Provider diversity in the NHS: impact on quality and innovation

The overall objective of the research project has been to assess the impact of provider diversity on quality and innovation in the NHS. The specific research aims were to identify the differences in performance between non-profit Third Sector organisations, for-profit private enterprises, and incumbent public sector institutions within the NHS as providers of health care services, as well as the factors that affect the entry and growth of new private and Third Sector providers. The study used both qualitative and quantitative methods based on case studies of four Local Health Economies (LHEs). Qualitative methods included documentary analysis and interviews with key informants and managers of both commissioning and provider organisations. To provide a focus to the study, two tracer conditions were followed: orthopaedic surgery and home health care for frail older people. In the case of hospital inpatient care, data on patient characteristics were also collected from the HES database. The analysis of this data provided preliminary estimates of the effects of provider type on quality, controlling for client characteristics and case mix. In addition, a survey of patient experience in diverse provider organisations was analysed to compare the different dimensions of quality of provision of acute services between incumbent NHS organisations and new independent sector treatment centres. The research has shown that, in respect of inpatient hospital services, diverse providers supply health services of at least as good quality as traditional NHS providers, and that there is ample opportunity to expand their scale and scope as providers of services commissioned by the NHS. The research used patient experience survey data to investigate whether hospital ownership affects the quality of services reported by NHS patients in areas other than clinical quality. The raw survey data appear to show that private hospitals provide higher quality services than the public hospitals. However, further empirical analysis leads to a more nuanced understanding of the performance differences. Firstly, the analysis shows that each sector offers greater quality in certain specialties. Secondly, the analysis shows that differences in the quality of patients’ reported experience are mainly attributable to patient characteristics, the selection of patients into each type of hospital, and the characteristics of individual hospitals, rather than to hospital ownership as such. Controlling for such differences, NHS patients are on average likely to experience a similar quality of care in a public or privately-run hospital. Nevertheless, for specific groups of patients and for specific types of treatments, especially the more straightforward ones, the private sector provides an improved patient experience compared to the public sector. Elsewhere, the NHS continues to provide a high quality service and outperforms the private sector in a range of services and for a range of clients.

Quantifying the impact and relevance of scientific research

Qualitative and quantitative methods are being developed to measure the impacts of research on society, but they suffer from serious drawbacks associated with linking a piece of research to its subsequent impacts. We have developed a method to derive impact scores for individual research publications according to their contribution to answering questions of quantified importance to end users of research. To demonstrate the approach, here we evaluate the impacts of research into means of conserving wild bee populations in the UK. For published papers, there is a weak positive correlation between our impact score and the impact factor of the journal. The process identifies publications that provide high quality evidence relating to issues of strong concern. It can also be used to set future research agendas.

Inertia in Japanese organizations: knowledge management routines and failure to innovate

This paper argues that features of Japanese organizations, previously held to be the foundations of innovation, change and flexibility, can equally be significant barriers to change, innovation and adaptation in turbulent economic environments. This paper draws on two in-depth case studies of Japanese organizations. It shows how, in both cases, these firms displayed specific weaknesses in the ways in which they integrate and bundle knowledge, in particular around their research and development (R&D) functions. Despite the adoption of strategies of technological innovation and internationalization, the data suggest that the pursuit of both strategies is beset by barriers of inertia. Embedded internal network connections and knowledge-sharing routines between central R&D and other divisions are inappropriate for the revised strategy. Existing external connections, with preferred suppliers and customers within keiretsu structures, and close relationships with existing R&D partners retard these firms' strategic flexibility. With a limited variety of latent routines, knowledge, capabilities and agency to draw on when needed, these firms have limited organizational responsiveness and high levels of path-dependency.

The professional voice: comparing questionnaire and telephone methods in a national survey of teachers' perceptions

This article compares the results obtained from using two different methodological approaches to elicit teachers’ views on their professional role, the key challenges and their aspirations for the future. One approach used a postal/online questionnaire, while the other used telephone interviews, posing a selection of the same questions. The research was carried out on two statistically comparable samples of teachers in England in spring 2004. Significant differences in responses were observed which seem to be attributable to the methods employed. In particular, more ‘definite’ responses were obtained in the interviews than in response to the questionnaire. This article reviews the comparative outcomes in the context of existing research and explores why the separate methods may have produced significantly different responses to the same questions.

A comparison of two identification and tracking methods for polar lows

In this study, we compare two different cyclone-tracking algorithms to detect North Atlantic polar lows, which are very intense mesoscale cyclones. Both approaches include spatial filtering, detection, tracking and constraints specific to polar lows. The first method uses digital bandpass-filtered mean sea level pressure (MSLP) fieldsin the spatial range of 200�600 km and is especially designed for polar lows. The second method also uses a bandpass filter but is based on the discrete cosine transforms (DCT) and can be applied to MSLP and vorticity fields. The latter was originally designed for cyclones in general and has been adapted to polar lows for this study. Both algorithms are applied to the same regional climate model output fields from October 1993 to September 1995 produced from dynamical downscaling of the NCEP/NCAR reanalysis data. Comparisons between these two methods show that different filters lead to different numbers and locations of tracks. The DCT is more precise in scale separation than the digital filter and the results of this study suggest that it is more suited for the bandpass filtering of MSLP fields. The detection and tracking parts also influence the numbers of tracks although less critically. After a selection process that applies criteria to identify tracks of potential polar lows, differences between both methods are still visible though the major systems are identified in both.

