Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Cultura organizacional e desempenho dos colaboradores :um estudo exploratório no setor hoteleiro

This work focuses on the relationship between organizational culture and quality culture in the hotel sector of NATAL/RN with respect to employee performance. The themes organizational culture and quality have been the research focus of administration theorists and a constant concern of professional managers, since the Japanese demonstrated effective forms or western management. In this study, the Competing Values Model (C.V.M.) (Quinn e Cameron, 1996; Quinn, 1998; Santos, 1998, 2000; Teixeira, 2001), which was tested on north-American organizations and considered a high value academic and professional instrument, was applied. The model maps the organizational culture on a profile with four elements: clan, adhocracy, market and hierarchy. The C.V.M., associated with the taximetrics created by Cameron (which classifies quality culture in for levels: status quo, error detection, error prevention and perpetual creative quality) has been related with organizational performance. In this study, these two models are used jointly and tested in the hotel sector. The results indicate that the strongest element of the profile is clan, which is characterized by internal focus, participation and people involvement, followed by the adhocracy element, which has an external focus, emphasizes flexibility and is characterized by dynamic enterprising and creativity. Regarding the level of the culture s quality in the hotel, the highest level, that of perpetual improvement and creativity, which attempts to enchant and to surprise the clients, was most frequently cited, followed by the error detection level, which has as its goal to discover and correct mistakes, trying, consequently, to reduce waste. The results suggest that employee performance as measured on some indicators is related to elements of the organizational culture profile and quality level

Influência da cultura organizacional na implementação de um programa de melhoria contínua de uma empresa de grande porte

The objective of this study was to identify the facilitators and restrictive factors promoted by the organizational culture on the implementation of a continuous improvement program in a company. The influence of organizational culture on tools used to improve processes and results demonstrate critical factors for international competitiveness, reflecting a company's strategy. Depending on how new working methods are implemented, organizational changes to reduce variation and waste, such as lean production, can affect the employee experience in the workplace and their learning conditions. Changes and formalization of the work process can be coercive, characterized by forced compliance, introduction of rules, and focus on technical and financial methods; or may be favorable, encouraging employee involvement in problem solving and stressing learning and innovation. The basis of the analysis lies with two models for assessing organizational culture - Denison Model and Competing Values Framework. The methodology used was: conducting interviews, a questionnaire, literature review and documentary analysis of a large company equipment industry. Results suggest that organizational culture plays an important role in the adoption of Lean practices. It can contribute to its effectiveness and job satisfaction, but it is not decisive feature of their success. The conclusion is that the organizational culture becomes a driving factor when aligned to the proposed practices and when taken into consideration for planning, acting as a limitation when it does not promote development and a participative environment

Influência da cultura organizacional na implementação de um programa de melhoria contínua de uma empresa de grande porte

The objective of this study was to identify the facilitators and restrictive factors promoted by the organizational culture on the implementation of a continuous improvement program in a company. The influence of organizational culture on tools used to improve processes and results demonstrate critical factors for international competitiveness, reflecting a company's strategy. Depending on how new working methods are implemented, organizational changes to reduce variation and waste, such as lean production, can affect the employee experience in the workplace and their learning conditions. Changes and formalization of the work process can be coercive, characterized by forced compliance, introduction of rules, and focus on technical and financial methods; or may be favorable, encouraging employee involvement in problem solving and stressing learning and innovation. The basis of the analysis lies with two models for assessing organizational culture - Denison Model and Competing Values Framework. The methodology used was: conducting interviews, a questionnaire, literature review and documentary analysis of a large company equipment industry. Results suggest that organizational culture plays an important role in the adoption of Lean practices. It can contribute to its effectiveness and job satisfaction, but it is not decisive feature of their success. The conclusion is that the organizational culture becomes a driving factor when aligned to the proposed practices and when taken into consideration for planning, acting as a limitation when it does not promote development and a participative environment

What is Family Preservation and Why Does it Matter?

