Do reviews of healthcare interventions teach us how to improve healthcare systems?

Planners, managers and policy makers in modern health services are not without ingenuity e they will always try, try and try again. They face deep-seated or ‘wicked’ problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the ‘typological review’. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a ‘theory-driven review’ underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare

An ontological framework for the formal representation and management of human stress knowledge

There is a great deal of information on the topic of human stress which is embedded within numerous papers across various databases. However, this information is stored, retrieved, and used often discretely and dispersedly. As a result, discovery and identification of the links and interrelatedness between different aspects of knowledge on stress is difficult. This restricts the effective search and retrieval of desired information. There is a need to organize this knowledge under a unifying framework, linking and analysing it in mutual combinations so that we can obtain an inclusive view of the related phenomena and new knowledge can emerge. Furthermore, there is a need to establish evidence-based and evolving relationships between the ontology concepts.Previous efforts to classify and organize stress-related phenomena have not been sufficiently inclusive and none of them has considered the use of ontology as an effective facilitating tool for the abovementioned issues.There have also been some research works on the evolution and refinement of ontology concepts and relationships. However, these fail to provide any proposals for an automatic and systematic methodology with the capacity to establish evidence-based/evolving ontology relationships.In response to these needs, we have developed the Human Stress Ontology (HSO), a formal framework which specifies, organizes, and represents the domain knowledge of human stress. This machine-readable knowledge model is likely to help researchers and clinicians find theoretical relationships between different concepts, resulting in a better understanding of the human stress domain and its related areas. The HSO is formalized using OWL language and Protégé tool.With respect to the evolution and evidentiality of ontology relationships in the HSO and other scientific ontologies, we have proposed the Evidence-Based Evolving Ontology (EBEO), a methodology for the refinement and evolution of ontology relationships based on the evidence gleaned from scientific literature. The EBEO is based on the implementation of a Fuzzy Inference System (FIS).Our evaluation results showed that almost all stress-related concepts of the sample articles can be placed under one or more category of the HSO. Nevertheless, there were a number of limitations in this work which need to be addressed in future undertakings.The developed ontology has the potential to be used for different data integration and interoperation purposes in the domain of human stress. It can also be regarded as a foundation for the future development of semantic search engines in the stress domain

Moderating effects of performance measurement use on the relationship between organizational performance, measurement diversity and product innovation

This study sets'out to address the question of whether the effect of organizational' performance measurement diversity on product innovation will differ depending on how organizational performance measures are used. There is strong empirical evidence that many companies who are successful today are less likely to be successful in the future because they fail to innovate. It is surprisingly then, that when everyone stresses the importance of innovation, there are many organizations adopting performance measurement systems, which may constrain their innovativeness. Currently, there are three differing perspectives on the effect of measurement on a firm's propensity to innovate. Moreover, each of these has empirical evidence to support its argument. The first perspective views measurement as constraining innovation because it impedes creativity, experimentation, and search in firms. The second perspective views measurement as helping innovation because it triggers search, facilitates decision-making, and increases risk-taking. The third perspective views measurement as having insignificant or little impact on innovation because it is used primarily for signalling. A possible explanation of the contradiction in the empirical findings of these studies is that they generally ignore how measurement is used. Therefore, using the behavioural theory of innovation, I argue that one possible way of resolving the contradictory findings is by incorporating measurement use as a moderating variable. Using data from a cross-sectional, large-scale, probability sample survey of 145 UK manufacturing firms, I show that organizational performance measurement diversity interacts with performance measurement use to determine product innovation. My findings suggest that the extent to which a firm offers new products will be more positively (negatively) associated with performancemeasurement diversity when diagnostic use is high (low) holding interactive use constant and will be more negatively (positively) associated with performance measurement diversity when interactive use is high (low) holding, diagnostic use constant.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Model driven validation approach for enterprise architecture and motivation extensions

