Addressing organizational issues /

"September 1984."

Everyone is; should healthcare? Outsourcing: Issues in strategic planning, organizational culture, and organizational ethics

Expenditures for personal health services in the United States have doubled over the last decade. They continue to outpace the growth rate of the gross national product. Costs for medical care have steadily increased at an annual rate well above the rate of inflation and have gradually outstripped payers' ability to meet their premiums. This limitation of resources justifies the ongoing healthcare reform strategies to maximize utilization and minimize costs. The majority of the cost-containment effort has focused on hospitals, as they account for about 40 percent of total health expenditures. Although good patient outcomes have long been identified as healthcare's central concern, continuing cost pressures from both regulatory reforms and the restructuring of healthcare financing have recently made improving fiscal performance an essential goal for healthcare organizations. ^ The search for financial performance, quality improvement, and fiscal accountability has led to outsourcing, which is the hiring of a third party to perform a task previously and traditionally done in-house. The incomparable nature and overwhelming dissimilarities between health and other commodities raise numerous administrative, organizational, policy and ethical issues for administrators who contemplate outsourcing. This evaluation of the outsourcing phenomenon, how it has developed and is currently practiced in healthcare, will explore the reasons that healthcare organizations gravitate toward outsourcing as a strategic management tool to cut costs in an environment of continuing escalating spending. ^ This dissertation has four major findings. First, it suggests that U.S. hospitals in FY2000 spent an estimated $61 billion in outsourcing. Second, it finds that the proportion of healthcare outsourcing highly correlates with several types of hospital controlling authorities and specialties. Third, it argues that healthcare outsourcing has implications in strategic organizational issues, professionalism, and organizational ethics that warrant further public policy discussions before expanding its limited use beyond hospital “hotel functions” and back office business processes. Finally, it devises an outsourcing suitability scale that organizations can utilize to ensure the most strategic option for outsourcing and concludes with some public policy implications and recommendations for its limited use. ^

Can outcome prediction data change patient outcomes and organizational outcomes?

PURPOSE OF REVIEW: Intensive care medicine consumes a high share of healthcare costs, and there is growing pressure to use the scarce resources efficiently. Accordingly, organizational issues and quality management have become an important focus of interest in recent years. Here, we will review current concepts of how outcome data can be used to identify areas requiring action. RECENT FINDINGS: Using recently established models of outcome assessment, wide variability between individual ICUs is found, both with respect to outcome and resource use. Such variability implies that there are large differences in patient care processes not only within the ICU but also in pre-ICU and post-ICU care. Indeed, measures to improve the patient process in the ICU (including care of the critically ill, patient safety, and management of the ICU) have been presented in a number of recently published papers. SUMMARY: Outcome assessment models provide an important framework for benchmarking. They may help the individual ICU to spot appropriate fields of action, plan and initiate quality improvement projects, and monitor the consequences of such activity.

National evaluation of NHS genetics service investments: emerging issues from the cancer genetics pilots

In seeking to fulfil the ambition of the 2003 genetics white paper, Our Inheritance, Our Future, to ‘mainstream’ genetic knowledge and practices, the Department of Health provided start-up funding for pilot services in various clinical areas, including seven cancer genetics projects. To help to understand the challenges encountered by such an attempt at reconfiguring the organization and delivery of services in this field, a programme-level evaluation of the genetics projects was commissioned to consider the organizational issues faced. Using a qualitative approach, this research has involved comparative case-study work in 11 of the pilot sites, including four of the seven cancer genetics pilots. In this paper, the researchers present early findings from their work, focusing in particular on the cancer genetics pilots. They consider some of the factors that have influenced how the pilots have sought to address pre-existing sector, organizational and professional boundaries to these new ways of working. The article examines the relationship between these factors and the extent to which pilots have succeeded in setting up boundary-spanning services, dealing with human-resource issues and creating sustainable, ‘mainstreamed’ provision which attracts ongoing funding in a volatile NHS commissioning environment where funding priorities do not always favour preventive, risk-assessment services.