This paper describes competing ideas about family preservation, defined both as a defined program of social services and a philosophical approach to helping troubled families. A straightforward definition has become almost impossible because the phrase has taken on so many different meanings, provoking controversy about its "real" meaning and value. Indeed, "family preservation" has become the proverbial elephant whose splendors and horrors are described with great certainty by those impressed by only one of its aspects. While skirmishes between "child savers" and "family preservers" have been part of the child welfare field since its beginning at the turn of the last century, recent debates over family preservation have been especially heated, generating more confusion and animosity than might be expected from the ranks of the small and usually mild-mannered social work profession. The debate is so heated that the director of one of the nation's largest child welfare agencies said recently that he is afraid to "even use the two words on the same page." <1> While the debate about the value of family preservation is unresolved, experimentation with different approaches to service delivery over the last two decades has helped to lay the groundwork for a resurgence of interest in family and community-centered reforms. Better understanding of the family preservation "debates" may be helpful if these reforms are to be successful over the long term. The paper discusses the competing ideas, values, and perceptions that have led observers to their different understandings of family preservation. It briefly chronicles the history of child welfare and examines key theories that have helped lay the groundwork for the resurgence of interest in family-centered services. It concludes with observations about how the competing values at stake in family preservation may affect the next generation of reforms.

The impact of organizational culture and reshaping capabilities on change implementation success: The mediating role of readiness for change

It was hypothesized that employees' perceptions of an organizational culture strong in human relations values and open systems values would be associated with heightened levels of readiness for change which, in turn, would be predictive of change implementation success. Similarly, it was predicted that reshaping capabilities would lead to change implementation success, via its effects on employees' perceptions of readiness for change. Using a temporal research design, these propositions were tested for 67 employees working in a state government department who were about to undergo the implementation of a new end-user computing system in their workplace. Change implementation success was operationalized as user satisfaction and system usage. There was evidence to suggest that employees who perceived strong human relations values in their division at Time 1 reported higher levels of readiness for change at pre-implementation which, in turn, predicted system usage at Time 2. In addition, readiness for change mediated the relationship between reshaping capabilities and system usage. Analyses also revealed that pre-implementation levels of readiness for change exerted a positive main effect on employees' satisfaction with the system's accuracy, user friendliness, and formatting functions at post-implementation. These findings are discussed in terms of their theoretical contribution to the readiness for change literature, and in relation to the practical importance of developing positive change attitudes among employees if change initiatives are to be successful.

Do Australian public sector employees have the type of culture they want in the era of new public management?

New public management theory proposes that public sector organisations should be managed more like private sector organisations. It is therefore expected that public sector managers will have preferences for an organisational culture that will reflect the culture of private sector organisations, with an external rather than internal orientation. The current research investigated the idea that managers' perceptions of ideal organisational culture would be different to the bureaucratic model of culture (internally oriented), which has traditionally been associated with public sector organisations. Responses to a competing values culture inventory were received from 925 public sector employees. Results indicated that the bureaucratic model is still pervasive; however, managers prefer a culture that is more external, and less control focussed, as expected. Lower level employees expressed a desire for a culture that emphasised human relations values.

Validating the organizational climate measure:links to managerial practices, productivity and innovation

This paper describes the development and validation of a multidimensional measure of organizational climate, the Organizational Climate Measure (OCM), based upon Quinn and Rohrbaugh's Competing Values model. A sample of 6869 employees across 55 manufacturing organizations completed the questionnaire. The 17 scales contained within the measure had acceptable levels of reliability and were factorially distinct. Concurrent validity was measured by correlating employees' ratings with managers' and interviewers' descriptions of managerial practices and organizational characteristics. Predictive validity was established using measures of productivity and innovation. The OCM also discriminated effectively between organizations, demonstrating good discriminant validity. The measure offers researchers a relatively comprehensive and flexible approach to the assessment of organizational members' experience and promises applied and theoretical benefits. Copyright © 2005 John Wiley & Sons, Ltd.

