Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?

Da estratégia individual à ação coletiva: grupos de suporte e gênero no contexto da gestão da diversidade

Este artigo trata da formação de grupo de suporte no marco das políticas de diversidade empresarial. São escassas as pesquisas que abordem essa prática de gestão da diversidade. Visando a contribuir para o preenchimento dessa lacuna, o trabalho analisa um Comitê de Mulheres, a fim de compreender de que forma ele é influenciado pela política de diversidade formatada pela direção da organização e a influencia. Foi realizado um estudo de caso etnográfico em uma corporação transnacional cuja sede no Brasil está localizada em São Paulo. Os resultados apontam para um paradoxo. Por um lado, o Comitê analisado representa um processo de emancipação, sinalizando para práticas gerenciais mais inclusivas e participativas. Por outro, notou-se a presença de mecanismos de controle, uma vez que há um esforço da direção da empresa em disciplinar o seu funcionamento.

Social rules for managing attempted interpersonal domination in the workplace: Influence of status and gender.

The present study utilized a social rules approach to investigate the relative influence of gender and status on managers' self-evaluations of their effectiveness in handling a dominating subordinate. In the first study 84 White middle-class participants identified the prescriptive and proscriptive rules for socially appropriate responding to a stimulus situation involving a pushy subordinate. Four rule sets were identified for female and male managers and subordinates, respectively. Rule-sets shared a number of common rules and showed some variation according to gender roles. In the second study, 91 White middle-class participants rated the individual rules for importance and also rated their personal and managerial effectiveness when responding to the stimulus situation using gender- and status-consistent and gender-and status-inconsistent response strategies. Both men and women rated the female gender and status- consistent strategy as most effective, and rated the status-inconsistent strategy as less effective than a gender-inconsistent response. Results were interpreted as providing more support for a situational gender-related theory of workplace behavior, rather than a traditional gender role perspective.

Managing innovation complexity: About the co-existence of innovation types

The purpose of this study is to contribute to the changing innovation management literature by providing an overview of different innovation types and organizational complexity factors. Aiming at a better understanding of effective innovation management, innovation and complexity are related to the formulation of an innovation strategy and interaction between different innovation types is further explored. The chosen approach in this study is to review the existing literature on different innovation types and organizational complexity factors in order to design a survey which allows for statistical measurement of their interactions and relationships to innovation strategy formulation. The findings demonstrate interaction between individual innovation types. Additionally, organizational complexity factors and different innovation types are significantly related to innovation strategy formulation. In particular, more closed innovation and incremental innovation positively influence the likelihood of innovation strategy formulation. Organizational complexity factors have an overall negative influence on innovation strategy formulation. In order to define best practices for innovation management and to guide managerial decision making, organizations need to be aware of the co-existence of different innovation types and formulate an innovation strategy to more closely align their innovation objectives.

Managing tobacco use: the neglected cardiovascular disease risk factor.

Cigarette smoking is a major risk factor for cardiovascular disease (CVD) and the leading avoidable cause of death worldwide. Exposure to secondhand smoke (SHS) increases the risk of CVD among non-smokers. Smoking cessation benefits all smokers, regardless of age or amount smoked. The excess risk of CVD is rapidly reversible, and stopping smoking after a myocardial infarction reduces an individual's risk of CVD mortality by 36% over 2 years. Smoking cessation is a key component of primary and secondary CVD prevention strategies, but tobacco use often receives less attention from cardiologists than other risk factors, despite the availability of proven treatments that improve smoking cessation rates. Both psychosocial counselling and pharmacotherapy are effective methods to help smokers quit, but they are most effective when used together. The first-line medications licensed to aid smoking cessation, nicotine replacement therapy, bupropion and varenicline, are effective in and appropriate for patients with CVD. An evidence-based approach for physicians is to routinely ask all patients about smoking status and SHS exposure, advise all smokers to quit and all patients to adopt smoke-free policies for their home and car, and offer all smokers in the office or hospital brief counselling, smoking cessation pharmacotherapy, and referral to local programmes where psychosocial support can be sustained in person or by telephone. Like other chronic diseases, tobacco use requires a long-term management strategy. It deserves to be managed as intensively as other CVD risk factors.