Value creation and value capture fro open source software publisher : a new business model based on mutualisation

Key topics: Since the birth of the Open Source movement in the mid-80's, open source software has become more and more widespread. Amongst others, the Linux operating system, the Apache web server and the Firefox internet explorer have taken substantial market shares to their proprietary competitors. Open source software is governed by particular types of licenses. As proprietary licenses only allow the software's use in exchange for a fee, open source licenses grant users more rights like the free use, free copy, free modification and free distribution of the software, as well as free access to the source code. This new phenomenon has raised many managerial questions: organizational issues related to the system of governance that underlie such open source communities (Raymond, 1999a; Lerner and Tirole, 2002; Lee and Cole 2003; Mockus et al. 2000; Tuomi, 2000; Demil and Lecocq, 2006; O'Mahony and Ferraro, 2007;Fleming and Waguespack, 2007), collaborative innovation issues (Von Hippel, 2003; Von Krogh et al., 2003; Von Hippel and Von Krogh, 2003; Dahlander, 2005; Osterloh, 2007; David, 2008), issues related to the nature as well as the motivations of developers (Lerner and Tirole, 2002; Hertel, 2003; Dahlander and McKelvey, 2005; Jeppesen and Frederiksen, 2006), public policy and innovation issues (Jullien and Zimmermann, 2005; Lee, 2006), technological competitions issues related to standard battles between proprietary and open source software (Bonaccorsi and Rossi, 2003; Bonaccorsi et al. 2004, Economides and Katsamakas, 2005; Chen, 2007), intellectual property rights and licensing issues (Laat 2005; Lerner and Tirole, 2005; Gambardella, 2006; Determann et al., 2007). A major unresolved issue concerns open source business models and revenue capture, given that open source licenses imply no fee for users. On this topic, articles show that a commercial activity based on open source software is possible, as they describe different possible ways of doing business around open source (Raymond, 1999; Dahlander, 2004; Daffara, 2007; Bonaccorsi and Merito, 2007). These studies usually look at open source-based companies. Open source-based companies encompass a wide range of firms with different categories of activities: providers of packaged open source solutions, IT Services&Software Engineering firms and open source software publishers. However, business models implications are different for each of these categories: providers of packaged solutions and IT Services&Software Engineering firms' activities are based on software developed outside their boundaries, whereas commercial software publishers sponsor the development of the open source software. This paper focuses on open source software publishers' business models as this issue is even more crucial for this category of firms which take the risk of investing in the development of the software. Literature at last identifies and depicts only two generic types of business models for open source software publishers: the business models of ''bundling'' (Pal and Madanmohan, 2002; Dahlander 2004) and the dual licensing business models (Välimäki, 2003; Comino and Manenti, 2007). Nevertheless, these business models are not applicable in all circumstances. Methodology: The objectives of this paper are: (1) to explore in which contexts the two generic business models described in literature can be implemented successfully and (2) to depict an additional business model for open source software publishers which can be used in a different context. To do so, this paper draws upon an explorative case study of IdealX, a French open source security software publisher. This case study consists in a series of 3 interviews conducted between February 2005 and April 2006 with the co-founder and the business manager. It aims at depicting the process of IdealX's search for the appropriate business model between its creation in 2000 and 2006. This software publisher has tried both generic types of open source software publishers' business models before designing its own. Consequently, through IdealX's trials and errors, I investigate the conditions under which such generic business models can be effective. Moreover, this study describes the business model finally designed and adopted by IdealX: an additional open source software publisher's business model based on the principle of ''mutualisation'', which is applicable in a different context. Results and implications: Finally, this article contributes to ongoing empirical work within entrepreneurship and strategic management on open source software publishers' business models: it provides the characteristics of three generic business models (the business model of bundling, the dual licensing business model and the business model of mutualisation) as well as conditions under which they can be successfully implemented (regarding the type of product developed and the competencies of the firm). This paper also goes further into the traditional concept of business model used by scholars in the open source related literature. In this article, a business model is not only considered as a way of generating incomes (''revenue model'' (Amit and Zott, 2001)), but rather as the necessary conjunction of value creation and value capture, according to the recent literature about business models (Amit and Zott, 2001; Chresbrough and Rosenblum, 2002; Teece, 2007). Consequently, this paper analyses the business models from these two components' point of view.

Business process management : an introduction to the special focus issue

The management and improvement of business processes are a core topic of the information systems discipline. The persistent demand in corporations within all industry sectors for increased operational efficiency and innovation, an emerging set of established and evaluated methods, tools, and techniques as well as the quickly growing body of academic and professional knowledge are indicative for the standing that Business Process Management (BPM) has nowadays. During the last decades, intensive research has been conducted with respect to the design, implementation, execution, and monitoring of business processes. Comparatively low attention, however, has been paid to questions related to organizational issues such as the adoption, usage, implications, and overall success of BPM approaches, technologies, and initiatives. This research gap motivated us to edit a corresponding special focus issue for the journal BISE/WIRTSCHAFTSINFORMATIK. We are happy that we are able to present a selection of three research papers and a state-of-the-art paper in the scientific section of the issue at hand. As these papers differ in the topics they investigate, the research method they apply, and the theoretical foundations they build on, the diversity within the BPM field becomes evident. The academic papers are complemented by an interview with Phil Gilbert, IBM’s Vice President for Business Process and Decision Management, who reflects on the relationship between business processes and the data flowing through them, the need to establish a process context for decision making, and the calibration of BPM efforts toward executives who see processes as a means to an end, rather than a first-order concept in its own right.

