A qualitative study of the relationship between clinician attributes, organization, and patient characteristics on implementation of a disease management program

The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices. © 2008 Mary Ann Liebert, Inc.

The two-way relationship between the Balanced Scorecard and Management Control Systems in organizations:Lessons from a Case Study

This paper reports a case study conducted in Quinta da Aveleda, one of
the three largest Portuguese wine companies. Our aim was to explore the
relationship established between a newly implemented Balanced Scorecard
(BSC) and the elements of the Management Control System (MCS) in the
organization. Thus, two specific objectives were pursued. Firstly, to identify
the influences (barriers, opportunities) of the existing MCS on the implementation
of the BSC. Secondly, to identify the impacts the BSC implementation
was able to exert on the configuration of the organization’s MCS.
We found that the budgeting process, the planning system, the information
infrastructure, and the organizational structure and culture were the elements
of the previous MCS that influenced the BSC implementation process.
Eventually, the BSC implementation led to important changes in the budgeting,
planning, reporting systems and processes. In order to explain these
findings, we briefly explored the main issues and factors accounting for the
scope and nature of the BSC’s impacts on Quinta da Aveleda. These issues
and factors were the mobilized organizational resources, the implementation
approach, the communication, and the organizational support.

Complex sociogenetic organization and reproductive skew in a primitively eusocial sweat bee, Lasioglossum malachurum, as revealed by microsatellites

The sweat bees (Family Halictidae) are a socially diverse taxon in which eusociality has arisen independently numerous times. The obligate, primitively eusocial Lasioglossum malachurum, distributed widely throughout Europe, has been considered the zenith of sociality within halictids. A single queen heads a colony of smaller daughter workers which, by mid-summer, produce new sexuals (males and gynes), of which only the mated gynes overwinter to found new colonies the following spring. We excavated successfully 18 nests during the worker- and gyne-producing phases of the colony cycle and analysed each nest's queen and either all workers or all gynes using highly variable microsatellite loci developed specifically for this species. Three important points arise from our analyses. First, queens are facultatively polyandrous (queen effective mating frequency: range 1–3, harmonic mean 1.13). Second, queens may head colonies containing unrelated individuals (n = 6 of 18 nests), most probably a consequence of colony usurpation during the early phase of the colony cycle before worker emergence. Third, nonqueen's workers may, but the queen's own workers do not, lay fertilized eggs in the presence of the queen that successfully develop into gynes, in agreement with so-called 'concession' models of reproductive skew