Managing Quality under Heterogeneous Consumer Demand and Product Quality, October 2005

Based on accepted advances in the marketing, economics, consumer behavior, and satisfaction literatures, we develop a micro-foundations model of a firm that needs to manage the quality of a product that is inherently heterogeneous in the presence of varying customer tastes or expectations for quality. Our model blends elements of the returns to quality, customer lifetime value, and service profit chain approaches to marketing. The model is then used to explain several empirical results pertaining to the marketing literature by explicitly articulating the trade-offs between customer satisfaction and costs (including opportunity costs) of quality. In this environment firms will find it optimal to allow some customers to go unsatisfied. We show that the relationship between the expected number of repeated purchases by an individual customer is endogenous to the choice of quality by the firm, indicating that the number of purchases cannot be chosen freely to estimate a customer’s lifetime value.

Stage managing bipolar disorder.

OBJECTIVES: Clinical staging is widespread in medicine - it informs prognosis, clinical course, and treatment, and assists individualized care. Staging places an individual on a probabilistic continuum of increasing potential disease severity, ranging from clinically at-risk or latency stage through first threshold episode of illness or recurrence, and, finally, to late or end-stage disease. The aim of the present paper was to examine and update the evidence regarding staging in bipolar disorder, and how this might inform targeted and individualized intervention approaches. METHODS: We provide a narrative review of the relevant information. RESULTS: In bipolar disorder, the validity of staging is informed by a range of findings that accompany illness progression, including neuroimaging data suggesting incremental volume loss, cognitive changes, and a declining likelihood of response to pharmacological and psychosocial treatments. Staging informs the adoption of a number of approaches, including the active promotion of both indicated prevention for at-risk individuals and early intervention strategies for newly diagnosed individuals, and the tailored implementation of treatments according to the stage of illness. CONCLUSIONS: The nature of bipolar disorder implies the presence of an active process of neuroprogression that is considered to be at least partly mediated by inflammation, oxidative stress, apoptosis, and changes in neurogenesis. It further supports the concept of neuroprotection, in that a diversity of agents have putative effects against these molecular targets. Clinically, staging suggests that the at-risk state or first episode is a period that requires particularly active and broad-based treatment, consistent with the hope that the temporal trajectory of the illness can be altered. Prompt treatment may be potentially neuroprotective and attenuate the neurostructural and neurocognitive changes that emerge with chronicity. Staging highlights the need for interventions at a service delivery level and implementing treatments at the earliest stage of illness possible.

Managing FOSS during development: preventive and curative approaches

Today, most software development teams use free and open source software (FOSS) components, because it increases the speed and the quality of the development. Many open source components are the de facto standard of their category. However, FOSS has licensing restrictions, and corporate organizations usually maintain a list of allowed and forbidden licenses. But how do you enforce this policy? How can you make sure that ALL files in your source depot, either belong to you, or fit your licensing policy? A first, preventive approach is to train and increase the awareness of the development team to these licensing issues. Depending on the size of the team, it may be costly but necessary. However, this does not ensure that a single individual will not commit a forbidden icon or library, and jeopardize the legal status of the whole release... if not the company, since software is becoming more and more a critical asset. Another approach is to verify what is included in the source repository, and check whether it belongs to the open-source world. This can be done on-the-fly, whenever a new file is added into the source depot. It can also be part of the release process, as a verification step before publishing the release. In both cases, there are some tools and databases to automate the detection process. We will present the various options regarding FOSS detection, how this process can be integrated in the "software factory", and how the results can be displayed in a usable and efficient way.

