What kinds of insights do Safety-I and Safety-II approaches provide? a critical reflection on the use of SHERPA and FRAM in healthcare

Over the past decade, the field of healthcare has seen a significant shift in its approach to patient safety. Traditionally, safety efforts focused on understanding past harm and preventing errors, primarily through the use of standardisation and the introduction of barriers and safeguards, such as standardised communication protocols (e.g., SBAR (Haig et al., 2006)), checklists (e.g., WHO surgical safety checklist (Haynes et al., 2009)) and technology with safety features (e.g., smart infusion pumps (Taxis and Franklin, 2011)). This type of thinking about patient safety in terms of past harm and errors is also referred to as Safety-I (Hollnagel, 2014), even though this terminology has been criticised as it does not reflect adequately the diversity in safety science thinking (Leveson, 2020). However, the evidence for whether interventions based on this (Safety-I) thinking lead to improvements in patient safety is mixed at best (Kellogg et al., 2017, Wears and Sutcliffe, 2019), and critics have argued that the additional “safety clutter” produced as a result of such interventions might be counterproductive (Rae et al., 2018, Halligan et al., 2023).This work was funded by the National Institute for Health Research (NIHR) [Programme Grant for Applied Research NIHR200868

The cultural grammar of governance: The UK Code of Corporate Governance, reflexivity, and the limits of 'soft' regulation

We identify limits of ‘reflexive governance’ by examining the UK Code of Corporate Governance that is celebrated for its ‘reflexivity’. By placing the historical genesis of the Code within its politico-economic context, it is shown how its scope and penetration is impeded by a shallow, ‘single loop’ of reflexivity. Legitimized by agency theory, the Code is infused by a ‘cultural grammar’ that perpetuates relations of shareholder primacy as it restricts accountability to narrow forms of information disclosure directed exclusively at shareholders. Engagement of a deeper, ‘double loop’ reflexivity allows account to be taken of the historical conditions and theoretical conceptions that shape practices and outcomes of corporate governance. Only then is it possible to disclose, challenge and reform narrow conceptions, boundaries and workings of ‘reflexive governance’

"Outroduction”: A Research Agenda on Collegiality in University Settings

Collegiality is the modus operandi of universities. Collegiality is central to academic freedom and scientific quality. In this way, collegiality also contributes to the good functioning of universities’ contribution to society and democracy. In this concluding paper of the special issue on collegiality, we summarize the main findings and takeaways from our collective studies. We summarize the main challenges and contestations to collegiality and to universities, but also document lines of resistance, activation, and maintenance. We depict varieties of collegiality and conclude by emphasizing that future research needs to be based on an appreciation of this variation. We argue that it is essential to incorporate such a variation-sensitive perspective into discussions on academic freedom and scientific quality and highlight themes surfaced by the different studies that remain under-explored in extant literature: institutional trust, field-level studies of collegiality, and collegiality and communication. Finally, we offer some remarks on methodological and theoretical implications of this research and conclude by summarizing our research agenda in a list of themes

SWOT analysis of the use of digital health technologies in primary health care in the Sub-Saharan African Region: a qualitative study

Background: In many health systems globally, digital health technologies (DHT) have become increasingly commonplace as a means of delivering primary care. COVID-19 has further increased the pace of this trend. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how DHT implementation has been realised in the sub-Saharan Africa (SSA) healthcare environment remains to be further explored. Objective: To capture the multidisciplinary experiences of SSA experts and primary care healthcare providers using DHTs to explore the strengths and weaknesses, as well as opportunities and threats regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (i.e., online focus groups and semi-structured interviews), using an online platform. Participants were recruited through AfroPHC and researchers contact networks, using convenience sampling, and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews and focus groups, using the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Transcripts were compiled verbatim and systematically reviewed by two independent reviewers using thematic analysis to identify emerging themes. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to ensure the study meets the recommended standards of qualitative data reporting. Results: Strengths of DHT use ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust, to greater collaboration, enabling safer decision-making, and hastening progress towards universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline healthcare resource expenditure, and provide a means to learn international best practices. Major threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and means for patient data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context, as a fast-moving health delivery modality, as well as the need for multi-stakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region, and its implications on health and health care equity, capitalising on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realised when informed by studies that incorporate patient perspective at every stage of the research cycle

