ERM Adoption in the Insurance Sector – Is it a Regulatory Imperative or Business Value Driven?

Purpose - This paper aims to investigate various institutional pressures driving the adoption and implementation of a new risk management system; enterprise risk management (ERM). Design/methodology/approach - The implementation of ERM-related practices is analysed based on an institutional framework and drawing on empirical evidence from multiple sources in 10 large/medium-sized insurance companies. This paper focuses on extraorganisational pressures exerted by political, social and economic institutions on insurance companies, which drove the adoption decision. Findings - It was found that different change agents have taken part in the decision to introduce new risk management system as a part of ERM implementation process. Further, the institutional pressures; coercive, mimetic and normative, were found to differ in character and strength over different intervals of time in relation to the adoption of ERM. Companies that adopted ERM early were mostly driven by internal strategic drivers while the recent adoption decision was more driven by coercive and mimetic pressures. Thus, evidence of divergence between insurance companies was found. Research limitations and implications - The findings have implications for policy makers, regulatory agencies and innovation developers. ERM was considered not only as a necessity but also as a value added to the insurance companies under study. Thus, regulators and innovation developers should survey main players in any specific organisational field to understand their views before issuing new compulsory regulations or developing innovations. They also need to consider exploring companies' experiences with ERM, which can provide a basis for the development of strengthened and more informative regulatory ERM frameworks. This will support a faster and easier understanding and implementation of ERM framework hindered by the confusions companies may face when considering the complicated/changing regulatory and risk requirements. Originality/value - This study extends the scope of institutional analysis to the risk management field, particularly ERM and to the explanation of how different institutions affect the decision to move towards ERM and modify the risk management rules applied within the organisational environment. It looks not only at convergences but also divergences associated with the period of time when ERM adoption decision was made. Thus, it develops a processual view of change

Inpatient falls in adult acute care settings: influence of patients’ mental status

tzeng h.-m. (2010)  Inpatient falls in adult acute care settings: influence of patients’ mental status. Journal of Advanced Nursing   66 (8), 1741–1746. Inpatient falls in adult acute care settings: influence of patients’ mental status. This paper is a report of a study of fallers’ mental status as one of the patient-related intrinsic risk factors for falls.Whether confusion is one of the most important risk factors associated with risk of falling in hospital settings is unclear. Literature reviews have not identified consistent evidence for effective preventive interventions for patients with mental status deficits.This retrospective research was conducted in six adult acute care units in a community hospital in the United States of America. The data source was the 1017 fall incidents occurring between 1 July 2005 and 30 April 2009. Descriptive statistics and Pearson chi-square tests were used to analyse the data.The presence of mental status deficits was identified as the dominant issue in 346 (34%) falls. The group of fallers with mental status deficits (32·1%, n  = 111) seemed to have fewer toileting-related falls than those without mental status deficits (46·7%, n  = 314). Fallers with mental status deficits tended to have more severe fall injuries than those without mental status deficits (χ 2  = 10·08, d.f. = 3, P  = 0·018).Risk assessment and targeted surveillance should be used as part of falls prevention policy. Involving nursing staff and family members in assessing a patient’s mental status may help to prevent falls caused by mental status deficits.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79196/1/j.1365-2648.2010.05343.x.pd

Regulating financial conglomerates

We investigate the optimal regulation of financial conglomerates which combine a bank and a non-bank financial institution. The conglomerate’s risk-taking incentives depend upon the level of market discipline it faces, which in turn is determined by the conglomerate’s liability structure. We examine optimal capital requirements for stand-alone institutions, for integrated financial conglomerates, and for financial conglomerates that are structured as holding companies. For a given risk profile, integrated conglomerates have a lower probability of failure than either their stand-alone or decentralized equivalent. However, when risk profiles are endogenously selected, conglomeration may extend the reach of the deposit insurance safety net and hence provide incentives for increased risk-taking. As a result, integrated conglomerates may optimally attract higher capital requirements. In contrast, decentralised conglomerates are able to hold assets in the socially most efficient place. Their optimal capital requirements encourage this. Hence, the practice of “regulatory arbitrage”, or of transferring assets from one balance sheet to another, is welfare-increasing. We discuss the policy implications of our finding in the context not only of the present debate on the regulation of financial conglomerates but also in the light of existing US bank holding company regulation

Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: an exploratory survey study in four USA hospitals

<p>Abstract</p> <p>Background</p> <p>Little research has been done on patient call light use and staff response time, which were found to be associated with inpatient falls and satisfaction. Nurses' perspectives may moderate or mediate the aforementioned relationships. This exploratory study intended to understand staff's perspectives about call lights, staff responsiveness, and the reasons for and the nature of call light use. It also explored differences among hospitals and identified significant predictors of the nature of call light use.</p> <p>Methods</p> <p>This cross-sectional, multihospital survey study was conducted from September 2008 to January 2009 in four hospitals located in the Midwestern region of the United States. A brief survey was used. All 2309 licensed and unlicensed nursing staff members who provide direct patient care in 27 adult care units were invited to participate. A total of 808 completed surveys were retrieved for an overall response rate of 35%. The SPSS 16.0 Window version was used. Descriptive and binary logistic regression analyses were conducted.</p> <p>Results</p> <p>The primary reasons for patient-initiated calls were for toileting assistance, pain medication, and intravenous problems. Toileting assistance was the leading reason. Each staff responded to 6 to 7 calls per hour and a call was answered within 4 minutes (estimated). 49% of staff perceived that patient-initiated calls mattered to patient safety. 77% agreed that that these calls were meaningful. 52% thought that these calls required the attention of nursing staff. 53% thought that answering calls prevented them from doing the critical aspects of their role. Staff's perceptions about the nature of calls varied across hospitals. Junior staff tended to overlook the importance of answering calls. A nurse participant tended to perceive calls as more likely requiring nursing staff's attention than a nurse aide participant.</p> <p>Conclusions</p> <p>If answering calls was a high priority among nursing tasks, staff would perceive calls as being important, requiring nursing staff's attention, and being meaningful. Therefore, answering calls should not be perceived as preventing staff from doing the critical aspects of their role. Additional efforts are necessary to reach the ideal or even a reasonable level of patient safety-first practice in current hospital environments.</p

Validation of the care transition measure in multi-ethnic South-East Asia in Singapore

10.1186/1472-6963-12-256BMC Health Services Research121

Comparing exercise interventions to increase persistence with physical exercise and sporting activity among people with hypertension or high normal blood pressure: study protocol for a randomised controlled trial

BACKGROUND: Increasing physical activity is known to have health benefits for people with hypertension and related conditions. Current general practitioner referrals for gym-based exercise increase physical activity but meta-analyses show that while these are effective the absolute health risk reduction is small due to patients failing to maintain activity levels over time. This study assesses the effectiveness of two sports-oriented interventions that are intended to bridge the intention-behaviour gap and thus increase the likelihood of sustained increases in physical activity. METHODS/DESIGN: Four-arm randomised controlled trial. The study tests two types of intervention that are intended to increase physical activity among currently inactive 18- to 74-year-old people with hypertension or high-normal blood pressure. This study will assess the effectiveness of a 12-week sports-oriented exercise programme, the efficacy of a web-delivered self-help tool to promote and support sports participation and healthy behaviour change and the effect of these interventions in combination. The control arm will be a standard care general practitioner referral for gym-based exercise. Participants will be allocated using block randomisation. The first author and primary analyst is blinded to participant allocation. The primary outcome measures will be time spent in physical activity assessed in metabolic equivalent minutes per week using the International Physical Activity Questionnaire 1 year after commencement of the intervention. Secondary outcomes include increased involvement in sporting activity and biomedical health outcomes including change in body mass index, and waist and hip measurement and reductions in blood pressure. DISCUSSION: If proven to be superior to general practitioner referrals for gym-based exercise, these sports-oriented interventions would constitute low-cost alternatives. The next stage would be a full economic evaluation of the interventions. TRIAL REGISTRATION: Current Controlled Trials ISRCTN71952900 (7 June 2013)