Practical framework for measuring performance of international construction firms

The internationalization of construction companies has become of significant interest as the global construction market continues to be integrated into a more competitive and turbulent business environment. However, due to the complicated and multifaceted nature of international business and performance, there is as yet no consensus on how to evaluate the performance of international construction firms (ICFs). The purpose of this paper, therefore, is to develop a practical framework for measuring the performance of ICFs. Based on the balanced scorecard (BSC), a framework with detailed measures is developed, investigated, and tested using a three-step research design. In the first step, 27 measures under six dimensions (financial, market, customer, internal business processes, stakeholders, and learning and growth) are determined by literature review, interviews with academics, and seminar discussions. Subsequently, a questionnaire survey is conducted to investigate weights of these 27 performance measures. The questionnaire survey also supports the importance of measuring intangible aspects of international construction performance from the practitioner’s viewpoint. Additionally, a case study is described to test the framework’s robustness and usefulness. This is achieved by benchmarking the performance of a Chinese ICF with nine other counterparts worldwide. It is found that the framework provides an effective basis for benchmarking ICFs to effectively monitor their performance and support the development of strategies for improved competitiveness in the international arena. This paper is the first attempt to present a balanced and practically tested framework for evaluating the performance of ICFs. It contributes to the practice of performance measurement and related internationalization in the construction industry in general.

Ethnography of software maintenance activities in an industrial engineering setup

New technical and procedural interventions are less likely to be adopted in industry, unless they are smoothly integrated into the existing practices of professionals. In this paper, we provide a case study of the use of ethnographic methods for studying software bug-fixing activities at an industrial engineering conglomerate. We aimed at getting an in-depth understanding of software developers' everyday practices in bug-fixing related projects and in turn inform the design of novel productivity tools. The use of ethnography has allowed us to look at the social side of software maintenance practices. In this paper, we highlight: 1) organizational issues that influence bug-fixing activities; 2) social role of bug tracking systems, and; 3) social issues specific to different phases of bug-fixing activities.

Empirical investigation of factors contributing to the psychological safety climate on construction sites

Employees’ safety climate perceptions dictate their safety behavior because individuals act based on their perceptions of reality. Extensive empirical research in applied psychology has confirmed this relationship. However, rare efforts have been made to investigate the factors contributing to a favorable safety climate in construction research. As an initial effort to address the knowledge gap, this paper examines factors contributing to a psychological safety climate, an operationalization of a safety climate at the individual level, and, hence, the basic element of a safety climate at higher levels. A multiperspective framework of contributors to a psychological safety climate is estimated by a structural equation modeling technique using individual questionnaire responses from a random sample of construction project personnel. The results inform management of three routes to psychological safety climate: a client’s proactive involvement in safety management, a workforce-friendly workplace created by the project team, and transformational supervisors’ communication about safety matters with the workforce. This paper contributes to the field of construction engineering and management by highlighting a broader contextual influence in a systematic formation of psychological safety climate perceptions.

Étude des débats menant à l’adoption du projet de loi no 38 sur la gouvernance des universités québécoises

Ce mémoire vise à comprendre les enjeux sociaux qui ont animé le champ social de l’enseignement supérieur à l’étape de la formulation du projet de loi no 38 sur la gouvernance des universités et à mettre en évidence le rôle et l'influence des diverses catégories d'acteurs sociaux impliqués dans ces débats, chacun tentant d’imposer sa définition des enjeux en fonction de ses intérêts, de même que les facteurs explicatifs de cette influence (stratégies, ressources, etc.). Les débats qui ont eu lieu autour du projet de loi à l’étude ont été traité comme étant le produit d’un système d'action, lequel permet de classer ces débats selon une typologie des enjeux, correspondant chacun à trois niveaux de l’action sociale : enjeux fondamentaux, enjeux organisationnels et enjeux politiques. L’analyse des débats font état d’un rapport conflictuel entre les acteurs « externes » à l’université et les acteurs associés à la communauté universitaire dont l’objet est l’organisation et l’exercice du pouvoir entre les acteurs et les instances au sein des établissements universitaires.

