Nursing leadership: championing quality and patient safety in the boardroom

OBJECTIVE: Identify the extent to which hospital boards of trustees, CEOs, and CNOs are engaged in quality and safety at the leadership and governance level and how CNOs can support board engagement in quality and safety. BACKGROUND: Although research is emerging, still relatively little is known about the impact and interface of hospital boards of trustees, CEOs, and nursing executives related to improving quality and patient safety. METHODS: 73 telephone interviews were conducted with hospital board chairs, CEOs, and CNOs from a convenience sample of 63 U.S. hospitals. The interviews (22 of which were with CNOs) lasted 30 to 45 minutes and were supplemented by a focus group of five nursing executives. RESULTS: There are significant differences in the perceptions of CNOs versus those of board chairs and CEOs. CNOs reported a greater familiarity of landmark reports on quality and patient safety than board chairs. CEOs and board chairs gave substantially higher ratings to integration of quality planning. Boards have limited comprehension of salient nursing quality issues. CONCLUSION: CNOs have a critical role as boardroom champions of patient safety and quality improvement.     

Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care

The results of analyses of the 2002 and 2004 National Sample Surveys of RNs and the 2004 National Sample of CNOs document the widespread perception that the shortage of nurses is a major problem for the overall quality of patient care in hospitals. In the eyes of the majority of hospital RNs and CNOs surveyed, care processes involving communication, timely response to pages and telephone calls, delays in patient discharges, and the time patients had to wait for tests and procedures were all affected negatively by the nursing shortage. These results are not encouraging.     

经济学供需模型的制度化改进与初步运用

新古典经济学的基础性分析工具是供需曲线,而这一模型是对现实经济运行的“过度”简化,缺失的重要环节就是交易费用或制度安排。基于新制度经济学对交易费用、制度安排的相关研究,在传统供需曲线模型所包含的资源配置与收入分配两项内容基础上,本文加入了交易费用曲线并对其做了结构化分析,构建了制度化了的供需模型,探索了当前认识条件下经济学供需模型的“统一场论”。进而,本文运用这一模型提出了资产增值的“不可能三角”,需求曲线的两个镜像关系,以需求弹性推导组织要素“侵蚀”能力及合约选择定律,交易费用限定资产交易边界、暗含市场规模的界定等创新性结论,体现出这一理论模型能够深刻诠释现实经济运行的能力,希望以此为我国经济改革发展中存在的一些矛盾与争论提供统一的分析框架。     

The Strategic Social Map of a Nongovernmental Organization

Currently, the traditional states-nation, as far as their social commitments are concerned, are giving way to the nongovernmental organizations (NGO). These organizations have a mission, strategy, and goals different from those organizations looking simply for profits. Nevertheless, NGOs are concerned about using management and information systems at least as good as those used by private companies. Organizations try to develop a social strategy taking their social responsibility as starting point. In this paper, the authors describe how to fix the organization mission, its strategy and goals, and also how to make its action map. A strategy proposal will be described, as well as the way on how to put it into practice. The main goals of this paper is to describe the mission, strategy, and goals of the organization; design its strategic social map; fix the limits of the organization's action; apply the theoretical model to a NGO; and design an information model in order to manage the strategic development. The authors would like to express their gratitude to M. Dolors Celma Benaiges, lecturer at the Escola Universitària del Maresme, Universitat Pompeu Fabra, for her assistance reviewing and translating the paper.     

New Competences for Crisis Times

In general, people always try to achieve their goals in several aspects of their lives such as the studies, jobs, and leisure time. Unfortunately, goals are not always achieved. Sometimes people simply give up on achieving them, or on other occasions, goals are not achieved completely (later, more costly, and to a lesser extent than desired). The principal objective of the present paper is to identify which variables determine success while people try to achieve their own goals. In order to analyze this fact, the authors will define a sample of university students, taking as a goal their current situation, defining the maximum quality of not staying down or not having more than two subjects left to pass. A questionnaire will be developed in order to identify which variables are more important to achieve goals. Answers from the students will permit one to know the importance given to the different variables by them, as well as how students manage these variables in order to achieve their goals. Moreover, a mathematical model will be used to evaluate what is the influence and relevance of each variable to achieving personal goals.     

Bridging the gap between technological possibilities and people:: Involving people in the early phases of technology development

Technology provides endless promising possibilities to support people's lives. In reality, it is not a matter of what is possible, but rather a matter of how and when technology will be integrated, accepted and adopted by people. However, conventionally within organizations the areas of technology development and market research are not closely related nor applied in the process of innovation and do not always share the same scope. In that sense there is a gap between the potential of technology and humankind's preferences.This paper discusses the current areas of technology development and market research in a business environment and proposes an integrated approach to bridge the gap between technology and people, in which people, rather than market sizes become central in the development of technology. In addition, it also describes how this approach of people-driven innovation is brought into practice through the development of early experience demonstrators. The core focus of this paper is on the processes and practices regarding innovation within an organization, rather than the adoption of innovation by users or the rate of the adoption of a marketed solution (Rogers, 1995 [E.M. Rogers, Diffusion of Innovations, The Free Press, New York, 1995. [1]]).     

