Effects of Changes in Public Policy on Efficiency and Productivity of General Hospitals in Vietnam

The health sector reform programme which began in Vietnam in 1989 in order to improve the efficiency of the health system has altered the way in which Vietnamese hospitals operate. The programme put the spotlight on input savings. This study aims to examine the relative efficiency of hospitals during the health reform process and assess - by looking at the relative efficiency of hospitals - the effects of the regulatory changes. The study employs the DEA two-stage approach referring to data from 101 general public hospitals over the period 1998-2006. The study revealed that there was evidence of improvement in the productivity of Vietnamese hospitals over the period 1998-2006, with a progress in total factor productivity of 1.4% per year. Furthermore, the differences in hospital efficiency can be attributed to both the regulatory changes and hospital-specific characteristics. The user fees and autonomy measures were found to increase technical efficiency. Provincial hospitals were revealed to be more technically efficient than their central counterparts and hospitals located in the North East, South East and Mekong River Delta regions performed better that hospitals from other regions

Social Networks, Corruption and Institutions of Accounting, Auditing and Accountability

Purpose: The purpose of this paper is to investigate institutions of accountability in Zambia in order to understand how social networks may influence such institutions not to discharge their mandates as expected from time to time. The study equally seeks to explore how social networks may perpetuate corrupt activities and compromise the functioning of institutions of accountability. Design/methodology/approach: The conceptual framework adopted in this study draws on insights from social network theory (SNT) and Bourdieu’s ideas of capital to devise a critical lens for investigating network activity and its influence on the functioning of institutions of accountability. Qualitative data were collected through semi-structured interviews with respondents drawn from different institutions of accountability. Social network analysis was conducted through content analysis. Findings: Research findings highlight the presence of networks of a corrupt nature operating within government structures and some institutions of accountability. Manifested in the form of systemic and familial archetypes, these networks appear to be championed and propelled by senior government officials like controlling officers and other actors of a political nature including ministers and presidents. Most of these corrupt activities are organised through brokerage mechanisms that interface internal and external networks. Research limitations/implications: Due to the clandestine nature of corruption activities, however, the study was unable to determine measures of centrality and density since these details were not forthcoming during interviews. Such information could only become available if willing individuals involved in corruption could be identified so that they explain who they conduct their corruption with together with the number of connections involved and the most influential individuals in those networks. Social implications: This study helps us to understand that activities of a corrupt nature are often undertaken through well-connected groups and networks that make it difficult for institutions of accountability to detect and untangle such activity. The study also suggests that accountants and other accountability actors may have forgotten that accounting is not just a technical discourse for enhancing one’s economic status but is an ethical profession as well. There is a great need to put institutions in place which should hold everyone, including the president and ministers, accountable to the Zambian people in the light of wrongdoing. Dismantling the corrupt network activities inferred from the data entails a complete top-down change in systems of politics, governance, wealth distribution and social values. Originality/value: This study contributes towards filling the gap of undertaking accounting research of a critical nature focussed on African contexts (Rahaman, 2010). The paper is equally an attempt at providing empirical flesh to Laughlin’s (1991) framework on organisational transformations through complementing that framework with SNT. The study is also among the first to draw on the experiences and insights of actors working within institutions of accountability to highlight accountability challenges within an African context

Radiation Synthesis of Adsorbents for Phosphate Removal from Aqueous Systems

Nonwoven fabrics made of PE coated PP fibres were irradiated by accelerated electrons in inert atmospheres for grafting of two different monomers, glycidyl methacrylate and dimethylaminoethyl methacrylate. Grafting conditions were optimized by a systematic investigation of the effects of absorbed dose, monomer concentration, reaction temperature and duration. 150% grafted copolymers were later modifed by protonation and quaternization of  poly(dimethylaminoethyl methacrylate) chains and by Cu(II) loading of dipyridyl amine modified poly(glycidyl methacrylate) graft chains. The PE/PP based adsorbents thus prepared were used for their suitability of removing phosphate ions from aqueous systems. Adsorption/ removal studies were carried out in both batch and continuous flow type systems. The selevtivity of adsorption of phosphate ions in the presence of other competing anions were also checked showing the enhanced selectivity for phosphate ions

Effects of Two Fluoride Varnishes and One Fluoride/Chlorhexidine Varnish on Streptococcus mutans and Streptococcus sobrinus Biofilm Formation in Vitro

Aims: The aim of this study was to evaluate and to compare the effect of two fluoride varnishes and one fluoride/chlorhexidine varnish on Streptococcus mutans and Streptococcus sobrinus biofilm formation, in vitro

