Local officials' preferences of performance measurements: A study of local police services

The purpose of this study is to identify the determinants of local officials' preferences of performance measures under the assumption that public officials' consensus on performance measures can enhance the accountability in public service delivery. This research consists of two steps: multiple case studies and a survey. The author conducted the case studies in five general-purpose municipalities in Florida, interviewing 25 local officials, attending community meetings, and reviewing relevant local documents. Based on the case studies and the relevant literature, a survey was developed and sent to 445 local officials in 67 general-purpose municipalities in Dade, Broward, and Palm Beach Counties, Florida. The findings of the case studies and the survey suggest that local officials' preferences of performance measures are influenced by their perception of utilities of performance measures and their desire to measure the achievement of organizational goals. The author concludes that a consensus among local officials for outcome-oriented performance measures is easier to achieve if a prospective performance measurement system is designed for reporting and management purposes rather than for budgeting purposes. ^

Outsourcing Information Services in the Hospitality Industry

Outsourcing of informational services, a growing trend outside the hospitality industry for several years, is the process of contracting with an outside vendor to take over all or part of a company's information processing needs. The author examines the pros and cons of outscourcing to help the hospitality industry determine if this si a business practice to be considered.

Differential Impacts of Information Technology Services in the Korean Hotel Industry: A Study of Management Perceptions

Successful introduction of information technology applications in various operations of hotel management is vital to most service firms. In recent decades, technologies of information, automation, and communication are increasingly recognized as essential components of a hotel company’s strategic plan. In this study, 62 super-deluxe hotels (5 star), deluxe hotels (4 star), and tourist hotels (3 star) in Korea are examined for differences in the impact of information technology services on guest’ satisfaction, guest convenience, and operational efficiency. The findings generally suggest that the impacts of information technology-enhanced services vary according to the category of hotels in Korea. The results of the study are expected to assist managers in the selections and implementation of information technology systems in their hotel.

The effects of advanced practice nurses (APNs) as intensivists in a surgical intensive care unit (SICU) on patient outcomes, healthcare charges, and apn intensivist services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD = 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M = 3.27, SD = 3.32), t (202) = 1.02, p = .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU. ^

The Effects of Advanced Practice Nurses (APNs) as Intensivists in a Surgical Intensive Care Unit (SICU) on Patient Outcomes, Healthcare Charges, and APN Intensivist Services in the SICU

Intensive Care Units (ICUs) account for over 10 percent of all US hospital beds, have over 4.4 million patient admissions yearly, approximately 360,000 deaths, and account for close to 30% of acute care hospital costs. The need for critical care services has increased due to an aging population and medical advances that extend life. The result is efforts to improve patient outcomes, optimize financial performance, and implement models of ICU care that enhance quality of care and reduce health care costs. This retrospective chart review study examined the dose effect of APN Intensivists in a surgical intensive care unit (SICU) on differences in patient outcomes, healthcare charges, SICU length of stay, charges for APN intensivist services, and frequency of APNs special initiatives when the SICU was staffed by differing levels of APN Intensivist staffing over four time periods (T1-T4) between 2009 and 2011. The sample consisted of 816 randomly selected (204 per T1-T4) patient chart data. Study findings indicated reported ventilator associated pneumonia (VAP) rates, ventilator days, catheter days and catheter associated urinary tract infection (CAUTI) rates increased at T4 (when there was the lowest number of APN Intensivists), and there was increased pressure ulcer incidence in first two quarters of T4. There was no statistically significant difference in post-surgical glycemic control (M = 142.84, SD= 40.00), t (223) = 1.40, p = .17, and no statistically significant difference in the SICU length of stay among the time-periods (M= 3.27, SD = 3.32), t (202) = 1.02, p= .31. Charges for APN services increased over the 4 time periods from $11,268 at T1 to $51,727 at T4 when a system to capture APN billing was put into place. The number of new APN initiatives declined in T4 as the number of APN Intensivists declined. Study results suggest a dose effect of APN Intensivists on important patient health outcomes and on the number of APNs initiatives to prevent health complications in the SICU.

