Implementation analysis of the Texas Vendor Drug Program

An agency is accountable to a legislative body in the implementation of public policy. It has a responsibility to ensure that the implementation of that policy is consistent with its statutory objectives.^ The analysis of the effectiveness of implementation of the Vendor Drug Program proceeded in the following manner. The federal and state roles and statutes pursuant to the formulation of the Vendor Drug Program were reviewed to determine statutory intent and formal provisions. The translation of these into programmatic details was examined focusing on the factors impacting the implementation process. Lastly, the six conditions outlined by Mazmanian and Sabatier as criteria for effective implementation, were applied to the implementation of the Vendor Drug Program to determine if the implementation was effective in relation to consistency with statutory objectives.^ The implementation of the statutes clearly met four of the six conditions for effective implementation: (1) clear and consistent objectives; (2) a valid causal theory; (3) structured the process to maximize agency and target compliance with the objectives; and (4) had continued support of constituency groups and sovereigns.^ The implementation was basically consistent with the statutory objectives, although the determination of vendor reimbursement has had and continues to have problems. ^

A survey of the implementation status of environmental management systems in U.S. colleges and universities, and, An environmental management system implementation model for U.S. colleges and universities

A census of 925 U.S. colleges and universities offering masters and doctorate degrees was conducted in order to study the number of elements of an environmental management system as defined by ISO 14001 possessed by small, medium and large institutions. A 30% response rate was received with 273 responses included in the final data analysis. Overall, the number of ISO 14001 elements implemented among the 273 institutions ranged from 0 to 16, with a median of 12. There was no significant association between the number of elements implemented among institutions and the size of the institution (p = 0.18; Kruskal-Wallis test) or among USEPA regions (p = 0.12; Kruskal-Wallis test). The proportion of U.S. colleges and universities that reported having implemented a structured, comprehensive environmental management system, defined by answering yes to all 16 elements, was 10% (95% C.I. 6.6%–14.1%); however 38% (95% C.I. 32.0%–43.8%) reported that they had implemented a structured, comprehensive environmental management system, while 30.0% (95% C.I. 24.7%–35.9%) are planning to implement a comprehensive environmental management system within the next five years. Stratified analyses were performed by institution size, Carnegie Classification and job title. ^ The Osnabruck model, and another under development by the South Carolina Sustainable Universities Initiative, are the only two environmental management system models that have been proposed specifically for colleges and universities, although several guides are now available. The Environmental Management System Implementation Model for U.S. Colleges and Universities developed is an adaptation of the ISO 14001 standard and USEPA recommendations and has been tailored to U.S. colleges and universities for use in streamlining the implementation process. In using this implementation model created for the U.S. research and academic setting, it is hoped that these highly specialized institutions will be provided with a clearer and more cost-effective path towards the implementation of an EMS and greater compliance with local, state and federal environmental legislation. ^

Comparative regional perspectives: the Bologna process and higher education attainment. Jean Monnet/Robert Schumann Paper Series Vol 13 No. 11, August 2013

Since 1999, countries have voluntarily chosen to reform their higher education systems to join the European Higher Education Area. This paper compares Bologna Process implementation across four regions within the European Union. While there are 47 countries participating in the Bologna Process, this paper uses statistical analysis to consider 25 of the 28 EU Member States. The time period of analysis is 2000-2011, prior to Croatia’s accession to the EU on 1 July 2013. Across Europe there are inter-regional differences in how the Bologna Process has been implemented and in the political economy contexts that influence higher education reform for policy convergence. There are three explanatory variables in the political economy context: 1. competitive economic pressures and globalization 2. domestic politics at the national level 3. leadership from the supranational European Union that socially constructs regional norms Tertiary education attainment is the dependent variable of interest in this research. The objective of 40%, for 30-34 year olds, is Europe 2020 benchmark target. There are additional higher education reform criteria encompassed in the Bologna Process. These criteria concern Credit and Degree Structure, Quality Assurance, and Recognition of academic degrees among countries in the EHEA. This tertiary education attainment variable, which is of interest in this paper, does not capture the entire implementation process. Nevertheless, it is a measure of one important indicator of success in providing higher education access to populations within the context of democratic governance. This research finds that statistically GDP Per Capita is the most significant variable in relationship to tertiary education attainment across four regional areas in the European Union.