L’analyse de l’introduction du changement dans les systèmes de santé des pays en développement : le cas d’un système de surveillance épidémiologique en Haïti

Les systèmes de santé des pays en développement font face à de nombreux enjeux organisationnels pour améliorer l’état de santé de leur population. Au nombre de ces enjeux, il est fréquemment mentionné la présence d’organisations internationales ayant des objectifs et caractéristiques peu convergents et qui interviennent de façon non nécessairement coordonnée. Cette thèse explore la thématique de l’introduction du changement dans ces systèmes de santé en mettant un accent spécifique sur l’enjeu lié à la présence de ces organisations internationales. La méthodologie utilisée est une analyse de concept. Cette approche méthodologique consiste à effectuer des revues critiques de la littérature sur des concepts, à mobiliser de nouvelles approches théoriques pour clarifier ces concepts et à réaliser des études de cas pour leur mise à l’épreuve empirique. En nous appuyant sur la théorie de l’action sociale de Parsons, la théorie de la complexité ainsi que les expériences d’introduction du changement dans différents systèmes de santé, nous avons développé un cadre théorique d’analyse de l’introduction du changement dans les systèmes de santé des pays en développement (1er concept). Ce cadre théorique, qui suggère de concevoir le processus d’introduction du changement comme un système d’action sociale complexe et émergent, a été appliqué à l’analyse de l’introduction d’un système de surveillance épidémiologique en Haïti. Plus précisément, nous avons analysé une étape ainsi que certains aspects du mécanisme sous-jacent au processus d’introduction du changement. Ce faisant, nous avons analysé, dans les deux premiers articles de la thèse, l’étape d’adoption du système de surveillance épidémiologique (2ème concept) ainsi que les déterminants de la collaboration entre les organisations impliquées dans le processus d’introduction du changement (3ème concept). Les résultats de ces analyses nous ont permis d’objectiver de faibles niveaux d’adoption, ainsi qu’une faible articulation des déterminants de la collaboration entre les différentes organisations impliquées dans le processus d’introduction du changement. Partant de ces constats, nous avons pu mettre en évidence, dans le troisième article, une phase de « chaos » dans le fonctionnement du système de santé d’Haïti. Cette phase de « chaos », qui pourrait expliquer les difficultés liées à l’introduction du changement dans les systèmes de santé des pays en développement en général et plus particulièrement en Haïti, était caractérisée par la présence d’un ordre sous-jacent au désordre apparent dans le fonctionnement de certaines composantes du système de santé d’Haïti, l’existence d’une instabilité, d’une imprédictibilité ainsi que d’une invariance structurelle aux différents niveaux de gouvernance. Par ailleurs, cette recherche a également permis de démontrer que les caractéristiques du « chaos » sont entretenues par la présence de trois groupes de systèmes d’action sociale bien articulés et bien cohérents à tous les échelons de la pyramide sanitaire en Haïti. Il s’agissait des systèmes d’action liés aux agences de coopération bilatérale, ceux liés aux initiatives ou fondations internationales de lutte contre le sida et finalement ceux associés aux organisations onusiennes. Ces systèmes d’action sociale sont en outre associés à d’autres systèmes d’action plus complexes qui sont situés à l’extérieur du système de santé d’Haïti. Au regard de ces résultats, nous avons proposé une nouvelle approche permettant de mieux appréhender l’introduction du changement dans les systèmes de santé des pays en développement et qui s’inscrit dans une logique permettant de favoriser une plus grande variété et une plus grande diversification. Cette variété et cette diversification étant soutenue par la création et la mise en place de plusieurs interconnections entre tous les systèmes d’action en présence dans les systèmes de santé qu’ils soient d’appartenance nationale, internationale ou qu’ils agissent au niveau central, départemental ou local. La finalité de ce processus étant l’émergence de propriétés systémiques issues non seulement des propriétés des groupes de systèmes d’action individuels qui interviennent dans la constitution du système émergent, mais aussi d’autres propriétés résultant de leur mise en commun.