As the endorsement of Enterprise Architecture (EA) modelling continues to grow in diversity and complexity, management of its schema, artefacts, semantics and relationships has become an important business concern. To maintain agility and flexibility within competitive markets, organizations have also been compelled to explore ways of adjusting proactively to innovations, changes and complex events also by use of EA concepts to model business processes and strategies. Thus the need to ensure appropriate validation of EA taxonomies has been considered severally as an essential requirement for these processes in order to exert business motivation; relate information systems to technological infrastructure. However, since many taxonomies deployed today use widespread and disparate modelling methodologies, the possibility to adopt a generic validation approach remains a challenge. The proliferation of EA methodologies and perspectives has also led to intricacies in the formalization and validation of EA constructs as models often times have variant schematic interpretations. Thus, disparate implementations and inconsistent simulation of alignment between business architectures and heterogeneous application systems is common within the EA domain (Jonkers et al., 2003). In this research, the Model Driven Validation Approach (MDVA) is introduced. MDVA allows modelling of EA with validation attributes, formalization of the validation concepts and transformation of model artefacts to ontologies. The transformation simplifies querying based on motivation and constraints. As the extended methodology is grounded on the semiotics of existing tools, validation is executed using ubiquitous query language. The major contributions of this work are the extension of a metamodel of Business Layer of an EAF with Validation Element and the development of EAF model to ontology transformation Approach. With this innovation, domain-driven design and object-oriented analysis concepts are applied to achieve EAF model’s validation using ontology querying methodology. Additionally, the MDVA facilitates the traceability of EA artefacts using ontology graph patterns

Private protected areas as institutional innovation in nature conservation: an empirical study on their emergence and assessment of their social and ecological fit