The effectiveness of an enhanced cognitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The E-CB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk-taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. ^ The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. ^ This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population. ^

Beyond the Pay: Current Illicit Activities of the Armed Forces in Central America

The growth of criminal gangs and organized crime groups has created unprecedented challenges in Central America. Homicide rates are among the highest in the world, countries spend on average close to 10 percent of GDP to respond to the challenges of public insecurity, and the security forces are frequently overwhelmed and at times coopted by the criminal groups they are increasingly tasked to counter. With some 90 percent of the 700 metric tons of cocaine trafficked from South America to the United States passing through Central America, the lure of aiding illegal traffickers through provision of arms, intelligence, or simply withholding or delaying the use of force is enormous. These conditions raise the question: to what extent are militaries in Central America compromised by illicit ties to criminal groups? The study focuses on three cases: Nicaragua, El Salvador, and Honduras. It finds that: Although illicit ties between the military and criminal groups have grown in the last decade, militaries in these countries are not yet “lost’ to criminal groups. Supplying criminal groups with light arms from military stocks is typical and on the rise, but still not common. In general the less exposed services, the navies and air forces, are the most reliable and effective ones in their roles in interdiction. Of the three countries in the study, the Honduran military is the most worrying because it is embedded in a context where civilian corruption is extremely common, state institutions are notoriously weak, and the political system remains polarized and lacks the popular legitimacy and political will needed to make necessary reforms. Overall, the armed forces in the three countries remain less compromised than civilian peers, particularly the police. However, in the worsening crime and insecurity context, there is a limited window of opportunity in which to introduce measures targeted toward the military, and such efforts can only succeed if opportunities for corruption in other sectors of the state, in particular in law enforcement and the justice system, are also addressed. Measures targeted toward the military should include: Enhanced material benefits and professional education opportunities that open doors for soldiers in promising legitimate careers once they leave military service. A clear system of rewards and punishments specifically designed to deter collusion with criminal groups. More effective securing of military arsenals. Skills and external oversight leveraged through combined operations, to build cooperation among those sectors of the military that have successful and clean records in countering criminal groups, and to expose weaker forces to effective best practices.

The effectiveness of an enhanced congnitive behavioral intervention in improving behavioral outcomes related to HIV prevention

This study analyzed outcomes of an enhanced cognitive-behavioral intervention with dually diagnosed severely mentally ill adults. It specifically addressed the improvement of attitudes, skills, self-efficacy to use condoms and the heightening of condom use. The data were analyzed via a randomized three-group repeated measures design composed of the experimental (E-CB), standard care (SC) comparison or a no-treatment control condition as the between-subjects variable and pre-post measure as the within-subjects variable. The ECB focused on cooperative, application, hands-on, skill-building and role-playing activities for sexual assertiveness, negotiation in risk-taking and proper condom use. The SC comparison, was didactic in its approach and addressed risk- taking and proper condom use in one session, but did not involve application approaches to problem-solving risky situations or condom use. Multiple assessments were conducted at pre-, post- and six months post-intervention. The analysis indicated that the E-CB intervention led to more favorable attitudes toward condoms and to improved and maintained skills regarding their use by participants six months after the intervention compared to the standard care and control groups. No significant improvements in self-efficacy were found. A repeated measures ANOVA conducted on the transformed values of percentage of vaginal condom use indicated no significant differences between the experimental and standard care conditions but both had a significantly higher mean percentage vaginal condom use than the control group, averaged across pre- and six-month post-intervention. No gender differences were seen in attitudes, skills or self-efficacy to use condoms. This study shed light upon the effectiveness of the instructional approach for the enhancement of attitudes, skills and self-efficacy outcomes related to HIV prevention. For heightened effectiveness, future approaches must address multiple factors impacting learning in this population.