Organizational culture in a terminally ill hospital

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a "Shared Vision" of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in "silos" and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market.     

Entrepreneurial rents and the theory of the firm

The creation of entrepreneurial rents occurs under conditions of uncertainty. Yet current theories of rent appropriation such as transactions cost theories of the firm focus their efforts primarily on how quasi-rents – rents that have already been created – are appropriated by parties to that exchange. Entrepreneurs face a dual challenge, that of creating entrepreneurial rents and appropriating some of these rents. Moreover, this challenge usually exists at a time when the entrepreneurial rents that might be created are not known or anticipatable. Indeed, entrepreneurs not only concern themselves with ensuring that they are able to appropriate at least some of the rents that might be eventually created but in fact they may not create any rents or potentially lose value. Understanding the dual nature of the rent creation and the rent appropriation problem has a variety of implications for the study of entrepreneurial organizations and generally for theory of the firm discussions.     

Gender disparities: a medical detoxification program

Significant gaps exist in health care regarding gender in the United States. Health status, social roles, culturally patterned behavior and access to health care can be influenced by gender. Women have been the primary users of health care and minority women usually have received poorer quality care than Non-Hispanic White (NHW) females. The objectives of this study were to identify gender, racial and ethnic disparities in access to substance abuse treatment in a Texas hospital. Secondary data collected on 1,309 subjects who underwent detoxification were studied. Gender, race/ethnicity, drug of abuse, relapse and financial classification were included in the analysis. Results indicate Hispanic females and Non-Hispanic Black (NHB) females were about 5 and 3.5 more likely than NHW females to use Medicaid services respectively (p < .05). NHW and NHB males were more likely to use Medicare than females (p < .05). NHB and Hispanic females were 5.8 and 2.1 times more likely to receive care for abuse of cocaine when compared to NHW females respectively (p < .05). Hispanic females were 2.3 times more likely to relapse than Non-Hispanic females, and uninsured NHB females were 7.1 times at a higher risk to abuse multiple drugs compare to NHW females (p < .05). Socio-economic factors, lower labor force participation rates, and less financial independence can explain females utilizing more often Medicaid regardless of their race/ethnicity. These results can be also explained by aggressive case management utilization, socio cultural barriers and/or discriminatory practices, both intentional and unintentional.     

The effects of integration agreements in Western Hemisphere trade, 1970–2014

The paper analyzes the effects of four regional integration agreements (Common Market of the South [MERCOSUR], Andean Community [ANCOM], Central American Common Market [CACM] and North America Free Trade Agreement [NAFTA]) on bilateral trade in 19 countries from the Western Hemisphere for the period 1970–2014. For this purpose we estimate different gravity models to control for trade creation and diversion, export diversification and intra-industry trade using OLS log-linearized gravity model and Poisson pseudo-maximum-likelihood panel data estimators that allow controlling for zero-value trade flows. We find trade creation for ANCOM, MERCOSUR and CACM and trade diversion for NAFTA and MERCOSUR countries. Export diversification negatively affects bilateral trade in all American agreements, while intra-industry trade has contributed to trade expansion in ANCOM and the opposite for NAFTA, MERCOSUR and CACM. Global supply chains may help us explain these results. Finally, we find anticipatory effects on trade several years before the signing of the agreements, but only NAFTA countries seem to be natural trading partners in the region while the rest of Latin American regional agreements have not resulted in a comprehensive, profound and consolidated common market.     

Hospital economic impact from hemostatic matrix usage in cardiac surgery

Objective:

Improved health outcomes can result in economic savings for hospitals and payers. While effectiveness of topical hemostatic agents in cardiac surgery has been demonstrated, evaluations of their economic benefit are limited. This study quantifies the cost consequences to hospitals, based on clinical outcomes, from using a flowable hemostatic matrix vs non-flowable topical hemostatic agents in cardiac surgery.

Research design and methods:

Applying clinical outcomes from a prospective randomized clinical trial, a cost consequence framework was utilized to model the economic impact of comparator groups. From that study, clinical outcomes were obtained and analyzed for a flowable hemostatic matrix (FLOSEAL, Baxter Healthcare Corporation) vs non-flowable topical hemostats (SURGICEL Nu-Knit, Ethicon–Johnson &; Johnson; GELFOAM, Pfizer). Costing analyses focused on the following outcomes: complications, blood transfusions, surgical revisions, and operating room (OR) time. Cardiac surgery costs were analyzed and expressed in 2012 US dollars based on available literature searches and US data. Comparator group variability in cost consequences (i.e., cost savings) was calculated based on annualized impact and scenario testing.

Results:

Results suggest that if a flowable hemostatic matrix (rather than a non-flowable hemostat) was utilized exclusively in 600 mixed cardiac surgeries annually, a hospital could improve patient outcomes by a reduction of 33 major complications, 76 minor complications, 54 surgical revisions, 194 transfusions, and 242?h of OR time. These outcomes correspond to a net annualized cost consequence savings of $5.38 million, with complication avoidance as the largest contributor.

