Brilliant mistake! Essays on incidents of management mistakes and mea culpa

Purpose – The purpose of this paper is to examine students’ perceptions of managerial mistakes and why (and why not) managers admit mistakes. Design/methodology/approach – This paper provides a reflective account of how students’ perceive management mistakes and deal with admitting “mea culpa” – “I am to blame”. Findings – The findings show a range of attitudes: they highlight the intermingling pressures associated with the cultural environment and mistakes; they identify media characteristics and its influences on mistakes and mea culpa; they highlight ceremonial processes and tasks that shape and influence the declaration of mea culpa; and they identify how the psychology and sociology of mistakes confronts and affects students. Taken together, the study highlights the varying degrees of wariness that is carried forward by the students from vicariously learning about management mistakes. Originality/value – This paper links up with recent discussions on retail failure and retail pedagogy. It is hoped that this paper will encourage more academics to address, and engage with, management mistakes creatively in their teaching.

An operational approach to object-oriented software development

The traditional waterfall software life cycle model has several weaknesses. One problem is that a working version of a system is unavailable until a late stage in the development; any omissions and mistakes in the specification undetected until that stage can be costly to maintain. The operational approach which emphasises the construction of executable specifications can help to remedy this problem. An operational specification may be exercised to generate the behaviours of the specified system, thereby serving as a prototype to facilitate early validation of the system's functional requirements. Recent ideas have centred on using an existing operational method such as JSD in the specification phase of object-oriented development. An explicit transformation phase following specification is necessary in this approach because differences in abstractions between the two domains need to be bridged. This research explores an alternative approach of developing an operational specification method specifically for object-oriented development. By incorporating object-oriented concepts in operational specifications, the specifications have the advantage of directly facilitating implementation in an object-oriented language without requiring further significant transformations. In addition, object-oriented concepts can help the developer manage the complexity of the problem domain specification, whilst providing the user with a specification that closely reflects the real world and so the specification and its execution can be readily understood and validated. A graphical notation has been developed for the specification method which can capture the dynamic properties of an object-oriented system. A tool has also been implemented comprising an editor to facilitate the input of specifications, and an interpreter which can execute the specifications and graphically animate the behaviours of the specified systems.

Accountability, organisational learning and risks to patient safety in England: conflict or compromise?

This article examines the current risk regulation regime, within the English National Health Service (NHS), by investigating the two, sometimes conflicting, approaches to risk embodied within the field of policies towards patient safety. The first approach focuses on promoting accountability and is built on legal principles surrounding negligence and competence. The second approach focuses on promoting learning from previous mistakes and near-misses, and is built on the development of a ‘safety culture’. Previous work has drawn attention to problems associated with risk-based regulation when faced with the dual imperatives of accountability and organisational learning. The article develops this by considering whether the NHS patient safety regime demonstrates the coexistence of two different risk regulation regimes, or merely one regime with contradictory elements. It uses the heuristic device of ‘institutional logics’ to examine the coexistence of and interrelationship between ‘organisational learning’ and ‘accountability’ logics driving risk regulation in health care.

Having a word with yourself:neural correlates of self-criticism and self-reassurance

Self-criticism is strongly correlated with a range of psychopathologies, such as depression, eating disorders and anxiety. In contrast, self-reassurance is inversely associated with such psychopathologies. Despite the importance of self-judgements and evaluations, little is known about the neurophysiology of these internal processes. The current study therefore used a novel fMRI task to investigate the neuronal correlates of self-criticism and self-reassurance. Participants were presented statements describing two types of scenario, with the instruction to either imagine being self-critical or self-reassuring in that situation. One scenario type focused on a personal setback, mistake or failure, which would elicit negative emotions, whilst the second was of a matched neutral event. Self-criticism was associated with activity in lateral prefrontal cortex (PFC) regions and dorsal anterior cingulate (dAC), therefore linking self-critical thinking to error processing and resolution, and also behavioural inhibition. Self-reassurance was associated with left temporal pole and insula activation, suggesting that efforts to be self-reassuring engage similar regions to expressing compassion and empathy towards others. Additionally, we found a dorsal/ventral PFC divide between an individual's tendency to be self-critical or self-reassuring. Using multiple regression analyses, dorsolateral PFC activity was positively correlated with high levels of self-criticism (assessed via self-report measure), suggesting greater error processing and behavioural inhibition in such individuals. Ventrolateral PFC activity was positively correlated with high self-reassurance. Our findings may have implications for the neural basis of a range of mood disorders that are characterised by a preoccupation with personal mistakes and failures, and a self-critical response to such events.

