Is merit pay changing ethos in public administration?

This article aims to explore the changes in the organizational culture of public administrations following the implementation of performance-related pay\u2014 PRP systems. The work explores the switch to an explicit remuneration system through the implementation of incentives and focuses on the effects, positive or negative, this has had on the ethos of public administrations. Data from a survey carried out among private and public employees in a specific area of Southern Italy are used to analyze how the shift from an implicit to an explicit remuneration system has impacted the public servants\u2019 ethos. Due to the application of PRP, public servants are now expected to be compensated based on their performance. The ineffective management of incentives in public administrations affects the intrinsic motivation of public employees and may lead to moral disengagement. While the previous literature has focused on the practical challenges and limitations of PRP, less has been written about how PRP has changed the culture of public administrations. This article shows how PRP can change the traditional ethos ofpublic administrations\u2019 services based on the Weberian model of bureaucracy, replacing the latter with a new on

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Poetry from the factory: “On the Line,” by Joseph Ponthus

International audienc

Developing a Culture of Solidarity Through a Three-Step Virtuous Process: Lessons from Common Good-Oriented Organizations

International audienceSolidarity is a principle oriented toward the common good that ensures that each person can have the necessary goods and services for a dignified life. As such, it is very often approached in a theoretical manner. In this empirical study, we explored the development of a culture of solidarity within an organizational context. In particular, we qualitatively investigated how a culture of solidarity can concretely spread within and beyond organizations by conducting 68 semi-structured interviews with members of three common good-oriented organizations located in the Philippines, Korea, and Paraguay. We found that a culture of solidarity develops through a three-step process that includes constructing the solidarity mission, sharing solidarity, and disseminating solidarity, which together form a virtuous circle. We further found that solidarity is not supported by constrained, instrumentalized, or sacrificial actions, but can instead be a free, authentic, and fulfilling way for members of an organization to flourish while serving the mission of their company

Is it the end of the world as we know it? Apocalyptic reflexivity in and around organizations

International audienceThe main aim of this essay is to encourage organizational scholars to engage with the notion of the apocalypse in a theoretically novel and insightful way. Despite a growing interest in theories about possible futures and the end of the world as we know it, scholars have so far mainly focused on the catastrophic implications of the notion, overlooking its generative potential. We have thus devised a specific approach to help organizational researchers in thinking through and navigating the apocalypse. Building on the idea of ‘apocalyptic reflexivity’, we illustrate the possibilities related to cultural analysis, speculation, and action opened up by the apocalypse, together with their implications for all those interested in studying, understanding, and changing contemporary organizational dynamics

Da Giacobbe a Israele : il rito nelle relazioni individuo-organizzazione

Ogni relazione interpersonale si caratterizza per la sua complessit\ue0. Spesso \ue8 un rapporto oscillante tra incontro/scontro, lotta/abbraccio, aggressione/abbandono fiducioso, e deve essere gestita con enorme rispetto dell\u2019altro. Come nella metafora biblica di Giacobbe che lotta con l\u2019angelo, la relazione pu\uf2 creare ferite ma anche generare benedizioni, cio\ue8 occasioni di crescita. Nel mondo economico (e nelle imprese) tuttavia la relazione tende a essere semplificata e ridotta a mero scambio utilitaristico. Tale semplificazione fa s\uec che spesso nelle organizzazioni le relazioni creino "ferite" psicologiche, cio\ue8 delusioni e frustazioni che gli individui non riescono a rielaborare, trasformando queste delusioni in elementi di riflessione e di crescita personale. In pratica le "ferite" non diventano "benedizioni", cio\ue8 profezie di sviluppo futuro. Il lavoro si propone di comprendere attraverso quali percorsi le "ferite" possono trasformarsi in "benedizioni". Una delle possibili risposte a questa domanda sta nel fatto che le organizzazioni moderne, in particolare nei Paesi occidentali, utilizzando una razionalit\ue0 economica di scambio utilitaristico e strumenti manageriali molto formalizzati, basati su liturgie con una loro ferrea ortodossia, non sembrano essere pi\uf9 in grado di riconoscere e gestire adeguatamente i riti che esistono al loro interno, i quali costituiscono lo strumento fondamentale per mantenere l\u2019equilibrio tra identit\ue0 individuale e identit\ue0 collettiva, e quindi permettono all\u2019individuo "ferito" di vivere ed elaborare una promessa di futuro ad ogni delusione e sconfitta. http://arl.liuc.it/dspace/handle/2468/432

