Entrepreneurial dynamics and social responsibility: mapping an expanded intellectual territory

Objectives: (1) To provide a constructive critique of the interface between the entrepreneurial growth dynamics research and social responsibility literatures; (2) to explore opportunities for making new connections between these literatures in order to address substantive ‘gaps’ in research and policy-making ; (3) to map the broader intellectual territory implied by this critique; (4) to outline a tentative research agenda. Prior work: The paper draws on two main strands of research: entrepreneurial growth dynamics and (corporate) social responsibility. While much has been achieved in the social responsibility literature with regards to established practices, we argue that insufficient attention has been paid to the more ‘entrepreneurial’ dimensions. At the same time, the current wave of enthusiasm for new models of socially-responsible enterprise has opened up a series of new research questions, including: (i) how are these organisational forms likely to grow and develop over the longer-term, at an intra-organisational level, and in terms of emerging inter-organisational relationships?; (iii) how will other actors respond to these developments?; (ii) what are the implications of the resulting dynamics for social, environmental and economic sustainability? Approach: The paper is based around a critical review of the relevant literatures, focusing on the role of entrepreneurial opportunity and capabilities in shaping entrepreneurial growth dynamics. The discussion addresses current methodological debates and considers how social responsibility can be integrated into the analysis. In doing so, it builds on a research tradition that has promoted historically-informed multi-level and co-evolutionary analysis and argues that such techniques are required in order to gain a better understanding of these phenomena. Results: We outline a research agenda, illustrated with a number of questions of particular relevance to researchers, policy-makers and practitioners Implications: The paper identifies a number of issues for researchers and policy-makers and practitioner audiences. It calls for a broadening of the intellectual territory around socially-responsible enterprise. Process-based and multi-level analysis of growth dynamics extends its temporal and organisational boundaries to encompass longer-term interactions and a wider range of actors. Value: The paper is designed to facilitate and to encourage more constructive interaction between research communities concerned with: social responsibility, social enterprise and process-based approaches to entrepreneurship. It advances understanding by mapping an intellectual space that is neither fully revealed in, nor adequately addressed by, existing bodies of knowledge

Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes

Background Despite the existence of multiple validated risk-assessment and quality benchmarking tools in surgery, their utility outside of High Income Countries is limited. We sought to derive, validate and apply a scoring system that is both 1) feasible, and 2) reliably predicts mortality in a Middle Income Country (MIC) context. Methods A 5-step methodology was used: 1. Development of a de novo surgical outcomes database modeled around the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA Dataset) 2. Use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection 3. Use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP 4. Apply the score in the original SA dataset and demonstrate it’s performance 5. Identify threshold cutoffs of the score to prompt action and drive quality improvement. Results Following Step one-three above, the 13 point Codman’s score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: 1) age≥65 (1), partially or completely dependent functional status (1), preoperative transfusions≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia (ASA) score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an inhospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths. Conclusion We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both 1) preoperative decision-making and 2) benchmarking the quality of surgical care in MIC’s

Implementation of a structured surgical quality improvement programme

As surgery assumes a greater position in the global health agenda, the need to not only improve access to surgical care but also improve the quality of surgical care, is paramount. Surgical quality improvement programmes have been shown to reduce morbidity and mortality following surgery. A key first step to the design and implementation of a structured surgical quality improvement programme is the collection and analysis of high-quality data. To quote Dr. Margaret Chan, the director general of the World Health Organisation, '…the real need (in global health) is to close the data gaps, especially in low and middle-income countries, so that we no longer have to rely heavily on statistical modeling for data on disease burden.' In this thesis it was hypothesized that emerging m-Health technology, defined as medical and public health practices supported by the use of mobile devices, would provide a solution to close such data gaps. Various m-Health applications were used to develop three databases describing the outcomes of major surgery performed within the Cape Metro West health district during the study period. After reviewing the design and analytical rationale of the American College of Surgeons National Surgical Quality Improvement Programme and Trauma Quality Improvement Programme, these de novo databases were used to develop three quality improvement programmes designed for local implementation: The Essentials programme for general and vascular surgery, a Procedure-targeted programme and a trauma quality improvement programme. Key to these programmes was the derivation and validation of prediction rules which reliably estimate the probability of an adverse outcome following major surgery in a risk-adjusted manner. Such rules promote internal and external benchmarking over time to identify opportunities for quality improvement and critically appraise the impact of any corrective action implemented. In order to improve the quality of surgical care we provide, a continuous cycle of monitoring, assessment, and management should be performed routinely. This thesis provides some guidance of how this can be done within the Cape Metro West health district