Enhancing student learning experience through a novel electronic coursework assessment and feedback management system

Recent National Student Surveys revealed that many U.K. university students are dissatisfied with the timeliness and usefulness of the feedback received from their tutors. Ensuring timeliness in marking often results in a reduction in the quality of feedback. In Computer Science where learning relies on practising and learning from mistakes, feedback that pin-points errors and explains means of improvement is important to achieve a good student learning experience. Though suitable use of Information and Communication Technology should alleviate this problem, existing Virtual Learning Environments and e-Assessment applications such as Blackboard/WebCT, BOSS, MarkTool and GradeMark are inadequate to support a coursework assessment process that promotes timeliness and usefulness of feedback while maintaining consistency in marking involving multiple tutors. We have developed a novel Internet application, called eCAF, for facilitating an efficient and transparent coursework assessment and feedback process. The eCAF system supports detailed marking scheme editing and enables tutors to use such schemes to pin-point errors in students' work so as to provide helpful feedback efficiently. Tutors can also highlight areas in a submitted work and associate helpful feedback that clearly links to the identified mistakes and the respective marking criteria. In light of the results obtained from a recent trial of eCAF, we discuss how the key features of eCAF may facilitate an effective and efficient coursework assessment and feedback process.

Economic transition in Central Europe and the Commonwealth of Independent States

Fifteen years ago, twenty-seven countries in Europe and Central Asia embarked on their economic transition paths. For some, the outcome was a considerable success. Several others are still struggling to shed the inheritance of the past and to correct more recent policy mistakes. Why were post-Communist recessions so long in some countries and growth disappointing? Why was fiscal performance so different? Was democracy a factor, which facilitated reforms or rather slowed them down? This book discusses these questions in the context of new empirical evidence, including a critical examination of the main themes in the economics of transition.

A survey of economic growth

Understanding the process of economic growth has been called the ultimate objective of economics. It has also been likened to an elusive quest – like the Holy Grail or the Elixir of Life (Easterly 2001). Taking on such a quest requires ingenuity and perseverance. Even small insights along the way can have major benefits to millions of people; small mistakes can do the reverse. Economies which achieve large increases in output over extended periods of time, not only enable rapid increases in standards of living, but also have dramatic changes in the economic, political and social landscape. For example, the USA is estimated to produce approximately 30 times as much in 1999 as it did in 1899. This sustained economic growth means that in 1999 the USA had an average income per capita of US$34 100. In contrast, sub-Saharan Africa had an average income of $490. Understanding these vast income differences, produced over many decades, is the elusive quest. The aim of this survey is to explain how economists try to understand the process of economic growth. To make the task manageable, the focus is on major issues and current debates. Models and conceptual frameworks are discussed in section III. Section IV summarises empirical studies, with a particular focus on econometric studies of groups of countries. This is not to say that case studies of single countries are not valuable, but space precludes covering everything. The following section sets out some facts about economic growth and, hopefully, motivates the further effort needed to tackle the theory and econometrics.

Giving whistleblowers greater protection:improving quality of care

This year, an independent review of whisleblowing in the NHS made recommendations as to how whistleblowers could be given greater protection. The review, chaired by Sir Robert Francis, intended to improve the quality of patient care and safety in the health service. But with many practitioners remaining unregulated, there are unanswered questions as to how reports of mistakes can be properly investigated and the necessary action taken against incompetent or negligent practitioners. Amanda Casey, Chair of the Registration Council for Clinical Physiologists, makes the case for regulation of professionals whose work poses potential risks to patients and can place healthcare managers in an invidious position.

Interaction of Kelvin waves and nonlocality of energy transfer in superfluids

We argue that the physics of interacting Kelvin Waves (KWs) is highly nontrivial and cannot be understood on the basis of pure dimensional reasoning. A consistent theory of KW turbulence in superfluids should be based upon explicit knowledge of their interactions. To achieve this, we present a detailed calculation and comprehensive analysis of the interaction coefficients for KW turbuelence, thereby, resolving previous mistakes stemming from unaccounted contributions. As a first application of this analysis, we derive a local nonlinear (partial differential) equation. This equation is much simpler for analysis and numerical simulations of KWs than the Biot-Savart equation, and in contrast to the completely integrable local induction approximation (in which the energy exchange between KWs is absent), describes the nonlinear dynamics of KWs. Second, we show that the previously suggested Kozik-Svistunov energy spectrum for KWs, which has often been used in the analysis of experimental and numerical data in superfluid turbulence, is irrelevant, because it is based upon an erroneous assumption of the locality of the energy transfer through scales. Moreover, we demonstrate the weak nonlocality of the inverse cascade spectrum with a constant particle-number flux and find resulting logarithmic corrections to this spectrum.