Universal Screening for Familial Colorectal Cancer Syndromes at Seattle Cancer Care Alliance: Qualitative Study of Providers involved in Implementation and Patients Experience with First Wave of Testing

Thesis (Master's)--University of Washington, 2016-06

Quality management (QM) implementation in the Kuwaiti Oil Industry:An empirical study and a proposed generic framework

In an Arab oil producing country in the Middle East such as Kuwait, Oil industry is considered as the main and most important industry of the country. This industry’s importance emerged from the significant role it plays in both country’s national economy and also global economy. Moreover, Oil industry’s criticality comes from its interconnectivity with national security and power in the Middle East region. Hence, conducting this research in this crucial industry had certainly added values to companies in this industry as it investigated thoroughly the main components of the TQM implementation process and identified which components affects significantly TQM’s implementation and its gained business results. In addition, as the Oil sector is a large sector that is known for its richness of employees with different national cultures and backgrounds. Thus, this culture-heterogeneous industry seems to be the most appropriate environment to address and satisfy a need in the literature to investigate the national culture values’ effects on TQM implementation process. Furthermore, this research has developed a new conceptual model of TQM implementation process in the Kuwaiti Oil industry that applies in general to operations and productions organizations at the Kuwaiti business environment and in specific to organizations in the Oil industry, as well it serves as a good theoretical model for improving operations and production level of the oil industry in other developing and developed countries. Thus, such research findings minimized the literature’s gap found the limited amount of empirical research of TQM implementation in well-developed industries existing in an Arab, developing countries and specifically in Kuwait, where there was no coherent national model for a universal TQM implementation in the Kuwaiti Oil industry in specific and Kuwaiti business environment in general. Finally, this newly developed research framework, which emerged from the literature search, was validated by rigorous quantitative analysis tools including SPSS and Structural Equation Modeling. The quantitative findings of questionnaires collected were supported by the qualitative findings of interviews conducted.

When cost-efficient technologies meet politics:a case study of radical wireless network implementation

Cost efficiency has been a dominant perspective in the traditional IT literature. However, in complex technology and business environment, the widely recognized cost efficient assumption of information technology has been increasingly challenged. Drawing from a case study of wireless network implementation situated in a politically sensitive workplace, this paper provided practice insights for IT managers in today’s networked economy. More specifically, stories experienced in the case study illustrated that despite well-calculated cost efficiency of wireless network infrastructure, the radical implementation process in the case organization encountered enormous challenges and opposition due to the fact that administrators failed to consider various stakeholders’ positions and interests. Eventually, the implementation objectives and outcome were considerably undermined. Implications from this empirical case research reemphasized the significance of understanding political forces situated in any business environment where different stakeholders hold conflicting interests. Lessons learned from the case story further encouraged IT managers and policy makers to better strategize emerging information technology in general and wireless networks in particular as the whole global society and business environment are increasingly facing an emerging wireless world.

Understanding the dynamics of information technology implementation: The case of clinical information systems

The ultimate intent of this dissertation was to broaden and strengthen our understanding of IT implementation by emphasizing research efforts on the dynamic nature of the implementation process. More specifically, efforts were directed toward opening the "black box" and providing the story that explains how and why contextual conditions and implementation tactics interact to produce project outcomes. In pursuit of this objective, the dissertation was aimed at theory building and adopted a case study methodology combining qualitative and quantitative evidence. Precisely, it examined the implementation process, use and consequences of three clinical information systems at Jackson Memorial Hospital, a large tertiary care teaching hospital.^ As a preliminary step toward the development of a more realistic model of system implementation, the study proposes a new set of research propositions reflecting the dynamic nature of the implementation process.^ Findings clearly reveal that successful implementation projects are likely to be those where key actors envision end goals, anticipate challenges ahead, and recognize the presence of and seize opportunities. It was also found that IT implementation is characterized by the systems theory of equifinality, that is, there are likely several equally effective ways to achieve a given end goal. The selection of a particular implementation strategy appears to be a rational process where actions and decisions are largely influenced by the degree to which key actors recognize the mediating role of each tactic and are motivated to action. The nature of the implementation process is also characterized by the concept of "duality of structure," that is, context and actions mutually influence each other. Another key finding suggests that there is no underlying program that regulates the process of change and moves it form one given point toward a subsequent and already prefigured end. For this reason, the implementation process cannot be thought of as a series of activities performed in a sequential manner such as conceived in stage models. Finally, it was found that IT implementation is punctuated by a certain indeterminacy. Results suggest that only when substantial efforts are focused on what to look for and think about, it is less likely that unfavorable and undesirable consequences will occur. ^

The eye of the beholder: The impact of a district implementation plan of state mandates as perceived by the implementers

