Disentangling barriers to internationalization

Abstract. Recent literature on multinational firms has focused on low productivity as a barrier to the internationalization of firms. But labour market frictions or financial constraints may also hamper internationalization. In order to assess the importance of these barriers, we present new empirical evidence on the extensive and intensive margin of exports and foreign direct investment (FDI) based on micro‐level data of German firms. First, we find a positive impact of firm size and productivity on firms’ international activities. Second, labour market frictions can constitute barriers to foreign activities. Third, self‐reported financial constraints have no impact on firms’ internationalization decisions. JEL classification: F23, G2     

Governing for improved quality and patient safety

Board members have a critical oversight role to play in monitoring and providing direction to improve health care quality and safety. In the emerging environment of health care reform, the board's role in overseeing quality and safety on behalf of stakeholders will become as or even more important than its financial oversight role. Nurses can expand their impact by joining the ranks of health care organization governing boards to lead and guide the entire health care enterprise to realize the goal of improved care and outcomes for all patients.     

Quality, patient safety, and the board

It is now broadly recognized that good outcomes for patients depend on more than a clinician's knowledge and skills and use of proven, effective practices or evidence-based medicine. Good outcomes also depend on the organization's culture, which affects how well providers and patients work together. Boards play a key role in helping their hospitals improve the quality and safety of the care they deliver--a governance imperative to ensure hospitals meet the needs of key stakeholders and perform effectively in an environment of reform. Nurse leaders who understand this key board responsibility will be better prepared to serve on boards and contribute to effective governance.     

The effect of workforce issues on patient safety

The workforce of any health care organization is vital to its continued survival, but a highly competent and committed workforce is vital to its success. The evidence is clear: employees influence not only the financial performance of the organization, but also the safety and quality of the clinical care provided to patients. Health care organizations must understand these important linkages and have in place corporate strategies to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes. New levels of knowledge, resources, and implementation are needed to move health care in the United States to the next level of quality performance. Staff satisfaction and retention should be at the heart of the clinical improvement strategies. Such an approach will allow organizations to cope and thrive in an environment of workforce shortages and increasing consumer demand for quality. To quote Robert Waller, MD, of the Mayo Clinic, "The goal is the best care for every patient, every day. Our patients deserve nothing less.     

Innovative activity and barriers to entry

The short-run effects of potential competition on innovative input decisions are studied for an innovating firm realizing that by increasing the magnitude of its efforts it may enlarge its temporary monopoly position. Additional protection from new competition is viewed as resulting from to the innovator exogenous barriers to rivals' entry decisions and from the assurance of a temporary monopoly during an entry lag. This protection is shown to promote innovative activity in some circumstances, but to temper such efforts in other situations.     

Measuring teamwork and patient safety attitudes of high-risk areas

Patient care leaders recognize that substantial reductions in health care errors will not come until more attention is given to human solutions, such as improving teamwork in health care teams. The authors introduce a short, valid, and reliable instrument to measure teamwork and patient safety attitudes in hospital high-risk areas, namely the emergency department, the operating room, and the intensive care unit. The instrument was tested among nurses in four hospitals and the results showed that the nurses favored the team approach, while recognizing that teamwork in their departments is not very advanced and that communication with some key team members is problematic. This situation seems ideal for the design of a team training intervention in these settings.     

Generalized barriers to entry and economic development

In their catching-up processes, less developed countries face inter-country barriers which hamper their efforts to imitate the technologies of advanced countries. These international barriers to entry can be traced back to differences in the institutions supporting technological advancement and to the physical and intangible resources necessary for the creation of new competences. In less developed countries, these international barriers aggravate the barriers to entry at the sectoral level and, together, they constitute the generalized barriers to entry. In our paper, we extend a model of economic growth by the entry of new sectors by including these international barriers and show how widening development gaps describing the differences in general income and employment trends can emerge in an auto-catalytic process.     

How barriers to international trade affect TFP

We ask how barriers to international trade affect TFP when there are monopoly rights in the import-competing industries. Holmes and Schmitz [1995. Resistance to new technology and trade between areas. Federal Reserve Bank of Minneapolis Quarterly Review 19, 2–17] show that without barriers to trade TFP in these industries is as large as possible. We study the general case of finite barriers to trade. We find that binding quotas lead to the use of inefficient technology in the import-competing industries. In addition, finite quotas or tariffs imply that the import-competing industries produce larger than efficient quantities, if they produce at all. For both of these reasons, barriers to international trade reduce TFP.     

Electoral competition and endogenous barriers to entry

As institutions matter for political and economic outcomes, they are (at least partly) shaped by the interests of political agents acting under these limitations. However, empirical evidence documenting such endogenous change of institutions is scarce. We address the issue by examining the link between the degree of electoral competition and the design of ballot access restrictions in the United States. Exploiting exogenous variation in electoral competition at the state level induced by the federal Voting Rights Act of 1965, our main finding is that ballot access rules have been systematically tightened in response to stronger electoral competition.     

A fragmented patient safety concept: the structure and culture of safety management in health care

The uniform and visible commitment to safety management is a cultural and structural change that health care organizations have not typically attempted. Committee structures are just one example of how culture drives structure in managing health care safety. The question is: "Are we interested in making nonpatient safety programs as well understood and as culturally significant as patient safety programs?" Models exist to institutionalize safety management in health care. We need only look to the JCAHO or OSHA and other high-hazard industry models for examples of safety management. Change requires a focus on safety, not occupational safety or patient safety, but just safety. In health care, safety would be a key characteristic of organizational culture. The organizational expectation is then that all employees will work safely and practice safety. Employees will apply safe practices when handling chemicals, in lifting, and when giving medications. Only when safety imbues the work and decisions of each employee in this way will the highest level of safety be attained.