Discovering knowledge structures in mind maps of mental health risks

This thesis addressed the problem of risk analysis in mental healthcare, with respect to the GRiST project at Aston University. That project provides a risk-screening tool based on the knowledge of 46 experts, captured as mind maps that describe relationships between risks and patterns of behavioural cues. Mind mapping, though, fails to impose control over content, and is not considered to formally represent knowledge. In contrast, this thesis treated GRiSTs mind maps as a rich knowledge base in need of refinement; that process drew on existing techniques for designing databases and knowledge bases. Identifying well-defined mind map concepts, though, was hindered by spelling mistakes, and by ambiguity and lack of coverage in the tools used for researching words. A novel use of the Edit Distance overcame those problems, by assessing similarities between mind map texts, and between spelling mistakes and suggested corrections. That algorithm further identified stems, the shortest text string found in related word-forms. As opposed to existing approaches’ reliance on built-in linguistic knowledge, this thesis devised a novel, more flexible text-based technique. An additional tool, Correspondence Analysis, found patterns in word usage that allowed machines to determine likely intended meanings for ambiguous words. Correspondence Analysis further produced clusters of related concepts, which in turn drove the automatic generation of novel mind maps. Such maps underpinned adjuncts to the mind mapping software used by GRiST; one such new facility generated novel mind maps, to reflect the collected expert knowledge on any specified concept. Mind maps from GRiST are stored as XML, which suggested storing them in an XML database. In fact, the entire approach here is ”XML-centric”, in that all stages rely on XML as far as possible. A XML-based query language allows user to retrieve information from the mind map knowledge base. The approach, it was concluded, will prove valuable to mind mapping in general, and to detecting patterns in any type of digital information.

Medicines reconciliation at the point of hospital discharge for children

Objectives: Hospital discharge is a transition of care, where medication discrepancies are likely to occur and potentially cause patient harm. The purpose of our study was to assess the prescribing accuracy of hospital discharge medication orders at a London, UK teaching hospital. The timeliness of the discharge summary reaching the general practitioner (GP, family physician) was also assessed based on the 72 h target referenced in the Care Quality Commission report.1 Method: 501 consecutive discharge medication orders from 142 patients were examined and the following records were compared (1) the final inpatient drug chart at the point of discharge, (2) printed signed copy of the initial to take away (TTA) discharge summary produced electronically by the physician, (3) the pharmacist's amendments on the initial TTA that were hand written, (4) the final electronic patient discharge summary record, (5) the patients final take home medication from the hospital. Discrepancies between the physician's order (6) and pharmacist's change(s) (7) were compared with two types of failures – ‘failure to make a required change’ and ‘change where none was required’. Once the patient was discharged, the patient's GP, was contacted 72 h after discharge to see if the patient discharge summary, sent by post or via email, was received. Results: Over half the patients seen (73 out of 142) patients had at least one discrepancy that was made on the initial TTA by the doctor and amended by the pharmacist. Out of the 501 drugs, there were 140 discrepancies, 108 were ‘failures to make a required change’ (77%) and 32 were ‘changes where none were required’ (23%). The types of ‘failures to make required changes’ discrepancies that were found between the initial TTA and pharmacist's amendments were paracetamol and ibuprofen changes (dose banding) 38 (27%), directions of use 34 (24%), incorrect formulation of medication 28 (20%) and incorrect strength 8 (6%). The types of ‘changes where none were required discrepancies’ were omitted medication 15 (11%), unnecessary drug 14 (10%) and incorrect medicine including spelling mistakes 3 (2%). After contacting the GPs of the discharged patients 72 h postdischarge; 49% had received the discharge summary and 45% had not, the remaining 6% were patients who were discharged without a GP. Conclusion: This study shows that doctor prescribing at discharge is often not accurate, and interventions made by pharmacist to reconcile are important at this point of care. It was also found that half the discharge summaries had not reached the patient's family physician (according to the GP) within 72 h.