theory, the interdependent and interconnected nature of these ecologies means that only by expanding beyond organizationally focused endeavors can we help generate the social transformation that will lead to a sustainable world.

This chapter argues that organizations are not sustainable if they operate in unsustainable societal and ecological contexts, and that operating in a way that contributes to the health of the larger system requires organizations to develop new capabilities. It demonstrates the role that rich internal and external networks play in developing sustainability capability particularly in providing pathways to generate, import, apply, and disseminate knowledge about how to operate more sustainably.

The case study of the sustainability transition of Cleveland Clinic is based on four years of interviews and archival data collection examining the system’s transformational change that began in 2007. The case focuses on the building of sustainability capability, including an internal infrastructure to focus the organization on this outcome, and building of rich networks for learning and action. The case is framed with capability and network theory.

Guided and catalyzed by a small central group called the Office for a Healthy Environment, Cleveland Clinic has achieved measurable progress in key strategic focuses including waste diversion, energy efficiency, and increasing integration of local foods into its supply chain. To do so, it has developed strong internal networks to disseminate knowledge and accelerate innovation and adoption of sustainable practices. Strong, dynamic external networks have enabled Cleveland Clinic to import knowledge about sustainable practice from its environment, and have enabled it to help build the sustainability capability of its vendors, the community upon which it depends, and the health-care industry.

Starting with the perspective that the sustainability of an organization depends on the sustainability of the ecosystems in which it exists, this chapter focuses not on the design of specific sustainability initiatives, but on the dynamic networks that underpin the capability to simultaneously improve the health of the organization and of the larger ecosystem. This perspective provides insight into new organizing principles.

Thailand continuously has had administrative reforms in spite of periods of military regime and democratic government. This chapter describes the leadership of administration reforms coming from issue experts and senior civil service officers described as a ‘jazz-banded’ leadership model of different actors. Political parties pick up reform packages consistent with their policy platforms, while the military looks for ready-to-deliver policy packages. The author discusses the example of education and health care reforms and the role of the Office of Public Sector Development Commission (OPDC). In Thailand, resistance usually occurred during the implantation stage rather than at the formulation stage. The chapter discusses that OPDC initiatives were implemented with bonuses of up to 12-month salary for some senior officers and department heads. In health care, success came from concerted efforts of health care experts who transcend their ideas from one generation to another and who kept convincing politicians running the Ministry of Public Health. However, in other instances, budget allocations may bump up against financial procedures that are detailed and tight due to anti-corruption practices. In education reforms, teachers were placed at different school districts that lacked commitment. In the decentralization of reforms, resistance comes from line ministries wanting to secure their authority, although local authorities are very active. Resistance often requires negotiation of many parties; rarely do politicians step in to overcome and assist.