The purpose of this inquiry was to investigate the impact of a large, urban school district's experience in implementing a mandated school improvement plan and to examine how that plan was perceived, interpreted, and executed by those charged with the task. The research addressed the following questions: First, by whom was the district implementation plan designed, and what factors were considered in its construction? Second, what impact did the district implementation plan have on those charged with its implementation? Third, what impact did the district plan have on the teaching and learning practices of a particular school? Fourth, what aspects of the implemention plan were perceived as most and least helpful by school personnel in achieving stated goals? Last, what were the intended and unintended consequences of an externally mandated and directed plan for improving student achievement? The implementation process was measured against Fullan's model as expounded upon in The Meaning of Educational Change (1982) and The New Meaning of Educational Change (1990). The Banya implementation model (1993), because it added a dimension not adequately addressed by Fullan, was also considered.^ A case study was used as the methodological framework of this qualitative study. Sources of data used in this inquiry included document analysis, participant observations in situ, follow-up interviews, the "long" interview, and triangulation. The study was conducted over a twelve-month period. Findings were obtained from the content analysis of interview transcripts of multiple participants. Results were described and interpreted using the Fullan and Banya models as the descriptive framework. A cross-case comparison of the multiple perspectives of the same phenomena by various participants was constructed.^ The study concluded that the school district's implementation plan to improve student achievement was closely aligned to Fullan's model, although not intentionally. The research also showed that where there was common understanding at all levels of the organization as to the expectations for teachers, level of support to be provided, and availability of resources, successful implementation occured. The areas where successful implementation did not occur were those where the complexity of the changes were underestimated and processes for dealing with unintended consequences were not considered or adequately addressed. The unique perspectives of the various participants, from the superintendent to the classroom teacher, are described. Finally, recommendations for enhancement of implementation are offered and possible topics for further research studies are postulated. ^

An examination of attitude toward change as a predictor of policy/program implementation

Policy/program implementation, e.g., the process of fulfilling policy/program directives, is fundamentally tied to change. Implementation studies have examined the process, identifying many critical organizational variables although individuals perform the activities.^ Many of the studies are predicated on the rational, goal oriented model of organizations and examine implementation, presenting only the goal-oriented view. Organizational change and its resistance, however, are not fully explained by the rational model of organizations. There are other schools of thought providing different views of organizations from which explanation may emerge. Bolman and Deal (1984, 1991a, 1994) provide a different perspective for examining organizations Bolman and Deal argue organizations should be viewed through four different frames or lenses. Framing and reframing organizational action captures the complexity of action and provides better understanding of organizational processes. Understanding of implementation of policies/programs also will benefit from the use of the four-frame approach.^ The goal of this research is to provide a better understanding of the implementation process by examining individual attitudes toward change, the dependent variable of this research, and studying the relationship between the dependent variable and frame. The research was conducted in two phases. In Phase One, a survey was sent to 306 school administrators and teachers in magnet programs in Dade County, Florida. The survey instrument was composed of 55 questions including six from Bolman and Deal's Leadership Orientation Survey (1988) and 38 questions about organizational change. In Phase Two, more in-depth analysis of four school was conducted, to further explore the relationship between frame and attitude toward change.^ The results revealed that frame was a factor in explaining differences in personal Attitude Toward Change and Comfort Level with Change. Individuals using the symbolic frame had more positive attitudes toward change and were also more comfortable with change. The results of Phase Two of the research partially supported this finding in that the most fully implemented program was the product of an administrator who had chosen the symbolic frame. ^

Taxonomy of Institutional Issues that Act as Barriers to the Implementation of Pavement Management Systems, 1994

The benefits of pavement management system when fully implemented are well known and the history of successful implementation is rich. Implementation occurs, for purposes of this paper, when the pavement management system is the critical component for making pavement decisions. This paper addresses the issues that act as barriers to full implementation of pavement management systems. Institutional barriers, not technical and financial barriers, are more commonly responsible for a pavement management systems falling short of full implementation. The paper groups these institutional issues into a general taxonomy. In general, more effort needs to be put forth by highway agencies to overcome institutional issues. Most agencies approach pavement management as a technical process, but more commonly, institutional issues become more problematic and thus require more attention paid to institutional issues. The paper concludes by summarizing the implementation process being taken by the Iowa Department of Transportation. The process was designed to overcome institutional barriers and facilitate the complete and full implementation of their pavement management system.

On the implementation of a Laboratory of Digital Television according to the ISDB-Tb standard

Este artículo resume el proceso de implementación del Laboratorio de Televisión Digital (DTV) de la Universidad de Cuenca, que surge como un entorno confiable de experimentación e investigación que hace uso de las características asociadas al estándar ISDB-Tb adoptado por Ecuador en el año 2010 para la transmisión de señales de televisión abierta. El objetivo de este artículo es documentar los aspectos que se han considerado para simular un escenario real en el que un Transport Stream (TS) formado por contenido audiovisual y aplicaciones interactivas, primero se genera, para luego transmitirse a través del canal de comunicaciones, y finalmente ser recibido en una televisión con receptor ISDB-Tb. Así, se facilita el desarrollo y la experimentación de nuevos servicios aprovechando el nuevo formato de DTV.