Conclusions:

This cost consequence framework and supportive modeling was used to evaluate the hospital economic impact of outcomes resulting from the usage of various hemostatic agents. These analyses support that cost savings can be achieved from routine use of a flowable hemostatic matrix, rather than a non-flowable topical hemostat, in cardiac surgery.     

The Relationships of Empathy,Moral Identity and Cynicism with Consumers’ Ethical Beliefs: The Mediating Role of Moral Disengagement

This study examines the relationships of empathy, moral identity and cynicism with the following dimensions of consumer ethics: the passive dimension (passively benefiting at the expense of the seller), the active/legal dimension (benefiting from questionable but legal actions), the ‘no harm, no foul’ dimension (actions that do not harm anyone directly but are considered unethical by some) and the ‘doing-good’/recycling dimension (pro-social actions). A survey of six hundred Australian consumers revealed that both empathy and moral identity were related to negative beliefs regarding the passive and the active/legal dimensions of consumer ethics and were related to positive beliefs regarding the ‘doing-good’/recycling dimension. Cynicism was related to positive beliefs regarding the passive dimension of consumer ethics and was related to negative beliefs regarding the ‘doing-good’/recycling dimension. The role of moral disengagement in mediating these relationships was examined. Empathy and moral identity were only indirectly negatively related to the ‘no harm, no foul’ dimension of consumer ethics through moral disengagement, while cynicism was indirectly positively related to this dimension through moral disengagement. Theoretical and practical implications of these findings are discussed.     

Speedier delivery: coastal shipping times and speeds during the Age of Sail †

There is a debate about whether coastal shipping experienced substantial productivity growth prior to the advent of steam power. To study changes over the long eighteenth century, this article uses thousands of coastal journey times culled from Board of Trade crew lists between 1835 and 1844 and coastal port books for the mid‐to‐late 1600s, along with a newly digitized coastal network. Comparisons between matched samples show that journey speeds, defined as miles sailed per day, were significantly higher in the crew lists compared to the port books, and that voyage cycle times, defined as days between starting two identical voyages, were substantially lower. The study also shows that voyage times in the east coast coal trade were substantially lower around 1840 than around 1700, but the difference was much smaller when peace years are compared. These new data imply that total factor productivity growth in the east coast coal trade was significant, especially if one accounts for gains from peace after 1815. The findings contribute to the larger literature studying the rate and sources of productivity growth during the industrial revolution.     

Collateral in Monetary Policy Operations

We present a portfolio decision model for banks that permits us to estimate the costs associated with the need to collateralise loans from the central bank. This allows us to calibrate the difference between a restrictive collateral eligibility framework for open market operations, such as that applied by the FED, with a more flexible approach such as that of Eurosystem. We also document that there could potentially appear relevant cost differences between the various collateral mobilisation procedures (pooling and earmarking) that currently coexist in the eurozone.     

An Alternative Approach to the Measurement of Emotional Attachment

Emotional attachment (EA)—the emotional bond connecting an individual with a specific target—has been identified as an important construct within the marketing domain. Despite all the research, there is no consensus on how the construct should be measured. A major factor contributing to this confusion is that current definitions and, consequently, scales of EA focus on describing reactions toward specific referents of attachment rather than on capturing the extent of emotion an individual feels; hence, hindering construct validity. In this article, the authors scrutinized the concept validity of EA. After defining the construct, scale development procedures were followed to propose an alternative one‐dimensional scale that reflects the abstract nature of EA. Three studies support the scale's reliability as well as the discriminant, convergent, criterion, and nomological validity of the measure. The studies tested the scale under different marketing contexts. Moreover, by employing the new measure, the findings showed that EA and self‐concept maintenance (SCM) are related, yet different constructs. Specifically, the results showed that these constructs interact to predict willingness to pay (WTP) for a brand such that when SCM is low, WTP is predicted by EA. However, when self‐concept is high, the effect of EA on WTP is not that strong. This new scale will help researchers extend research on EA to a broader set of contexts, explore the relationship between EA and related constructs, develop nomological networks, and prevent the confounding of terms.     

Regaining Missed Opportunities: The Role of Tourism in Post-war Development in Sri Lanka

Sri Lanka had the opportunity to become one of the best tourism countries (TCs) in Asia immediately after independence in 1948. However, it missed opportunities on a number of occasions due to inappropriate economic policies, continuous political violence and war. Between 1983 and May 2009 the Sri Lankan tourism sector was seriously affected by nearly three decades of separatist war. Immediately after the end of the war, tourism in Sri Lanka bounced back and it has now become one of the main engines of economic growth in post-war Sri Lanka. In this article, a historical analysis has been undertaken to demonstrate how, despite its large tourism potential, Sri Lanka missed opportunities and fell far behind its Asian counterparts on a number of occasions. This article demonstrates that opportunities exist for the Sri Lankan tourism sector to play a vital role in the current post-war inclusive development strategy in terms of generating much needed foreign exchange, poverty alleviation via employment generation, accelerating economic growth and uplifting living standards of all Sri Lankans.