La mise en œuvre de services cliniques intégrés sous l’angle du sensemaking organisationnel : le cas des services intégrés en santé mentale et en dépendance

Cette thèse a comme objectif général d’enrichir la compréhension du phénomène de mise en œuvre des services cliniques intégrés en contexte organisationnel. Elle s’inscrit dans la perspective théorique du sensemaking organisationnel (Weick, 1995). Dans un premier temps, nous avons étudié comment des acteurs ont construit le sens du projet d’intégration qu’ils devaient mettre en œuvre, et les répercussions de cette construction de sens sur des enjeux cliniques et organisationnels. Le contexte étudié est une nouvelle organisation de santé créée afin d’offrir des services surspécialisés à des personnes aux prises avec un trouble concomitant de santé mentale et de dépendance. Une stratégie de recherche de type qualitatif a été utilisée. L’analyse a reposé sur des données longitudinales (8 ans) provenant de trois sources : des entrevues semi-dirigées, des observations et de l’analyse de documents. Deux articles en découlent. Alors que l’article 1 met l’accent sur la transformation des pratiques professionnelles, l’article 2 aborde le phénomène sous l’angle de l’identité organisationnelle. Dans un deuxième temps, nous avons réalisé une analyse critique des écrits. Celle-ci a porté sur les tendances actuelles dans la façon d’étudier la mise en œuvre des services intégrés pour les troubles concomitants. Les résultats obtenus sont présentés dans l’article 3. Quatre grands constats se dégagent de l’ensemble de ce travail. Le premier est que la mise en œuvre de services cliniques intégrés est un phénomène dynamique, mais sous contrainte. Autrement dit, il s’agit d’un phénomène évolutif qui se définit et se redéfinit au gré des événements, mais avec une tendance lourde à maintenir la direction dans laquelle il s’est déployé initialement. L’énaction et l’engagement des professionnels sont apparus des mécanismes explicatifs centraux à cet égard. Le second constat est que la mise en œuvre s’actualise à travers des niveaux d’intégration interdépendants, ce qui signifie que le contexte et l’objet qui est mis en œuvre coévoluent et se transforment mutuellement. Nos résultats ont montré que la notion de "pratiques de couplage" était utile pour capter cette dynamique. Notre troisième constat est que la mise en œuvre demeure profondément ancrée dans le sens que les membres organisationnels construisent collectivement du projet d’intégration à travers leurs actions et interactions quotidiennes. Cette construction de sens permet de comprendre comment le contenu et la forme du projet d’intégration se façonnent au gré des circonstances, tant dans ses aspects cliniques qu’organisationnels. Enfin, le quatrième constat est que ces dynamiques demeurent relativement peu explorées à ce jour dans les écrits sur l’implantation des services intégrés pour les troubles concomitants. Nous faisons l’hypothèse que ce manque de reconnaissance pourrait expliquer une partie des difficultés de mise en œuvre actuelles. Globalement, ces constats permettent d’enrichir considérablement la compréhension du phénomène en révélant les dynamiques qui le constituent et les enjeux qu’il soulève. Aussi, leur prise en compte par les décideurs et les chercheurs a-t-elle le potentiel de faire progresser les pratiques vers une intégration accrue.

Apport des technologies mobiles à l'amélioration des soins en cancérologie

Réalisé en cotutelle avec Claude Sicotte PhD Université de Montréal et le Pr. Étienne Minvielle École des Hautes Études en Santé Publique à Paris.

The GlobMODEL demonstrator: assimilation of new satellite products in an operational meteorological center

As part of its Data User Element programme, the European Space Agency funded the GlobMODEL project which aimed at investigating the scientific, technical, and organizational issues associated with the use and exploitation of remotely-sensed observations, particularly from new sounders. A pilot study was performed as a "demonstrator" of the GlobMODEL idea, based on the use of new data, with a strong European heritage, not yet assimilated operationally. Two parallel assimilation experiments were performed, using either total column ozone or ozone profiles retrieved at the Royal Netherlands Meteorological Institute (KNMI) from the Ozone Monitoring Instrument (OMI). In both cases, the impact of assimilating OMI data in addition to the total ozone columns from the SCanning Imaging Absorption spectroMeter for Atmospheric CartograpHY (SCIAMACHY) on the European Centre for Medium Range Weather Forecasts (ECMWF) ozone analyses was assessed by means of independent measurements. We found that the impact of OMI total columns is mainly limited to the region between 20 and 80 hPa, and is particularly important at high latitudes in the Southern hemisphere where the stratospheric ozone transport and chemical depletion are generally difficult to model with accuracy. Furthermore, the assimilation experiments carried out in this work suggest that OMI DOAS (Differential Optical Absorption Spectroscopy) total ozone columns are on average larger than SCIAMACHY total columns by up to 3 DU, while OMI total columns derived from OMI ozone profiles are on average about 8 DU larger than SCIAMACHY total columns. At the same time, the demonstrator brought to light a number of issues related to the assimilation of atmospheric composition profiles, such as the shortcomings arising when the vertical resolution of the instrument is not properly accounted for in the assimilation. The GlobMODEL demonstrator accelerated scientific and operational utilization of new observations and its results - prompted ECMWF to start the operational assimilation of OMI total column ozone data.