A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace

Background: Recently both the UK and US governments have advocated the use of financial incentives to encourage healthier lifestyle choices but evidence for the cost-effectiveness of such interventions is lacking. Our aim was to perform a cost-effectiveness analysis (CEA) of a quasi-experimental trial, exploring the use of financial incentives to increase employee physical activity levels, from a healthcare and employer’s perspective.

Methods: Employees used a ‘loyalty card’ to objectively monitor their physical activity at work over 12 weeks. The Incentive Group (n=199) collected points and received rewards for minutes of physical activity completed. The No Incentive Group (n=207) self-monitored their physical activity only. Quality of life (QOL) and absenteeism were assessed at baseline and 6 months follow-up. QOL scores were also converted into productivity estimates using a validated algorithm. The additional costs of the Incentive Group were divided by the additional quality adjusted life years (QALYs) or productivity gained to calculate incremental cost effectiveness ratios (ICERs). Cost-effectiveness acceptability curves (CEACs) and population expected value of perfect information (EVPI) was used to characterize and value the uncertainty in our estimates.

Results: The Incentive Group performed more physical activity over 12 weeks and by 6 months had achieved greater gains in QOL and productivity, although these mean differences were not statistically significant. The ICERs were £2,900/QALY and £2,700 per percentage increase in overall employee productivity. Whilst the confidence intervals surrounding these ICERs were wide, CEACs showed a high chance of the intervention being cost-effective at low willingness-to-pay (WTP) thresholds.

Conclusions: The Physical Activity Loyalty card (PAL) scheme is potentially cost-effective from both a healthcare and employer’s perspective but further research is warranted to reduce uncertainty in our results. It is based on a sustainable “business model” which should become more cost-effective as it is delivered to more participants and can be adapted to suit other health behaviors and settings. This comes at a time when both UK and US governments are encouraging business involvement in tackling public health challenges.

Nonmarket Capabilities and the Prosecution of Trade Remedy Cases in the United States

The study investigates the prosecution of US trade remedy cases as examples of administrative government agency investigations and seeks to identify key capabilities for effective corporate political strategy targeting these institutions. Trade remedy cases are important policy tools, designed to protect domestic firms from ‘unfair’ import competition. The research contributes to the growing literature on corporate political activity and its links with superior outcomes in the marketplace. Three capabilities are identified: the capability to collect market/non-market intelligence, the capability to build and shape the administrative record, and the capability to align business practice with the US trade remedy institutions.

The sustainability and assessment of drystone retaining walls

The art of drystone walling is a highly sustainable traditional practice which uses local materials and craftsmen. As no
mortar is used they have low embodied carbon, and much repair work or rebuilding can be carried out using very little if any new
materials. However local practices developed to suit local materials, leading to a range of construction styles, making them difficult to
assess. This paper examines a range of construction styles of drystone retaining walls in use across the United Kingdom.
Understanding of the substantial variations of construction style is essential to enable proper assessment of these structures. Different
frictional and weathering characteristics, and the naturally occurring shapes of stone found in an area, all affect the ways in which the
stones have traditionally been assembled into walls. Ease of construction also plays a part, as the craftsman will naturally wish to
achieve a robust construction in a way that is economical of time and effort. Aesthetics may be very important, for both client and
craftsman. It is also shown that construction style is influenced by the location and function of the structures, with harbour walls
particularly likely to have unique characteristics, and the reasons for this are explored.

Sustaining school partnerships: The context of cross-sectoral collaboration between schools in a separate education system in Northern Ireland

This study explores the current understanding of cross-sectoral collaboration between schools in a divided society. The paper provides the context surrounding inter-school collaboration in Northern Ireland then presents findings based on a qualitative study of five post-primary partnerships made up of schools from the various sectors in Northern Ireland (maintained/Catholic, controlled/Protestant and integrated sectors). Participants in the study are teachers and school leaders. Evidence from this study reveals a number of things: despite a separate education system made up of different sectors, schools on an inter-sectoral basis are willing to collaborate and those represented in this study appeared disposed to sustain partnership activities; schools recognised that collaboration and partnership while beset with a number of logistical challenges, is also beneficial for pupils and institutions. In all cases there remained evidence of sustainable collaborative practice; although some of this was more developed in some partnerships than in others. In effect this paper concludes by recognising that schools do require some level of funding to sustain partnership working but that sustainability should not be couched entirely around these terms; rather, sustainability is about creating the right conditions to allow schools to develop effective and strong partnerships. These conditions are outlined in the latter stages of this paper.

Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial

Background
Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions

Methods/design
This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention “dose”, website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.

Discussion
The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a ‘points’ based loyalty platform, whereby local businesses ‘sponsor’ the incentive (retail vouchers) in return for increased footfall to their business.

The practice of home in old Cairo: Towards socio-spatial models of sustainable living

The article investigates the practice of home as an everyday system for sustainable living in Old Cairo. The idea of home in this historic urban space has long involved fluid socio-spatial associations and made efficient use of space-activity-time dynamics. As in the past, a individual’s sense of home may here extend beyond or shrink within the physical boundaries of a particular house, as spatial settings are produced and consumed according to time of day, gender association, or special events. The article argues that architects working in this context must understand the dynamics of this complex traditional system if they are to develop locally informed, genuine designs that build on everyday spatial practices. Work by the architect Salah Zaki Said and by the Historic Cities Program of the Aga Khan Trust for Culture is described to illustrate the potential of such engagement, especially as it contrasts to more abstract architectural proposals.