Private Protected Areas (PPAs) are increasingly considered a promising complement topublic-run protected areas. Their rapid proliferation worldwide and increased adoption as policy tools, have made the PPA phenomenon one of the most important in current nature protection strategies. Nevertheless, there has been little scholarly attention paid to their emergence and the implications of their implementation, especially in Europe. This dissertation explores the genesis of PPAs as innovative institutional arrangements for conservation policies and investigates their suitability for enhancing nature conservation without neglecting social issues. To begin with, an investigation into PPAs used as policy tools in European countries, showed that PPA institutional models resemble public-private partnerships that differ among countries: in the roles of public actors as regulators and facilitators for the involvement of private actors, and in the distinct typology of the latter. Hence, in countries that have centered their conservation policy on public-run protected areas and top-down approaches, PPA adoption appears to be an emblematic result of a change in governance towards voluntary approaches and partnerships with non-state actors. The research focus then shifts to Portugal, where PPA adoption clashes with the centralized top-down institutional heritage. A diachronic analysis on non-state actors’ involvement in the establishment and management of protected areas revealed that the privately governed protected areas are not a recent model within the national system of conserved areas. However, the novelty of the current model lies in its emergence against a backdrop of conservation governance rescaling and restructuring and the professionalization of NGOs, which has resulted in access to international funding for conservation. The subsequent research line aims to question the suitability of PPAs to protect nature in a socially just way, challenging a dichotomous viewpoint, alternatively presenting PPAs as a panacea or rejecting them altogether as neoliberal techniques. To do so, we developed a multicriteria assessment framework, which draws on the concepts of social and ecological institutional fit and is underpinned by a socio-ecological system approach. This framework is applied to the case of the Faia Brava natural reserve. Our findings suggest that the current Portuguese PPA institutional model, is unable to avoid the (re)production of some of the drawbacks and social issues usually associated with topdown regulations in public-run protected areas, nor to elude the risk of advancing a neoliberal conservation. The main issues to be addressed include the risk of allowing a concentration of land to be placed into the hands of private actors without guarantee of long-term protection; the lack of recognition criteria aimed to target the most endangered sites; the lack of public funding that would avoid a tendency towards nature commodification. Alongside the development of the socio-ecological assessment tool, this dissertation provides new insights into the debate on the government to governance shift in nature conservation, with empirical contributions regarding the institutional arrangements and practices of PPAs. An additional key contribution, with respect to the overarching research approach, is a reflection on the meta-theoretical bases offered by Critical Realism, to advance our understanding of policy change and socio-ecological systems.As Áreas Protegidas Privadas (APPs) são consideradas um complemento promissor às áreas protegidas públicas. A sua rápida proliferação como ferramentas das políticas de conservação da natureza, tornaram o fenómeno das APPs um dos mais importantes a nível mundial em termos de estratégias de proteção ambiental. Contudo, há poucos estudos sobre o seu surgimento e as consequências da sua implementação, especialmente na Europa. Esta dissertação explora a génese das APPs como modelos de inovação institucional no contexto das políticas de conservação e investiga a adequação dos mesmos para uma preservação da natureza integradora das questões sociais. Começou-se por explorar as APPs como instrumento de política pública em países Europeus. O estudo comparativo mostrou que as APPs têm características de parcerias público-privadas e diferem pela configuração do papel do ator público, como regulador e facilitador do envolvimento de atores privados, e pela tipologia destes últimos. Em países que centraram a sua política de conservação na implementação de áreas protegidas públicas e em abordagens de cima para baixo, a adoção das APPs parece emblemática de uma mudança no sentido da promoção de abordagens voluntárias e parcerias com atores privados. Seguidamente, a investigação centrou-se em Portugal, onde a adoção das APPs colide com uma tradição de administração pública centralizada. Uma análise diacrônica sobre o envolvimento de atores não estatais (i.e. administração central) no estabelecimento e gestão de áreas protegidas, revelou que as APPs não são, contudo, uma alternativa recente. A novidade do modelo atual situa-se no seu surgimento no contexto de uma reestruturação da governança da conservação e da profissionalização das ONGs, e.g. no acesso a financiamentos internacionais. A linha de pesquisa subsequente questionou a capacidade das APPs de levar a cabo a sua função de proteção da natureza de maneira socialmente justa, desafiando um debate dicotômico, que as apresenta alternativamente ou como uma panaceia ou as rejeita por completo como soluções neoliberais. Para isso, desenvolveu-se uma ferramenta de avaliação multicritério baseada no conceito de encaixe institucional e sustentada por uma abordagem socio-ecológica. O enquadramento desenvolvido foi aplicado ao caso de estudo da reserva natural da Faia Brava. Esta investigação sugere que o atual modelo português para as APPs não é capaz de evitar a (re)produção de conflitos e problemas sociais associados às áreas protegidas públicas, nem evitar o risco de emergência de uma abordagem neoliberal de conservação da natureza. As principais questões incluem o risco de concentração de terras nas mãos de atores privados sem garantia de proteção da natureza a longo prazo; a falta de critérios de reconhecimento de APPs que privilegie os sítios mais ameaçados; e a falta de financiamento público destinado a evitar a mercantilização da natureza. Para além do desenvolvimento desta ferramenta de avaliação, contribui-se para o debate sobre a mudança do modelo de governança da conservação da natureza em Portugal, com contributos empíricos sobre modelos e práticas das APPs. Um contributo adicional é uma reflexão sobre as bases meta-teóricas que o Realismo Crítico oferece para avançar o nosso entendimento sobre as mudanças nas políticas públicas e nos sistemas socioecológicos