The Effects of Oxidative Stress in Urinary Tract Infection During Pregnancy

The purpose of this study was to determine the effect of urinary tract infection (UTI) on antioxidant systems and lipid peroxidation (LPO) levels during pregnancy. We also investigated if these antioxidant systems and LPO levels differed in each trimester. One hundred forty-three nonpregnant women, as a control group, and 77 pregnant women were included in the study. Urine cultures were performed according to standard techniques. Catalase (CAT), superoxide dismutase (SOD), and LPO levels were measured using a spectrophotometer. UTI was observed in 14 of 77 pregnant women and the isolated microorganisms were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus. CAT, SOD, and LPO levels were increased in pregnant women compared with nonpregnant women (P < .01). CAT, SOD activities, and LPO levels were increased from the first trimester to the third trimester in pregnancy without UTI. However, CAT and SOD activities were decreased, LPO levels were increased from the first trimester to the third trimester in pregnancy with UTI (P < .01). Pregnancy causes oxidative stress and also UTI during pregnancy may aggravate oxidative stress

Waiting time targets and informal professional networks in English NHS

Purpose: This paper examines the relationship between key actors in an organisation and informal professional networks. It uses pragmatic constructivism (PC) as a research paradigm together with concepts borrowed from the theory of social networks to investigate how these actors responded to a particular set of non-financial performance targets. Design/methodology/approach: The implementation process of waiting time targets in the Accident and Emergency Department was observed as part of an in-depth study at a large English National Health Service hospital. The main sources of data were face-to-face interviews with key actors, documentary archival evidence and observation diaries. Findings: The results indicated that with the effect of information sharing through these networks, implementation methodology switched from systems approach to actors approach. Professional connections between key actors had allowed them to generate their own understanding in responding to new performance measures. As a consequence, the perceptions of other actors in relevant networks, as well as the implementation practices were influenced. Research limitations/implications: This is a single-site, in-depth case study; hence, the findings are not generalizable. Practical implications: This study demonstrated just how influential some key actors can be in shaping the implementation of performance measures. Originality/value: The paper contributes to PC by providing evidence on the influence of informal professional networks and structural holes in shaping organisational topos

Explaining health managers' information seeking behaviour and use

The aims of the project were to analyse the information behaviour of health service managers in decision-making, to identify the facilitators and barriers to the use of information, and to develop guidelines for improving practice. The study employed a mixed methodology in two phases - five qualitative case studies, and a national survey of managers, and NHS librarians. Managers used a variety of different sources, online, written, people/ networks, and education and training courses. Internet/online sources were very widely used, but personal contacts are more important, and there was also a heavy use of internal Trust data. Only one third found it easy to find information relevant to their work as a manager. They also found it difficult to access information either through lack of time, information overload, or not knowing where to find it. Training in information search was helpful, but those with significant expertise in search and research based sources – librarians and medical staff – reported most difficulty in finding information related to management. However, those who have studied management find it easier, indicating that grounding in management knowledge is important for effective search, selection and application

Boundary Spanners and Calculative Practices

This paper questions to what extent particular calculative practices used for inter organisational decision-making help or hinder boundary spanners meet performativity ideals. It uses programmatic rationalities of government as a framework to study reciprocity between them and the conditions of performativity. Empirical data was collected from health care commissioning spaces of English NHS. Data triangulation was achieved through documentary analysis, data collected through interviews, and observation notes taken in local commissioning meetings and national conferences. Findings revealed an apparent lack of reciprocity between programmatic rationality and calculative practices surrounding the commissioning activities of boundary spanners. As a consequence, in local commissioning situations boundary spanners with formal roles used calculative practices differently than semi-formal boundary spanners. Unlike their formal counterparts, who used only accounting information in their calculative practices, semi-formal boundary spanners incorporated non-accounting information and devised alternative calculative practices. In addition, while formal boundary spanners on NHS Committees used calculative practices in maintaining clear boundaries between commissioning and provider organisations, semi-formal boundary spanners observed made use of the data of both parties in order to reach inter organisational decisions. The study has three main contributions. First, it differentiates boundary spanners and explains differences in their interaction with calculative practices. Second, it introduces the concept of reciprocity to inter-organisational studies in accounting. Third, it shows how conditions of performativity reflected in micro settings influenced how semi-formal boundary spanners used calculative practices (and other supplementary information) to achieve performance ideals of government programmes

Uncertainty and commitment in commissioning of health services

This article reports on the use of management accounting information in commissioning of health services in England. The effects of environmental pressures and uncertainty on the use of this information in the decision-making process was examined. The relationship was further analysed from the perspective of interorganizational dependence and commitment with reference to particular financial management and budgeting practices. A more integrated approach to health care commissioning could be achieved by better harmonizing fund allocation, performance measurement and management systems and by supporting cultivation of joint multiprofessional groups so that regional hubs of information could be used to formulate consistent, bottom-up and lasting local strategies to secure inter-organizational trust and mutual dependency between local health alliances