Managing regulatory risks when outsourcing network-related services in the electricity distribution sector

Deregulation of the electricity sector liberated the electricity sale and production for competitive forces while in the network business, electricity transmission and distribution, natural monopoly positions were recognised. Deregulation was accompanied by efficiencyoriented thinking on the whole electricity supply industry. For electricity distribution this meant a transition from a public service towards profit-driven business guided by economic regulation. Regulation is the primary means to enforce societal and other goals in the regulated monopoly sector. The design of economic regulation is concerned with two main attributes; end-customer price and quality of electricity distribution services. Regulation limits the costs of the regulated company but also defines the desired quality of monopoly services. The characteristics of the regulatory framework and the incentives it provides are therefore decisive for the electricity distribution sector. Regulation is not a static factor; changes in the regulatory practices cause discontinuity points, which in turn generate risks. A variety of social and environmental concerns together with technological advancements have emphasised the relevance of quality regulation, which is expected to lead to the large-scale replacement of overhead lines with underground cables. The electricity network construction activity is therefore currently witnessing revolutionary changes in its competitive landscape. In a business characterised by high statutory involvement and a high level of sunk costs, recognising and understanding the regulatory risks becomes a key success factor. As a response, electricity distribution companies have turned into outsourcing to attain efficiency and quality goals. This doctoral thesis addresses the impacts of regulatory risks on electricity network construction, which is a commonly outsourced activity in the electricity distribution network sector. The chosen research approach is characterised as an action analytical research on account of the fact that regulatory risks are greatly dependent on the individual nature of the regulatory regime applied in the electricity distribution sector. The main contribution of this doctoral thesis is to develop a concept for recognising and managing the business risks stemming from economic regulation. The degree of outsourcing in the sector is expected to increase in years to come. The results of the research provide new knowledge to manage the regulatory risks when outsourcing services.

Collectiveness within startup teams – Leading the way to initiating and managing collective pursuit of opportunities in organizational contexts