Performance budgeting

A performance budget is a budget for the activities of a cost center or organization. Performance budgeting evaluates performance in terms of goals for a variety of activities, rather than a single budgeted output level, such as patient days.     

Bridging the gap between technological possibilities and people:: Involving people in the early phases of technology development

Technology provides endless promising possibilities to support people's lives. In reality, it is not a matter of what is possible, but rather a matter of how and when technology will be integrated, accepted and adopted by people. However, conventionally within organizations the areas of technology development and market research are not closely related nor applied in the process of innovation and do not always share the same scope. In that sense there is a gap between the potential of technology and humankind's preferences.This paper discusses the current areas of technology development and market research in a business environment and proposes an integrated approach to bridge the gap between technology and people, in which people, rather than market sizes become central in the development of technology. In addition, it also describes how this approach of people-driven innovation is brought into practice through the development of early experience demonstrators. The core focus of this paper is on the processes and practices regarding innovation within an organization, rather than the adoption of innovation by users or the rate of the adoption of a marketed solution (Rogers, 1995 [E.M. Rogers, Diffusion of Innovations, The Free Press, New York, 1995. [1]]).     

The Evolution of Social and Economic Networks

We examine the dynamic formation and stochastic evolution of networks connecting individuals. The payoff to an individual from an economic or social activity depends on the network of connections among individuals. Over time individuals form and sever links connecting themselves to other individuals based on the improvement that the resulting network offers them relative to the current network. In addition to intended changes in the network there is a small probability of unintended changes or errors. Predictions can be made regarding the likelihood that the stochastic process will lead to any given network at some time, where the stochastic process selects from among the statically stable networks and cycles. We apply these results to examples including the Gale-Shapley marriage problem. Thus the paper achieves two goals. First, it outlines a dynamic solution concept for networks. Second, it applies this concept to matching problems. Journal of Economic Literature Classification Numbers: A14, D20, J00.     

从花旗集团拆分反思“金融超市”模式

花旗集团不得不重组拆分并最终回归至传统的银行业务,意味着曾风靡一时的"金融超市"模式很难成功.其模式的主要问题在于规模和范围扩张似乎并不经济,内部却存在严重的利益冲突,同时混业风险相互关联,而风险管理机制又很脆弱;混业经营事实上损害而非提升了公司的市场价值.花旗混业经营的失败并非个素,为蜂拥追逐"混业"梦想的中国金融机构敲响了警钟.     

An analysis of factors improving technology roadmap credibility: A communications theory assessment of roadmapping processes

In recent years, many industrial firms have been able to use roadmapping as an effective process methodology for projecting future technology and for coordinating technology planning and strategy. Firms potentially realize a number of benefits in deploying technology roadmapping (TRM) processes. Roadmaps provide information identifying which new technologies will meet firms' future product demands, allowing companies to leverage R&D investments through choosing appropriately out of a range of alternative technologies. Moreover, the roadmapping process serves an important communication tool helping to bring about consensus among roadmap developers, as well as between participants brought in during the development process, who may communicate their understanding of shared corporate goals through the roadmap. However, there are few conceptual accounts or case studies have made the argument that roadmapping processes may be used effectively as communication tools. This paper, therefore, seeks to elaborate a theoretical foundation for identifying the factors that must be considered in setting up a roadmap and for analyzing the effect of these factors on technology roadmap credibility as perceived by its users. Based on the survey results of 120 different R&D units, this empirical study found that firms need to explore further how they can enable frequent interactions between the TRM development team and TRM participants. A high level of interaction will improve the credibility of a TRM, with communication channels selected by the organization also positively affecting TRM credibility.     

Building confident organizations by filling buckets, building infrastructures, and shining the flashlight

Leaders have the ability to create confidence or fear in the organization. Kanter (2004) writes that confidence is the "...sweet spot between arrogance and despair" (p. 8). Overconfidence causes people to overshoot, and to assume they are invulnerable. Under-confidence is just as harmful because it leads to under-investing in people, under-innovating, and eventually leads to the disenfranchisement of staff and poor morale. If we take Kanter's advice, we will build an infrastructure that creates confidence in everyone and the organization. But we will not stop there. We will focus "flashlights" on people and activities that are inspiring to others.     

Effective workforce management starts with leveraging technology, while staffing optimization requires true collaboration

Effective staffing is at the very core of quality patient care. Staffing that achieves a balance between quality, safety, labor costs, and staff satisfaction is incredibly complex. Technology can make the complexity manageable and provide health care leaders with the tools to optimize their most valuable resource--their employees. Through such a partnership, the business intelligence brought forth will not only meet the unique needs and goals of each organization, but will also result in innovations and advancements in best practices around excellence in staffing.     