Designing a new scoring system (QualyP Score) correlating the management of cardiopulmonary bypass to postoperative outcomes

AIM: The aim of this study was to ascertain if a score, directly derived from CPB records, could correlate to major postoperative outcomes. METHODS: An additive score (QualyP Score) was created from 10 parameters: peak lactate value during CPB, peak VCO(2)i, lowest DO(2)i/VCO(2)i, peak respiratory quotient, CPB time, cross-clamp time, lowest CPB temperature, circulatory arrest, ultrafiltration during CPB, number of packed red cells transfused intraoperatively. The PerfSCORE was calculated, as well. Multivariable logistic regression models were built to detect the independent predictors of: peak lactate >3 mmol/L during the first three postoperative days; the incidence of acute kidney injury network (AKIN) 1-2-3; respiratory insufficiency; mortality. RESULTS: The mean score was 4.8±2.6 (0-10). A QualyP Score ≥1 was predictive of postoperative acidosis (OR=1.595). A score ≥2 was predictive of AKIN 2 (OR=1.268) and respiratory insufficiency (OR=1.526). A score ≥5 was predictive of AKIN 3 (OR=1.848) and mortality (OR=1.497). CONCLUSIONS: QualyP Score may help to provide a quality marker of perfusion, emphasizing the need for goal-directed perfusion strategies

Nutritional parameters associated with prognosis in non-critically ill hospitalized COVID-19 patients: The NUTRI-COVID19 study

Background & aims: To investigate the association between the parameters used in nutritional screening assessment (body mass index [BMI], unintentional weight loss [WL] and reduced food intake) and clinical outcomes in non-critically ill, hospitalized coronavirus disease 2019 (COVID-19) patients. Methods: This was a prospective multicenter real-life study carried out during the first pandemic wave in 11 Italian Hospitals. In total, 1391 patients were included. The primary end-point was a composite of in-hospital mortality or admission to ICU, whichever came first. The key secondary end-point was in-hospital mortality. Results: Multivariable models were based on 1183 patients with complete data. Reduced self-reported food intake before hospitalization and/or expected by physicians in the next days since admission was found to have a negative prognostic impact for both the primary and secondary end-point (P 21 mg/dL) and LDH (>430 mU/mL) levels yielded consistent findings. Conclusions: Reduced self-reported food intake before hospitalization and/or expected by physicians in the next days since admission was associated with negative clinical outcomes in non-critically ill, hospitalized COVID-19 patients. This simple and easily obtainable parameter may be useful to identify patients at highest risk of poor prognosis, who may benefit from prompt nutritional support. The presence of comorbidities could be the key factor, which may determine the protective or harmful role of a high body mass index in COVID-19

Multimorbidity and polypharmacy in the elderly: Lessons from REPOSI

The dramatic demographic changes that are occurring in the third millennium are modifying the mission of generalist professionals such as primary care physicians and internists. Multiple chronic diseases and the related prescription of multiple medications are becoming typical problems and present many challenges. Unfortunately, the available evidence regarding the efficacy of medications has been generated by clinical trials involving patients completely different from those currently admitted to internal medicine: much younger, affected by a single disease and managed in a highly controlled research environment. Because only registries can provide information on drug effectiveness in real-life conditions, REPOSI started in 2008 with the goal of acquiring data on elderly people acutely admitted to medical or geriatric hospital wards in Italy. The main goals of the registry were to evaluate drug prescription appropriateness, the relationship between multimorbidity/polypharmacy and such cogent outcomes as hospital mortality and re-hospitalization, and the identification of disease clusters that most often concomitantly occur in the elderly. The findings of 3-yearly REPOSI runs (2008, 2010, 2012) suggest the following pertinent tasks for the internist in order to optimally handle their elderly patients: the management of multiple medications, the need to become acquainted with geriatric multidimensional tools, the promotion and implementation of a multidisciplinary team approach to patient health and care and the corresponding involvement of patients and their relatives and caregivers. There is also a need for more research, tailored to the peculiar features of the multimorbid elderly patient