While traditional entrepreneurship literature addresses the pursuit of entrepreneurial opportunities to a solo entrepreneur, scholars increasingly agree that new ventures are often founded and operated by entrepreneurial teams as collective efforts especially in hightechnology industries. Researchers also suggest that team ventures are more likely to survive and succeed than ventures founded by the individual entrepreneur although specific challenges might relate to multiple individuals being involved in joint entrepreneurial action. In addition to new ventures, entrepreneurial teams are seen central for organizing work in established organizations since the teams are able to create major product and service innovations that drive organizational success. Acknowledgement of the entrepreneurial teams in various organizational contexts has challenged the notion on the individual entrepreneur. However, considering that entrepreneurial teams represent a collective-level phenomenon that bases on interactions between organizational members, entrepreneurial teams may not have been studied as indepth as could be expected from the point of view of the team-level, rather than the individual or the individuals in the team. Many entrepreneurial team studies adopt the individualized view of entrepreneurship and examine the team members’ aggregate characteristics or the role of a lead entrepreneur. The previous understandings might not offer a comprehensive and indepth enough understanding of collectiveness within entrepreneurial teams and team venture performance that often relates to the team-level issues in particular. In addition, as the collective-level of entrepreneurial teams has been approached in various ways in the existing literatures, the phenomenon has been difficult to understand in research and practice. Hence, there is a need to understand entrepreneurial teams at the collective-level through a systematic and comprehensive perspective. This study takes part in the discussions on entrepreneurial teams. The overall objective of this study is to offer a description and understanding of collectiveness within entrepreneurial teams beyond individual(s). The research questions of the study are: 1) what collectiveness within entrepreneurial teams stands for, what constitutes the basic elements of it, and who are included in it, 2) why, how, and when collectiveness emerges or reinforces within entrepreneurial teams, and 3) why collectiveness within entrepreneurial teams matters and how it could be developed or supported. In order to answer the above questions, this study bases on three approaches, two set of empirical data, two analysis techniques, and conceptual study. The first data set consists of 12 qualitative semi-structured interviews with business school students who are seen as prospective entrepreneurs. The data is approached through a social constructionist perspective and analyzed through discourse analysis. The second data set bases on a qualitative multiplecase study approach that aims at theory elaboration. The main data consists of 14 individual and four group semi-structured thematic interviews with members of core entrepreneurial teams of four team startups in high-technology industries. The secondary data includes publicly available documents. This data set is approached through a critical realist perspective and analyzed through systematic thematic analysis. The study is completed through a conceptual study that aims at building a theoretical model of collective-level entrepreneurship drawing from existing literatures on organizational theory and social-psychology. The theoretical work applies a positivist perspective. This study consists of two parts. The first part includes an overview that introduces the research background, knowledge gaps and objectives, research strategy, and key concepts. It also outlines the existing knowledge of entrepreneurial team literature, presents and justifies the choices of paradigms and methods, summarizes the publications, and synthesizes the findings through answering the above mentioned research questions. The second part consists of five publications that address independent research questions but all enable to answer the research questions set for this study as a whole. The findings of this study suggest a map of relevant concepts and their relationships that help grasp collectiveness within entrepreneurial teams. The analyses conducted in the publications suggest that collectiveness within entrepreneurial teams stands for cognitive and affective structures in-between team members including elements of collective entity, collective idea of business, collective effort, collective attitudes and motivations, and collective feelings. Collectiveness within entrepreneurial teams also stands for specific joint entrepreneurial action components in which the structures are constructed. The action components reflect equality and democracy, and open and direct communication in particular. Collectiveness emerges because it is a powerful tool for overcoming individualized barriers to entrepreneurship and due to collectively oriented desire for, collective value orientation to, demand for, and encouragement to team entrepreneurship. Collectiveness emerges and reinforces in processes of joint creation and realization of entrepreneurial opportunities including joint analysis and planning of the opportunities and strategies, decision-making and realization of the opportunities, and evaluation, feedback, and sanctions of entrepreneurial action. Collectiveness matters because it is relevant for potential future entrepreneurs and because it affects the ways collective ventures are initiated and managed. Collectiveness also matters because it is a versatile, dynamic, and malleable phenomenon and the ideas of it can be applied across organizational contexts that require team work in discovering or creating and realizing new opportunities. This study further discusses how the findings add to the existing knowledge of entrepreneurial team literature and how the ideas can be applied in educational, managerial, and policy contexts.

Managing threatened species – the ecological toolbox, evolutionary theory and the declining-population paradigm

1. The management of threatened species is an important practical way in which conservationists can intervene in the extinction process and reduce the loss of biodiversity. Understanding the causes of population declines (past, present and future) is pivotal to designing effective practical management. This is the declining-population paradigm identified by Caughley. 2. There are three broad classes of ecological tool used by conservationists to guide management decisions for threatened species: statistical models of habitat use, demographic models and behaviour-based models. Each of these is described here, illustrated with a case study and evaluated critically in terms of its practical application. 3. These tools are fundamentally different. Statistical models of habitat use and demographic models both use descriptions of patterns in abundance and demography, in relation to a range of factors, to inform management decisions. In contrast, behaviourbased models describe the evolutionary processes underlying these patterns, and derive such patterns from the strategies employed by individuals when competing for resources under a specific set of environmental conditions. 4. Statistical models of habitat use and demographic models have been used successfully to make management recommendations for declining populations. To do this, assumptions are made about population growth or vital rates that will apply when environmental conditions are restored, based on either past data collected under favourable environmental conditions or estimates of these parameters when the agent of decline is removed. As a result, they can only be used to make reliable quantitative predictions about future environments when a comparable environment has been experienced by the population of interest in the past. 5. Many future changes in the environment driven by management will not have been experienced by a population in the past. Under these circumstances, vital rates and their relationship with population density will change in the future in a way that is not predictable from past patterns. Reliable quantitative predictions about population-level responses then need to be based on an explicit consideration of the evolutionary processes operating at the individual level. 6. Synthesis and applications. It is argued that evolutionary theory underpins Caughley’s declining-population paradigm, and that it needs to become much more widely used within mainstream conservation biology. This will help conservationists examine critically the reliability of the tools they have traditionally used to aid management decision-making. It will also give them access to alternative tools, particularly when predictions are required for changes in the environment that have not been experienced by a population in the past.