Nursing informatics: an evolving specialty

Health care organizations will continue to invest heavily in clinical information systems to help improve patient safety, reduce variability of care, and increase the efficiency of their staff. These clinical information systems can assist in reducing medication errors through sophisticated medication management solutions and provide clinical decision support to aid in the decision making of all clinicians. They can also help offset the effects of a growing worker shortage, especially hard-felt in nursing, by reducing redundant tasks, improving communication, and streamlining clinical data collection. As these clinical systems are implemented, there is an increased need for information management of all of this complex data. By bringing both clinical and information systems expertise to bear, the informatics nurse plays a crucial role in ensuring that these goals are met to help the organization maximize its use of clinical information technology.$     

新产品开发成功因素的文献综述与研究展望

新产品开发是现代企业经营的重要环节,而影响新产品开发成功的因素有很多。首先讨论了新产品开发成功因素的研究角度;然后从个性因素、组织因素、环境因素三大方面对新产品开发成功因素进行了文献回顾;在此基础上提出了未来的研究方向:团队领导的个性对NPD绩效的影响、集成客户的跨组织边界的整合是否以及如何对NPD绩效进行影响、NPD成功的文化因子具体有哪些等。     

二重社会制度结构的困厄——对20世纪中国乡村合作经济困境的一种尝试性诠释

制度结构的特征直接影响制度变迁的方向和进程,制度结构决定着制度选择集合和制度选择的空间。中西方社会制度结构上的多元与二重的差异性,决定了内生于西方的合作经济制度,在被移植嵌入到中国乡村而作为一种制度安排在"强制"状态下单兵推进时,其原来与之匹配的各种制度之间协调演进而形成的均衡机制已不复存在,故而在运行方面出现的合作社的"异化"和"异化"的合作社等困境是情理之中的事情。对此探讨或许会有助于政府在倡导新农村建设运动时的制度安排。     

Case management: key to access, quality, and financial success

Several strategic, organizational, and operational variables drive successful case management programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the case manager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a case management program to higher level of performance. While many organizations have employees called "case managers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance.     

平台到生态系统成长的势效应——基于iOS移动操作系统的案例研究

移动互联网的快速兴起不仅推动操作系统平台成为移动通讯产业新的竞争制高点，更加速传统通讯行业竞争格局向操作系统生态竞争转变。现有研究关于平台到生态系统的演进成长机理仍不甚清晰，通过引入平台势概念，描述平台到生态系统的持续成长历程，并对iOS移动操作系统开展探索性案例研究，尝试从持续、动态视角打开平台成长为生态系统过程的“黑箱”。研究发现，平台到生态系统的持续成长不仅存在显著阶段性特征，即平台企业在不同发展阶段不仅会依据平台发展特性、需求和组织情境特征，形成不同战略重点与目标，还蕴含着平台势的复杂积聚过程，平台势持续积聚推动着平台到生态系统的持续演进发展；不同发展阶段下，平台的借势型、造势型和应势型战略行动使平台势变化呈现出从逐渐积聚到逐渐加速积聚，再到积聚速度呈加快—减缓—加快形式的转换过程，从而影响平台到生态系统的演进成长进程。     

Cost-Effective and Stochastic Dominance Approaches to Stochastic Pollution Control

Most economic studies of pollution externalities focus on the relative efficiency or cost-effectiveness of alternative pollution control instruments. Much less attention has been paid to policy goals and objectives. However, a comprehensive pollution control strategy depends on all of these choices. This paper examines several efficiency properties of cost-effective pollution control strategies in a stochastic setting when economic damages from pollution are unknown. A number of policy goals are considered. In this setting and under a primal approach, it is found that certain stochastic dominance conditions must be satisfied for the strategies to exhibit desirable efficiency properties. A dual approach to cost-effective pollution control, which is based on a stochastic dominance objective, is also considered.     

The pigeon breeders' cup: a selection on selection theory of economic evolution

Both the evolutionary literature in economics and the competitive advantage literature in business strategy point to the importance of a firm's replication/selection mechanisms in developing and sustaining inimitable organization capabilities, competencies, competitive advantage and economic rents. This mechanism can be conceived of as a hierarchy of organization processes where primary, added-value processes are nested within control processes, which are nested within deployment processes, that are nested within learning processes. The evolution of this organization of processes and their complementary assets along the added-value chain within the firm and among firms is the result of the legacy of the past process-thinking skills of the firms in the added-value chain and their present thinking skills. Served and factor markets select on the dynamic effects and products of these processes and, hence, ultimately on the phenomenon that create the processes (process thinking). This selection on selection (SoS) theory is used to explain Schumpeterian ?creative destruction? at a new level of analysis, extend the satisficing principle, and identify a new stream of potentially promising empirical research.JEL Classification: A1, B31, B52, D21, M1Comments by Geoffrey M. Hodgson, Alan J. Malter, Paul W. Miniard, Paul W. Farris, and an anonymous reviewer on earlier drafts of this paper are gratefully acknowledged. The editing of Kathryn Morris is also appreciated.