The complexity of leadership and organisations

The thesis contributes to the evolving process of moving the study of Complexity from the arena of metaphor to something real and operational. Acknowledging this phenomenon ultimately changes the underlying assumptions made about working environments and leadership; organisations are dynamic and so should their leaders be. Dynamic leaders are behaviourally complex. Behavioural Complexity is a product of behavioural repertoire - range of behaviours; and behavioural differentiation - where effective leaders apply appropriate behaviour to the demands of the situation. Behavioural Complexity was operationalised using the Competing Values Framework (CVF). The CVF is a measure that captures the extent to which leaders demonstrate four behaviours on four quadrants: Control, Compete, Collaborate and Create, which are argued to be critical to all types of organisational leadership. The results provide evidence to suggest Behavioural Complexity is an enabler of leadership effectiveness; Organisational Complexity (captured using a new measure developed in the thesis) moderates Behavioural Complexity and leadership effectiveness; and leadership training supports Behavioural Complexity in contributing to leadership effectiveness. Most definitions of leadership come down to changing people’s behaviour. Such definitions have contributed to a popularity of focus in leadership research intent on exploring how to elicit change in others when maybe some of the popularity of attention should have been on eliciting change in the leader them self. It is hoped that this research will provoke interest into the factors that cause behavioural change in leaders that in turn enable leadership effectiveness and in doing so contribute to a better understanding of leadership in organisations.

The influence of organizational and national culture on new product performance

The authors conduct a meta-analysis on the combined influence of organizational and national culture on new product performance. For this purpose, they refer to the effectiveness of value congruency and develop a conceptual model describing the fit between organizational culture types as suggested by the competing values framework and national culture, as described by Hofstede's cultural dimensions. The meta-analysis is based on 489 effect sizes taken from 123 manuscripts. The findings show that organizations with a market culture show the highest new product performance, while hierarchy-type organizations show the lowest performance. The influence of national culture variables supports the effect of value congruency, and shows that in individualistic cultures the impact of a clan culture decreases, the impact of an adhocracy culture type decreases with uncertainty avoidance, and the influence of a hierarchy culture type increases with power distance. The superior effect of a market culture type can be matched by other organizational orientations, but in particular national cultures only. The combined findings underline the importance for firms that seek to improve the success rate of new products on international markets to consider the fit of a national culture with a firm's organizational culture.

A modern termelési koncepciók és a szervezeti kultúra kapcsolata - Irodalomfeldolgozás

Habár egyöntetű a kutatók és szakértők véleménye a tekintetben, hogy a szervezeti kultúra változtatása nélkül nem lehet sikeres és fenntartható egyik modern termelési koncepció sem, meglehetősen csekély az egyes termelési koncepciók és a szervezeti kultúra kapcsolatát vizsgáló empirikus munkák száma. Így máig megválaszolatlan a témával kapcsolatos számos alapkérdés. Jelen irodalomfeldolgozás a vezető termelésmenedzsment- folyóiratokban megjelent munkákra építve vizsgálja a modern termelési koncepciók és a szervezeti kultúra kapcsolatát. A szervezeti kultúra empirikus megragadásánál az egyik széles körben elfogadott eszközt, a versengő értékek modelljét (Competing Values Framework – CVF) állítja középpontba. A tanulmány az első felében bemutatja a szervezeti kultúra kutatásának motivációit, a releváns irodalomként meghatározott kiemelt cikkek kiválasztásának lépéseit, a CVF-modellt. A tanulmány második része foglalkozik, hogy a kiválasztott forrásokban leírt kutatások milyen kapcsolatot tártak fel a CVF-modellel megragadott szervezeti kultúra és három modern termelési koncepció, a teljes körű minőségmenedzsment (TQM), a fejlett termeléstechnológia (Advanced Manufacturing Technology – AMT) és a lean menedzsment esetében. A szerzők a cikk végén a hazai kutatások eredményeit mutatják be, majd a tanulmány fő megállapításait összegzik.