Managing threatened species: the ecological toolbox, evolutionary theory and declining-population paradigm

1. The management of threatened species is an important practical way in which conservationists can intervene in the extinction process and reduce the loss of biodiversity. Understanding the causes of population declines (past, present and future) is pivotal to designing effective practical management. This is the declining-population paradigm identified by Caughley. 2. There are three broad classes of ecological tool used by conservationists to guide management decisions for threatened species: statistical models of habitat use, demographic models and behaviour-based models. Each of these is described here, illustrated with a case study and evaluated critically in terms of its practical application. 3. These tools are fundamentally different. Statistical models of habitat use and demographic models both use descriptions of patterns in abundance and demography, in relation to a range of factors, to inform management decisions. In contrast, behaviour-based models describe the evolutionary processes underlying these patterns, and derive such patterns from the strategies employed by individuals when competing for resources under a specific set of environmental conditions. 4. Statistical models of habitat use and demographic models have been used successfully to make management recommendations for declining populations. To do this, assumptions are made about population growth or vital rates that will apply when environmental conditions are restored, based on either past data collected under favourable environmental conditions or estimates of these parameters when the agent of decline is removed. As a result, they can only be used to make reliable quantitative predictions about future environments when a comparable environment has been experienced by the population of interest in the past. 5. Many future changes in the environment driven by management will not have been experienced by a population in the past. Under these circumstances, vital rates and their relationship with population density will change in the future in a way that is not predictable from past patterns. Reliable quantitative predictions about population-level responses then need to be based on an explicit consideration of the evolutionary processes operating at the individual level. 6. Synthesis and applications. It is argued that evolutionary theory underpins Caughley's declining-population paradigm, and that it needs to become much more widely used within mainstream conservation biology. This will help conservationists examine critically the reliability of the tools they have traditionally used to aid management decision-making. It will also give them access to alternative tools, particularly when predictions are required for changes in the environment that have not been experienced by a population in the past.

A New Approach for Managing Bovine Tuberculosis: Veterinary Services’ Proposed Action Plan

Bovine tuberculosis (TB) is a serious disease with animal health, public health, and international trade consequences. The cooperative Federal-State-industry effort to eradicate bovine TB from cattle in the United States has made significant progress since the program’s inception in 1917. However, the goal of eradication remains elusive. This proposed action plan presents Veterinary Services’ (VS’) current thinking about changes we are considering for the TB program to address our current challenges. This action plan will: 1. Reduce the introduction of TB into the U.S. national herd from imported animals and wildlife by: o Applying additional requirements to cattle imports from Mexico o Enhancing efforts to mitigate risks from wildlife 2. Enhance TB surveillance by: o Crafting a comprehensive national surveillance plan o Accelerating diagnostic test development to support surveillance 3. Increase options for managing TB-affected herds by: o Conducting epidemiological investigations and assessing individual herd risk o Applying whole-herd depopulation judiciously and developing alternative control strategies o Applying animal identification (ID) standards to meet animal ID needs 4. Modernize the regulatory framework to allow VS to focus resources where the disease exists 5. Transition the TB program from a State classification system to a science-based zoning approach to address disease risk To succeed, this new approach will require VS’ continued partnership with State animal health and wildlife officials, other Federal agencies, industry, international partners, academia, and other stakeholders. Successful partnerships will allow us to use available resources efficiently to achieve program objectives and protect our nation’s herd. Implementation of the VS proposed action plan will benefit Federal and State animal health officials, the regulated industries, and producers by allowing a more rapid response that employs up-to-date science and can adapt rapidly to changing situations.