Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing

Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-36 scores. Medical and nursing diagnoses explained large variations in client outcomes. Clients cared for by degree-prepared nurses improved knowledge and behavior scores. Unanticipated case complexity was negatively associated with client outcome even with nursing intervention. The study revealed that "for every unit increase in assignment of baccalaureate-prepared nurses, clients will on average demonstrate an 80% greater likelihood of improvement in knowledge scores and a 120% greater likelihood of improvement in behavior scores in relation to their health condition at discharge." This two-part study has offered insight into the controllable variables influencing the cost and quality of home care services.     

Wages & benefits of nursing personnel in nursing homes: correcting the inequities

The nursing home industry is an increasingly important component of long-term care. Yet major problems in access and quality are evident. Correcting the inadequate wages and benefits of nursing home personnel is a necessary first step in addressing this issue.     

The impact of nursing on patient and organizational outcomes

The impact of nursing on patient and organizational outcomes has received significant attention from researchers in the past 10 years. Although some research has been based on a theoretical framework, to date, there has not been one, consistent framework that can guide this research. In addition, the frameworks that have been used do not identify nursing as the pivotal concept in the model. The purpose of this article is to identify a framework to guide such research with an emphasis on nursing as the essential concept. Unit culture, nurse staffing, staffing mix, and other variables do not have a direct effect on outcomes. It is only through these variables' influence on the delivery of nursing care that outcomes are affected.     

Linking nursing unit's culture to organizational effectiveness: a measurement tool

Organizational culture consists of the deep underlying assumptions, beliefs, and values that are shared by members of the organization and typically operate unconsciously. The four organizational culture traits of the Denison Organizational Culture Model (DOCM) are characteristics of organizational effectiveness, which include adaptability, involvement, consistency, and mission. Effective organizations demonstrate high levels of the four cultural traits which reflect their ability to balance the dynamic tension between the need for stability and the need for flexibility within the organization. The Denison Organizational Culture Survey (DOCS) is a measurement tool that was founded on the theoretical framework of the DOCM, and in the field of business, is one of the most commonly used tools for measuring organizational culture. The DOCS offers a promising approach to operationalizing and measuring the link between organizational culture and organizational effectiveness in the context of nursing units.     

The impact of the corporate income tax: evidence from state organizational form data

By taxing the income of corporate firms at a different rate than non-corporate firms, taxes can play an important role in a firm's choice of organizational form. The sensitivity of the organizational form decision to tax rates provides a key indicator of the distortion created by the corporate income tax. This paper uses new cross-sectional data on organizational form choices across states compiled in the Census of Retail Trade to estimate this sensitivity. The results document a significant impact of the relative taxation of corporate to personal income on the share of real economic activity that is done by corporations and that the impact is many times larger than has been found in the previous empirical literature based on time-series data. The results show little impact, however, on the actual operations of firms such as their labor intensity, wages and the like. They do indicate that firms are able to exploit the progressivity of the corporate income tax system by dividing into numerous firms.     

Application capability of e-business, e-business success, and organizational performance: Empirical evidence from China

Previous research efforts suggested that firms' overall e-business success tends to deliver greater organizational performance. However, few researchers examined how a firm leverages e-business investment to gain greater e-business success. Even fewer researchers investigated the different impacts of different levels of e-business success on organizational performance. This paper addresses two questions: (1) what capabilities influence a firms' ability to build e-business success and enjoy greater organizational performance, where firm-level e-business success is measured by e-business service capability and IT-enabled collaborative advantage; and (2) whether the two ways of measuring e-business success result in different impacts on organizational performance? We propose that a firm's application capability of e-business involving systems development and systems usage is positively related to a firm's overall e-business success, thus having a positive impact on organizational performance. We use survey data from 152 Chinese manufacturing firms and their B2B e-business systems participants to test our theoretical hypotheses and proposed model. The findings suggest that both systems development and systems usage have significant and positive impacts on e-business service capability, which in turn leads to greater IT-enabled collaborative advantage. This finding could be translated into the important role of a firm's application capability of e-business on e-business success. It is concluded that the application capability of e-business acts as one of the main mechanisms through which the e-business investment leads to greater e-business success. We also find that IT-enabled collaborative advantage, compared with e-business service capability, has a more significant and greater impact on organizational performance. This study extends prior e-business success research by opening up the ‘black box’ between a firm's e-business investment and its e-business success, and by distinguishing the relative impacts of e-business service capability versus IT-enabled collaborative advantage on organizational performance. Another contribution of this study is that the effect of context factors (firm size, industry, and system duration) in developing country on our proposed model.     

Fringe benefits and small businesses: evidence from the federal reserve board small business survey

Data from the 1993 National Survey of Small Businesses (NSSBF) is used to analyse the factors affecting the provision of pensions and health insurance by small businesses. The race of the business owner is found to impact the provision of taxadvantaged fringe benefits, even after accounting for a wide range of other economic and demographic variables. It is not possible to determine why owner race impacts the provision of fringe benefits by small businesses but the significance of the race variable might reflect a lower level of marketing effort by financial service firms in minority-dominated communities. The owner education variable, which is also significant in both the pension and health insurance models, could also be a proxy for the availability of general information about the importance of fringe benefits. With the exception of the sole proprietorship variable, the demographic and economic variables appear to have similar effects on the provision of both pensions and health insurance by small businesses. Some sole proprietors appear to prefer pension benefits to health insurance benefits possibly because pensions allow the business owner to shield some assets in the case of bankruptcy.     