Landscape and planning: strengthening discussions in the decision-making process

Since the emergence of the European Landscape Convention (ELC) in 2000, the important link between landscape and planning has greatly intensified. Now, more than ever, the fundamental role of the planning system in delivering the ELC’s requirements is recognised. This has been further substantiated within Ireland’s recently published National Landscape Strategy. However it has continually been suggested that decision-making processes need to adapt better to the holistic, valueladen and multidimensional approaches underpinning the ELC. In light of these milestones for the preservation, management and planning of landscape, this research sets out to establish synergies and disparities in the existing relationship between landscape and planning. It investigates detailed evidence of the presence and manifestations of landscape in key processes of day-to-day planning practice in Ireland, from individual planning appeals and ‘special’ cases, to the major strategic instruments that inform the making of landscape policies within development plans. This is set within wider theoretical and policy contexts where the compatibility of landscape and planning is subjected to critical scrutiny and then explored through these practical case studies. Driving this research is the intention to make a case for the planning domain to be an ideal ‘home’ for landscape – in all its deep, multidimensional meaning – and for enhancing landscape arguments and objectives in the face of conflict, competing values and power-plays in the real world. Emerging out of this research is a set of recommendations for how, at a national level, new approaches for decision making for and about landscape can be more effective and meaningful.

Understanding stakeholder preferences for flood adaptation alternatives with natural capital implications

Inland flood risks are defined by a range of environmental and social factors, including land use and floodplain management. Shifting patterns of storm intensity and precipitation, attributed to climate change, are exacerbating flood risk in regions across North America. Strategies for adapting to growing flood risks and climate change must account for a community’s specific vulnerabilities, and its local economic, environmental, and social conditions. Through a stakeholder-engaged methodology, we designed an interactive decision exercise to enable stakeholders to evaluate alternatives for addressing specific community flood vulnerabilities. We used a multicriteria framework to understand what drives stakeholder preferences for flood mitigation and adaptation alternatives, including ecosystem-based projects. Results indicated strong preferences for some ecosystem-based projects that utilize natural capital, generated a useful discussion on the role of individual values in driving decisions and a critique of local environmental and hazard planning procedure, and uncovered support for a river management alternative that had previously been considered socially infeasible. We conclude that a multicriteria decision framework may help ensure that the multiple benefit qualities of natural capital projects are considered by decision makers. Application of a utility function can demonstrate the role of individual decision-maker values in decision outcomes and help illustrate why one alternative may be a better choice than another. Although designing an efficient and accurate multicriteria exercise is quite challenging and often data intensive, we imagine that this method is applicable elsewhere. It may be especially suitable to group decisions that involve varying levels of expertise and competing values, as is often the case in planning for the ecological and human impacts of climate change.

Troublesome Knowledge of SoTL

This study explores the Scholarship of Teaching and Learning (SoTL) as a form of troublesome knowledge (Perkins 1999) that continues to trouble its practitioners. Forty-eight higher education professionals from six countries described their understanding of SoTL in an online survey; ten individuals participated in follow-up interviews to consider how SoTL experiences shape, support, or hinder academic identity and knowing. We categorize our findings according to the dynamic factors—personal, relational, and contextual—identified by Lieff et al (2012); we argue that SoTL serves to illuminate and expose tensions created by competing values and that these values can lead to, or create, a troublesome space wherein promoting SoTL can be enabling and disabling.

Gobierno empresarial: etnografía de un proyecto de cultura organizacional en la Cía. Aceros Ltda

La presente investigación analiza las dinámicas y relaciones sociales de la implementación de un estudio de cultura organizacional en un escenario etnográfico concreto. El propósito del presente trabajo, es analizar el estudio de la cultura organizacional como una técnica de gobierno con unas prácticas específicas, negociadas, consensuadas y establecidas en el marco de la participación de los empleados en el estudio realizado por la empresa.