Exploring CRM effectiveness: an institutional theory perspective

This study identifies the potential contribution that institutional theory can make to understanding the success of marketing practices. Based on institutional theory, we argue that the effectiveness of marketing practices decreases when firms are motivated to adopt such practices under the influence of institutional pressures originating in firms' environments. However, alignment between a practice and a firm's marketing strategy may buffer against these negative effects. We apply these insights to the case of customer relationship management (CRM). CRM is considered an important way to enhance customer loyalty and firm performance, but it has also been criticized for being expensive and for not living up to expectations. Empirical data from 107 organizations confirm that, in general, adopting CRM for mimetic motives is likely to result in fewer customer insights as a result of using this practice. Our study suggests that institutional theory has much to offer to the investigation of the effectiveness of marketing practices

Comparative genomics of proteins involved in RNA nucleocytoplasmic export

Background: The establishment of the nuclear membrane resulted in the physical separation of transcription and translation, and presented early eukaryotes with a formidable challenge: how to shuttle RNA from the nucleus to the locus of protein synthesis. In prokaryotes, mRNA is translated as it is being synthesized, whereas in eukaryotes mRNA is synthesized and processed in the nucleus, and it is then exported to the cytoplasm. In metazoa and fungi, the different RNA species are exported from the nucleus by specialized pathways. For example, tRNA is exported by exportin-t in a RanGTP-dependent fashion. By contrast, mRNAs are associated to ribonucleoproteins (RNPs) and exported by an essential shuttling complex (TAP-p15 in human, Mex67-mtr2 in yeast) that transports them through the nuclear pore. The different RNA export pathways appear to be well conserved among members of Opisthokonta, the eukaryotic supergroup that includes Fungi and Metazoa. However, it is not known whether RNA export in the other eukaryotic supergroups follows the same export routes as in opisthokonts. Methods: Our objective was to reconstruct the evolutionary history of the different RNA export pathways across eukaryotes. To do so, we screened an array of eukaryotic genomes for the presence of homologs of the proteins involved in RNA export in Metazoa and Fungi, using human and yeast proteins as queries. Results: Our genomic comparisons indicate that the basic components of the RanGTP-dependent RNA pathways are conserved across eukaryotes, and thus we infer that these are traceable to the last eukaryotic common ancestor (LECA). On the other hand, several of the proteins involved in RanGTP-independent mRNA export pathways are less conserved, which would suggest that they represent innovations that appeared later in the evolution of eukaryotes. Conclusions: Our analyses suggest that the LECA possessed the basic components of the different RNA export mechanisms found today in opisthokonts, and that these mechanisms became more specialized throughout eukaryotic evolution

“Outroduction” : a research agenda on collegiality In university settings

Collegiality is the modus operandi of universities. Collegiality is central to academic freedom and scientific quality. In this way, collegiality also contributes to the good functioning of universities’ contribution to society and democracy. In this concluding paper of the special issue on collegiality, we summarize the main findings and takeaways from our collective studies. We summarize the main challenges and contestations to collegiality and to universities, but also document lines of resistance, activation, and maintenance. We depict varieties of collegiality and conclude by emphasizing that future research needs to be based on an appreciation of this variation. We argue that it is essential to incorporate such a variation-sensitive perspective into discussions on academic freedom and scientific quality and highlight themes surfaced by the different studies that remain under-explored in extant literature: institutional trust, field-level studies of collegiality, and collegiality and communication. Finally, we offer some remarks on methodological and theoretical implications of this research and conclude by summarizing our research agenda in a list of themes

From Interactions to Institutions: Microprocesses of Framing and Mechanisms for the Structuring of Institutional Fields

Despite the centrality of meaning to institutionalization, little attention has been paid to how meanings evolve and amplify to become institutionalized cultural conventions. We develop an interactional framing perspective to explain the microprocesses and mechanisms by which this occurs. We identify three amplification processes and three ways frames stack up or laminate that become the building blocks for diffusion and institutionalization of meanings within organizations and fields. Although we focus on “bottom-up” dynamics, we argue that framing occurs in a politicized social context and is inherently bidirectional, in line with structuration, because microlevel interactions instantiate macrostructures. We consider how our approach complements other theories of meaning making, its utility for informing related theoretical streams, and its implications for organizing at the meso and macro levels