Market orientation and firm performance in Ghana's telecommunications industry

This study set out to achieve a comprehensive understanding of the adoption levels of market orientation (MO) in Ghana’s mobile telecommunications industry, and to assess its relationship to performance. This was necessitated by the fact that, in-spite of the superfluity of literature on market orientation and its relationship to performance in developed economies and a few on developing nations such as Ghana, there are hardly any studies on Ghana’s mobile telecommunications industry despite its impressive performance. Furthermore, available studies generally assessed market orientation without incorporating any assessment by customers. The study, in addressing these deficiencies, makes significant contribution to academic knowledge on market orientation. Based on literature reviewed, a conceptual model and nine hypotheses are proposed for this study. Both qualitative and quantitative research methods, underpinned by realism philosophy enabled the assessment of the market orientation performance relationship. Qualitative data collection entailed an in-depth interview of ten senior officers of five mobile telecommunications firms operating in Ghana selected by a judgmental sampling method, whose response was analysed by thematic analysis. Quantitative data was obtained by administering questionnaires on 275 staff selected by a simple random sampling method and 302 subscribers selected by a two-stage process of quota and convenience sampling methods. Confirmatory factor analysis, correlation matrix, structural equation modeling and T-test are utilized in the analysis of the quantitative data and the testing of the hypotheses. The findings of the study established that in Ghana’s mobile telecommunications industry, market orientation is determined by one internal antecedent - top management emphasis with no external antecedent influencing it. The significant effect of market orientation on business performance, customer satisfaction, customer retention, employee commitment and employee esprit de corps have also been established by this study. Finally, the study establishes that, when compared, subscribers and staff assessment of the dimensions of market orientation differed with staff rating them higher than subscribers. Based on the findings, the study recommends the need not only for mobile telecommunication operators to continue in the pursuit of market orientated activities, but also undertake measures to close the market orientation gap between them and their subscribers. Top management should also continue with the pivotal role they are playing in the implementation of market orientation, and enhance their information generation, dissemination and responsiveness processes not only to sustain market orientation but also their performance. Notwithstanding the shortfalls identified, which did not adversely affect outcomes of the study, the study has developed an empirical model for market orientation, firm performance relationship for the mobile telecommunications industry incorporating a comparison of the assessment of the dimensions of market orientation by subscribers and staff. It is hoped that this new model will be used for further studies in both developed and developing countries to test the viability of its application

Information Quality in Secondary Use of EHR Data : A Case Study of Quality Management in a Norwegian Hospital

The motivation for undertaking this study relates to my experiences from practice in a public hospital, where I have observed variations in reaching organizational goals of quality management informed by electronic health records (EHR) data. For example, while some departments and units have long-time traditions in meeting the quality goals that are set locally, regionally, or nationally, other departments and units struggle to meet the same quality goals. Thus, generating actionable information by reusing routinely collected EHR data does not necessary lead to action in response to the information. This process of generating information from existing EHR data, and communicating and using such information for organizational purposes, may be challenging in a highly complex environment such as health care organizations. Within this process, information quality (IQ) may influence actors’ perceptions of action possibilities the information offers, thus influencing the actual use of the information required to reach organizational goals. EHR data can be used for clinical purposes at the point-of-care (i.e., primary use) and reused for purposes that do not involve patient treatment directly (i.e., secondary use). Examples of such secondary use includes quality management, research, and policy development. Though it is widely accepted that IQ influences the use of EHR systems and the information generated by EHR systems, research on the implications of IQ on health care processes is limited: the focus of the current literature is concerned with defining and assessing IQ in primary use of EHR data, whereas the role of IQ in secondary use of EHR data remains unclear. Thus, this dissertation investigates the role of IQ in secondary use of EHR data in an organizational context. This dissertation addresses this practical and theoretical challenge by focusing on the overall research objective of understanding the role of IQ in secondary use of EHR data. To address this research objective, this dissertation explores the following research questions: RQ1. How do human actors influence in transformation of IQ while generating, communicating, and using information in secondary use of EHR data? RQ2. What are the underlying generative mechanisms through which IQ transforms in the process of secondary use of EHR data?publishedVersio