Quality of implementation in evidence-based positive parenting programs in Spain: Introduction to the special issue

The main contribution of this special issue is to present evaluation studies involving large-scale experiences of implementation of positive parenting programs delivered through home, group-based, and on-line formats in Spain. Two research questions were addressed: (1) what factors affect implementation; and (2) for whom and under which implementation conditions the programs lead to positive outcomes. Target populations were mainly families from low and middle socioeconomic backgrounds, and parents at psychosocial risk attending family support services in need of improving their parenting skills. All the programs fall under the umbrella of the positive parenting initiative launched by the Council of Europe, are evidence-based, follow a collaborative schema with national, regional, or local authorities, have multi-site implementation, and are supported by highly experienced researchers from Spanish universities. Special attention is given to the program adaptations to different contexts, the profile of parents who benefited most from the programs, analyses of the implementation process, and the assessment of parenting programs in the community. The information provided will help to increase our knowledge of evidence-based parenting programs in Spain, their implementation processes and results, and the future challenges that need to be addressed to continue the current expansion of evidence-based parenting programs.

Home and group-based implementation of the "Growing Up Happily in the Family" program in at-risk psychosocial contexts

"Growing Up Happily in the Family" is a program to prevent child maltreatment targeted at parents of children aged 0-5 years old in at-risk psychosocial contexts. The program is delivered via either a group-based or a home-visit format. The objective of this study was to evaluate the impact of various implementation components in the home and group versions on changes in parental attitudes about child development and education. At-risk and non at-risk parents participated in the group-based (196 participants in 26 groups) and home-visit (95 participants) versions of the program delivered through local social services. We analyzed program adherence, adaptations, participant responsiveness, quality of delivery, and implementation barriers as predictors of changes in parental attitudes. The results showed that greater program adherence, better quality of delivery and participant responsiveness, and positive climate predicted changes in parental attitudes in both formats. Therefore, it is important to take into account the quality of the implementation process when testing the effectiveness of early group-based and home-visit interventions in at-risk families.

"Learning together, growing with family": the implementation and evaluation of a family support programme

The "Learning together, growing with family" programme is targeted to at-risk parents and children from 6 to 11 years old, with a preventive focus on promoting positive parent-child relationships. In this study, we examined the quality of the programme implementation and its influence on the programme results in a sample of 425 parents and 138 facilitators drawn from the first trial. Mixed methods were used, consisting of: parental self-reports on parenting dimensions, professionals' records on parental attendance and appraisals on six topics of the implementation process, and focus group discussions in which facilitators reported on the initial steps of the implementation. Results showed a high quality of implementation with respect to the group facilitator and the programme organization factors, followed by the coordination with services and the support facilities offered to participants and, finally, by the factors of fidelity and prior organization steps. Results of the focus groups confirmed that the prior steps were challenging and offered the more effective strategies. Better quality in the implementation factors predicted better parenting styles and parental competencies after the programme, as well as a higher attendance rate. In sum, this study demonstrates the importance of good implementation in at-risk contexts and provides some clues as to the key elements that moderate programme effectiveness.

A regionalização intramunicipal do Sistema Único de Saúde (SUS): um estudo de caso do município de São Paulo-SP, Brasil

A regionalização tem sido apontada como um dos principais desafios para viabilizar a equidade e a integralidade do SUS. Este artigo tem como objetivo avaliar o processo de implementação de um projeto de organização de regiões de saúde no município de São Paulo. Para tanto, foi realizado um estudo de caso em uma região selecionada desse município, a partir do referencial da análise de implantação, utilizando-se como fonte de dados documentos da gestão e entrevistas semiestruturadas com informantes-chave da gestão municipal 2005-2008. A análise temática evidenciou que o projeto de regionalização idealizado no início da gestão não foi efetivamente implementado. Dentre os fatores que interferiram nesse insucesso, destacam-se: a) a Secretaria Municipal de Saúde (SMS), além de seu caráter centralizador, manteve estruturas político-administrativas independentes para a gestão da atenção básica e da assistência hospitalar; b) a SMS não assumiu a gestão, de fato, de ambulatórios e hospitais estaduais; c) o poder institucional e a resistência dos hospitais em se integrar ao sistema de saúde. Discute-se, ainda, a necessidade de avançar na descentralização intramunicipal do SUS e buscar novas estratégias para a construção de pactos que consigam superar as resistências e articular instituições historicamente consolidadas, visando uma regionalização cooperativa e solidária.