Fragmented coherence: Solid waste management in Colombo

Notwithstanding the increasingly fragmented organizational relationships within Colombo's urban governance system, the cooperative nature of stakeholder relationships lends a high level of coherence to the overall system. Since 1995, Colombo's solid waste management system has been characterized by the increased role of the private sector, community-based organizations and NGOs. Whilst the increasingly fragmented nature of this system exhibits some deeply ingrained problems, there are also a number of positives associated with the increased role of civil society actors and, in particular, the informal sector. Reforming regulatory frameworks so as to integrate some of the social norms that are integral to the lives of the majority of urban residents will contribute to regulatory frameworks being considerably more enforceable than is currently the case. Such reform requires that institutional and regulatory frameworks need to be flexible enough to adapt to the changing social, political and economic context. In the Colombo case, effective cooperation between public sector and civil society stakeholders illustrates that adaptive institutional arrangements grounded in pragmatism are feasible. The challenge that arises is to translate these institutional arrangements into adaptive regulatory frameworks - something that would require a significant mind shift on the part of planners and urban managers.

A prospective multicentre study of pharmacist initiated changes to drug therapy and patient management in acute care government funded hospitals

Aims To determine the cost savings of pharmacist initiated changes to hospitalized patients' drug therapy or management in eight major acute care government funded teaching hospitals in Australia. Methods This was a prospective study performed in eight hospitals examining resource implications of pharmacists' interventions assessed by an independent clinical panel. Pharmacists providing clinical services to inpatients recorded details of interventions, defined as any action that directly resulted in a change to patient management or therapy. An independent clinical review panel, convened at each participating centre, confirmed or rejected the clinical pharmacist's assessment of the impact on length of stay (LOS), readmission probability, medical procedures and laboratory monitoring and quantified the resultant changes, which were then costed. Results A total of 1399 interventions were documented. Eight hundred and thirty-five interventions impacted on drug costs alone. Five hundred and eleven interventions were evaluated by the independent panels with three quarters of these confirmed as having an impact on one or more of: length of stay, readmission probability, medical procedures or laboratory monitoring. There were 96 interventions deemed by the independent panels to have reduced LOS and 156 reduced the potential for readmission. The calculated savings was $263 221 for the eight hospitals during the period of the study. This included $150 307 for length of stay reduction, $111 848 for readmission reduction. Conclusions The annualized cost savings relating to length of stay, readmission, drugs, medical procedures and laboratory monitoring as a result of clinical pharmacist initiated changes to hospitalized patient management or therapy was $4 444 794 for eight major acute care government funded teaching hospitals in Australia.

Understanding service experience in non-profit performing arts: Implications for operations and service management

Recent research in the non-profit performing arts has shown that marketing efforts designed to increase revenue from ticket sales are not achieving the results required to sustain the performing arts. This paper applies operations management analytical techniques to the non-profit performing arts to increase understanding of operational issues and inform service management strategy. The paper takes a two-study idiographic approach. Implementing a modified version of service transaction analysis (STA), Study One describes a performing arts service from provider and customer perspectives, identifies service gaps and develops an elaborated service description incorporating both perspectives. In Study Two, building on the elaborated service description and extant research, in-depth interviews are conducted to gather thick descriptions of predictors of satisfaction, value and service quality as they relate to repurchase intention (RI). Technical, functional and critical factors required to improve organizational performance are identified. Implications for operational strategy, service design and service management theory for this context are discussed. (c) 2005 Published by Elsevier B.V.

The impact of leadership and change management strategy on organizational culture and individual acceptance of change during a merger

This article reports a longitudinal study that examined mergers between three large multi-site public-sector organizations. Both qualitative and quantitative methods of analysis are used to examine the effect of leadership and change management strategies on acceptance of cultural change by individuals. Findings indicate that in many cases the change that occurs as a result of a merger is imposed on the leaders themselves, and it is often the pace of change that inhibits the successful re-engineering of the culture. In this respect, the success or otherwise of any merger hinges on individual perceptions about the manner in which the process is handled and the direction in which the culture is moved. Communication and a transparent change process are important, as this will often determine not only how a leader will be regarded, but who will be regarded as a leader. Leaders need to be competent and trained in the process of transforming organizations to ensure that individuals within the organization accept the changes prompted by a merger.

OHS in the nursing workplace: accountability and the management of stress

There has been growing interest in occupational stress in the nursing context, both in New Zealand and internationally. This article takes a critical approach to the literature on nursing stress by examining the implications of a body of research largely informed by a theoretical approach which highlights the individual. In spite of evidence that the main sources of stress for nurses are related to workplace conditions, the focus is on the individual nurse and his/her personal response to stress. This approach encourages the development of interventions where the objectives are the individual management of stress, and thereby consolidates nurses' perceptions of powerlessness. Alternatives to these palliative measures, such as highlighting the legal obligations for employers to provide a safe workplace or collective industrial action for change, are glaringly absent in the literature. The importance of such an approach is supported by recent findings from the United States on the advantages of hospitals which promote nurses' autonomy and control.