Local financial benefits of rain forests: comparative evidence from Amerindian societies in Bolivia and Honduras

Researchers generally express the local value of tropical rain forests in dollars/ha/year. The approach is problematic because it produces low values to local users, underestimating the importance of the forest expressed as a share of household consumption or earnings. Here we contribute to valuation studies of rain forests by estimating the financial importance of the forest measured in three ways: (1) the contribution of forests to annual household consumption and (2) earnings; and (3) the value of a hectare of rain forest to villagers measured through the biological goods consumed and sold. We collected panel data on consumption and earnings from 81 households in four villages of two Amerindian societies in two nations (Tsimane’, Bolivia; Tawahka, Honduras). Analyses suggest: (1) forests account for a large share of household consumption (median 38.5%; range 14.65–53.11%); (2) forests contribute more to household consumption than to household earnings (median 22.69%; range 16.56–44.81%); (3) the relative contribution of forests to household consumption and earnings falls among villages closer to towns; and (4) the range of values/year of rain forest/ha is US$7.10–9.70 using 1999 dollars or US$18.46–46.56 using purchasing power parity indexes, below previous estimates. Results show much variation in forest values; valuation methods and stakeholder perspectives affect the variation. Given the variation, a useful strategy to promote forest conservation would transfer income to villagers to compensate them for non-local forest values.     

Predicting nurses' organizational and professional identification: the effect of nursing roles, professional autonomy, and supportive communication

Recruiting and retaining qualified nursing staff is of growing importance to today's hospital and nurse leaders. Findings from a survey completed by 190 RNs at a major teaching hospital revealed that nursing roles, professional autonomy, and supportive communication were differentially related to the nurses' organizational and professional identification. Professional autonomy was by far the strongest predictor of nurse identification, followed by manager and co-worker support. Co-worker support and traditional nursing roles predicted nurse professional identification, but neither traditional nor collaborative roles predicted nurses' identification with their organization. Communication strategies intended to help executives retain qualified nursing staff are presented.     

The impact of benefits on unemployment in Britain in the interwar period: Some further empirical evidence

Smyth's (1983) model of the labor market is modified to allow for real wage rather than money wage adjustment. The results reported by Smyth are robust with respect to this change in specification.     

Children’s health benefits of reducing environmental tobacco smoke exposure: evidence from parents who smoke

This paper uses data from the 1991 National Maternal and Infant Health Survey to estimate propositions derived from a model of intrahousehold allocation, wherein parents engage in a consumption activity (smoking) that produces own utility, while generating environmental tobacco smoke (ETS) that harms their children’s health. We find a statistically significant negative association between sample mothers‘ assessed health of their children and the children’s daily exposures to ETS. Mothers’ average annual willingness-to-pay (WTP) for a 1-hour-per-day reduction in child ETS exposure (about a 17% decrease in daily exposure) is about $150. WTP estimates for respondent mother and child health status further suggest that smoking mothers on average value their child’s health roughly 55% higher than their own health. Helpful comments and suggestions by Scott Atkinson, Donald Kenkel, and two anonymous referees are gratefully acknowledged. Marcy Agee and Stefanos Nastis provided valuable research assistance. Although the U.S. Environmental Protection Agency provided financial support through Grant#R82871601, the research has not been subjected to the Agency’s required peer and policy review and therefore does not necessarily reflect the views of the Agency     

On leadership organizational intelligence/organizational stupidity: the leader's challenge

Creating organizations with a high IQ or creating organizations without the necessary intelligence guarantees success or failure of the organization. Without structures such as shared leadership and other forms of participative management, the organization or unit cannot access and use the available information and wisdom in the organization. When nurses and other health care professionals do not feel like they have a shared stake and do not feel like citizens of the organization, they lack passion for the organization's work. When nurses feel a sense of share ownnership and autonomy for the clinical practice, terrific outcomes are achieved. Leaders must accept the challenge to build the infrastructure that leads to excellence in organizational IQ.     

Telephone pools and economic incentives

We identify the incentive structure for a firm that participates in a pooling arrangement. These pooling arrangements have been common in the telecommunications industry, both in the United States and in Canada. We identify alternative mechanisms, including cost caps, yardstick competition, transfer prices, and fixed revenue allocators. A pooling firm has inferior incentives for cost reducing innovation, truthful reporting of costs, and avoidance of abuse relative to alternative mechanisms. These incentive problems are similar to those that arise under rate-of-return regulation. Notably, transfer/access pricing, does not rectify the poor incentives embodied in pools. However, pooling does facilitate demand enhancement, due to its ability to internalize potential network effects.The authors wish to gratefully acknowledge the financial support of Southwestern Bell Telephone in the preparation of this paper. The views expressed are those of the authors and not those of Southwestern Bell. We are grateful for comments received at the 14th Annual Conference of the Center for Research in Regulated Industries, Graduate School of Management, Rutgers University, and valuable suggestions by Michael A. Crew and the referee.