What Happened to the ‘Development’ in Sustainable Development? Business Guidelines Two Decades After Brundtland

Over twenty years ago ‘Our Common Future’ presented a conceptualization and explanation of the concept of sustainable development. Since then numerous alternative definitions of the concept have been offered, of which at least some are exclusive to each other. At the same time, the role of business in the transition to sustainable development has increasingly received attention. Bringing these two trends in sustainable development together, this paper returns to the Brundtland version of the concept to examine to what extent the original principles of sustainable development are still embedded within key business guidelines, namely the UN Global Compact, the OECD Guidelines for Multinational Enterprises, the ICC Business Charter for Sustainable Development, the CAUX Principles, the Global Sullivan Principles and the CERES Principles. The findings suggest that these business guidelines tend to emphasize environmental rather than social aspects of sustainable development, in particular to the detriment of the original Brundtland prioritization of the needs of the poorest. Furthermore, the attention to environmental aspects stresses win-win situations and has a clear managerialist focus; whereas more conceptual environmental issues concerning systems interdependencies, critical thresholds or systemic limits to growth find little attention. The normative codes and principles targeted at the private sector thus not only add another voice to the multiple discourses on sustainable development but also contribute to a reinterpretation of the original agenda set by Brundtland towards conceptualizations of sustainable development around the needs of industrialised rather than developing countries. Copyright © 2011 John Wiley & Sons, Ltd and ERP Environment

The role of facilities manager in sustainable practice in the UK and Ireland

Purpose – The purpose of this paper is to explore the role of facilities managers in sustainable practice. It also analyzes the change in facilities management (FM) in terms of sustainability.

Design/methodology/approach – This research adopted a combination of literature review and expert interviews. Empirical data were collected through in-depth interviews with 40 industrial experts in the UK and Ireland.

Findings – The analysis of interview results shows a sustainable movement in the context of FM. Facilities managers play important roles in sustainable practice, including integrating all sustainability considerations, linking strategic level with operational level, incorporating FM knowledge and experience into design, disseminating sustainable knowledge and educating people and encouraging sustainability through innovation.

Research limitations/implications – This research goes beyond the limitations of existing studies that are characterized by a lack of positioning facilities managers in sustainability.

Practical implications – Sustainable delivery represents a direction of FM development. This research describes what facilities managers can do and how they should do for sustainable delivery of FM, based on which improvements are made and benefits are maximized.

Originality/value – This research provides a deeper insight into the FM role in the sustainable agenda. The findings of this research help industrial practitioners and academic researchers to better understand sustainable FM.

Integrating Land-use Planning and Transportation in Belfast: A New Policy Agenda for Sustainable Development

Much of the interest in promoting sustainable development in planning for the city-region focuses on the apparently inexorable rise in the demand for car travel and the contribution that certain urban forms and land-use relationships can make to reducing energy consumption. Within this context, policy prescription has increasingly favoured a compact city approach with increasing urban residential densities to address the physical separation of daily activities and the resultant dependency on the private car. This paper aims to outline and evaluate recent efforts to integrate land use and transport policy in the Belfast Metropolitan Area in Northern Ireland. Although considerable progress has been made, this paper underlines the extent of existing car dependency in the metropolitan area and prevailing negative attitudes to public transport, and argues that although there is a rhetorical support for the principles of sustainability and the practice of land-use/transportation integration, this is combined with a selective reluctance to embrace local changes in residential environment or in lifestyle preferences which might facilitate such principles.

Does Gender Matter? Women Business Angels and the Supply of Entrepreneurial Finance

There is a substantial literature on the relationship between gender and access to finance. However, most studies have been concerned with access to debt finance. More recently, the focus of this research has broadened to examine women and venture capital. This article extends the focus further by examining the role of women in the business angel market, which is more important than the formal venture capital market in terms of both the number of ventures supported and total capital flows. Based on a detailed analysis of business angels in the U.K., the study concludes that women investors who are active in the market differ from their male counterparts in only limited respects. Future research into women business angels, and the possible existence of gender differences, needs to be based on more fully elaborated standpoint epistemologies that focus on the experience of the woman angel investor per se, and center on the examination of the role of homophily, social capital, networking, and competition in investment behavior.

The Sustainability Balanced Scorecard. Linking Sustainability Management to Business Strategy.

The Balanced Scorecard of Kaplan and Norton is a management tool that supports the successful implementation of corporate strategies. It has been discussed and considered widely in both practice and research. By linking operational and non-financial corporate activities with causal chains to the firm's long-term strategy, the Balanced Scorecard supports the alignment and management of all corporate activities according to their strategic relevance. The Balanced Scorecard makes it possible to take into account non-monetary strategic success factors that significantly impact the economic success of a business. The Balanced Scorecard is thus a promising starting-point to also incorporate environmental and social aspects into the main management system of a firm. Sustainability management with the Balanced Scorecard helps to overcome the shortcomings of conventional approaches to environmental and social management systems by integrating the three pillars of sustainability into a single and overarching strategic management tool. After a brief discussion of the different possible forms of a Sustainability Balanced Scorecard the article takes a closer look at the process and steps of formulating a Sustainability Balanced Scorecard for a business unit. Before doing so, the basic conventional approach of the Balanced Scorecard and its suitability for sustainability management will be outlined in brief.