Kansainväliset rankingit hallinnan välineinä

Quantitative knowledge plays an increasing role in transnational governance, even when not explicitly part of formal processes of decision making. This study consists of five research articles that individually and together deal with the subtle ways by which socio-political quantification influence governance and politics. Rather than looking at the direct impact a specific ranking has on a particular policy or set of policies, the articles focus on processes that precede and frame individual and institutional decision making and conduct. As such, this research aligns with certain variants of new institutionalist literature, the theory of interactive governance and the idea of metagovernance (Torfing et al. 2011), and with the Foucault-inspired studies in governmentality. The empirical cases - democracy and good governance, and higher education policies and university autonomy - demonstrate how quantification constitutes (1) knowledge in setting the parameters within the limits of which a concept, idea, domain, empirical fact or a policy prescription comes to be understood collectively; (2) identities in individualizing social units, making them appear separate, self-sufficient, responsible and competitive; (3) authority in transferring legitimacy to the participants of the numbers industry, bestowing on them an aura of expertise, or to those who numbers present in a favorable light. Comparative rankings tell us what the world is like, who we are, what we should accomplish, how we can reach our objectives, and who we should look up to. In addition to shedding light on and systematizing the ways in which quantification functions as a mechanism of governing, the empirical cases build up evidence for arguing that the contemporary trend for quantification - manifest in the proliferation of demands for evidence-based policy making, managerial reforms in national public administration and supranational efforts to produce accessible knowledge for various purposes - is often premised on an atomistic social ontology that reinforces the ideology of competition and supports economistic problem setting and policy solutions. Whether or not one likes the role quantification plays in governing, there is no doubt that the analysis of socio-political quantification forms an important aspect of governance research, which the articles in this thesis strongly confirm.Kansainvälinen numeerinen ja vertailukelpoinen tieto on nykyisin näkyvä osa julkista keskustelua, hallinnollista toimintaa ja poliittista päätöksentekoa. Erityisen näkyviä ovat poikkikansalliset vertailut, jotka erilaisten indikaattorien ja laskentakaavojen perusteella järjestävät valtioita, yhteiskuntia ja organisaatioita paremmuusjärjestykseen mitä moninaisimmilla ulottuvuuksilla. Globaalit rankingit kertovat nopeasti, mikä maa on demokraattisin, kilpailukykyisin, vähiten korruptoitunein tai onnellisin. Väitöskirjassa esitetään sisältämiinsä tapaustutkimuksiin ja teoreettiseen kirjallisuuteen perustuen, ettei kansainvälisiä vertailuja tulisi yhtäältä ohittaa merkityksettömänä viihteenä eikä toisaalta ymmärtää yksinomaa muuttujaperusteisen tutkimuksen tarpeita palvelevaksi neutraaliksi aineistoksi. Numeeriset vertailut ovat myös monin tavoin toimivia hallinnan tekniikoita ja siten itsessään kiinnostavia tutkimuskohteita politiikan ja vallantutkimukselle. Väitöskirja koostuu viidestä tutkimusartikkelista, joissa demokratian, hyvän hallinnon ja korkeakoulutuksen määrällistämistä - mittaamisen menetelmiä, sisältöjä ja tuotoksia sekä mittaajia ja heidän verkostojaan - käsittelevien yksityiskohtaisten tapaustutkimusten avulla analysoidaan rankingien usein näkymättömiksi tai julkilausumattomiksi jääviä hallinnallisia funktiota. Koska numeeristen vertailujen hallinnalliset vaikutukset ovat paljolti kollektiivisiin ideoihin ja representaatioihin sitoutuneita ja siten formaalia päätöksentekoprosessia edeltäviä ja rakenteistavia, on niiden tarkastelu erityisen mielenkiintoista globaalin hallinnan näkökulmasta. Empiirisiin osatutkimuksiin vedoten väitöskirjassa esitetään, että rankingien hallinnallisuus toteutuu (1) todellisuutta ja toivottavia asiantiloja kuvaavan tiedon avulla, (2) konstituoimalla mm. itsehallintaan ohjaavia identiteettejä sekä (3) legitimoimalla asiantuntijuuteen ja mitattuun suoritukseen perustuvaa auktoriteettia. Artikkeleissa esitetyt analyysit ovat lähellä diskursiivista uusinstitutionalistista hallinnan tutkimuksen traditiota sekä Michel Foucault n inspiroimaa hallinnan ja hallintamentaliteettien tutkimuskenttää. Yleisen hallinnan mekanismien analyysin rinnalla osatutkimukset paljastavat sisällöllisesti, kuinka kansainväliset rankingit, atomistisen logiikan pohjalle rakentuessaan, vahvistavat ja ylläpitävät yleistä kilpailuideologiaa sekä tukevat uusliberaalin taloudellisen argumentaation ensisijaisuutta julkishallinnossa ja korkeakoulupolitiikan alalla