Some uniform stability and convergence results for integral equations on the real line and projection methods for their solution

The paper considers second kind equations of the form (abbreviated x=y + K2x) in which and the factor z is bounded but otherwise arbitrary so that equations of Wiener-Hopf type are included as a special case. Conditions on a set are obtained such that a generalized Fredholm alternative is valid: if W satisfies these conditions and I − Kz, is injective for each z ε W then I − Kz is invertible for each z ε W and the operators (I − Kz)−1 are uniformly bounded. As a special case some classical results relating to Wiener-Hopf operators are reproduced. A finite section version of the above equation (with the range of integration reduced to [−a, a]) is considered, as are projection and iterated projection methods for its solution. The operators (where denotes the finite section version of Kz) are shown uniformly bounded (in z and a) for all a sufficiently large. Uniform stability and convergence results, for the projection and iterated projection methods, are obtained. The argument generalizes an idea in collectively compact operator theory. Some new results in this theory are obtained and applied to the analysis of projection methods for the above equation when z is compactly supported and k(s − t) replaced by the general kernel k(s,t). A boundary integral equation of the above type, which models outdoor sound propagation over inhomogeneous level terrain, illustrates the application of the theoretical results developed.

BIM: innovation in design management, influence and challenges of implementation

The construction industry is widely being criticised as a fragmented industry. There are mounting calls for the industry to change. The espoused change calls for collaboration as well as embracing innovation in the process of design, construction and across the supply chain. Innovation and the application of emerging technologies are seen as enablers for integrating the processes ‘integrating the team’ such as building information modelling (BIM). A questionnaire survey was conducted to ascertain change in construction with regard to design management, innovation and the application of BIM as cutting edge pathways for collaboration. The respondents to the survey were from an array of designations across the construction industry such as construction managers, designers, engineers, design coordinators, design managers, architects, architectural technologists and surveyors. There was a general agreement by most respondents that the design team was responsible for design management in their organisation. There is a perception that the design manager and the client are the catalyst for advancing innovation. The current state of industry in terms of incorporating BIM technologies is posing a challenge as well as providing an opportunity for accomplishment. BIM technologies provide a new paradigm shift in the way buildings are designed, constructed and maintained. This paradigm shift calls for rethinking the curriculum for educating building professionals, collectively.

Impression management, fabrication and myth creation in private social and environmental reporting: insights from Erving Goffman

This paper explores the nature of private social and environmental reporting (SER). From interviews with UK institutional investors, we show that both investors and investees employ Goffmanesque, staged impression management as a means of creating and disseminating a dual myth of social and environmental accountability. The interviewees’ utterances unveil private meetings imbued with theatrical verbal and physical impression management. Most of the time, the investors’ shared awareness of reality belongs to a Goffmanesque frame whereby they accept no intentionality, misrepresentation or fabrication, believing instead that the ‘performers’ (investees) are not intending to deceive them. A shared perception that social and environmental considerations are subordinated to financial issues renders private SER an empty encounter characterised as a relationship-building exercise with seldom any impact on investment decision-making. Investors spoke of occasional instances of fabrication but these were insufficient to break the frame of dual myth creation. They only identified a handful of instances where intentional misrepresentation had been significant enough to alter their reality and behaviour. Only in the most extreme cases of fabrication and lying did the staged meeting break frame and become a genuine occasion of accountability, where investors demanded greater transparency, further meetings and at the extreme, divested shares. We conclude that the frontstage, ritualistic impression management in private SER is inconsistent with backstage activities within financial institutions where private financial reporting is prioritised. The investors appeared to be in a double bind whereby they devoted resources to private SER but were simultaneously aware that these efforts may be at best subordinated, at worst ignored, rendering private SER a predominantly cosmetic, theatrical and empty exercise.

Executive project management structure and the challenges acing its adoption in the Nigerian construction industry

Project management (PM) is a globally recognized discipline and has been widely adopted within the construction industry. Despite advancements in the PM discipline, the ineffective traditional management system, typical of the non-executive PM structure, is still widely used in the Nigerian construction industry. The aim of this paper is thus to explore the challenges facing the adoption of the executive PM structure in Nigeria. The paper first assesses the level of growth of PM in Nigeria using UK best practices as a benchmark and identifies the key PM characteristics in the two countries. Focus group interviews were used to collect the primary data for the study and content analysis was used to present the results in a thematic format. The study revealed the key barriers to the adoption of an executive PM structure in Nigeria as a lack of proper awareness, unfavorable policies, skill shortages, the traditional culture of stakeholders and the absence of a regulatory body. It is recommended that the government, as a major player/client in the Nigerian construction industry, should lead the campaign to change the traditional industry approach to project management. This is necessary if construction stakeholders in Nigeria are to be educated and encouraged towards adopting and putting into practice effective PM.

Building post crisis watchtowers: investment management Systems and new institutional logics for regulatory compliance

The financial crisis of 2007-2009 has precipitated large scale regulatory change. Tight deadlines for implementation require organizations to start working on remediation projects before final drafts of regulations are crystalized. Firms are faced with engaging in complex and costly change management programs at a time when profits are diminished. As a consequence of these factors, pre-crisis logics for organizing compliance practices are being questioned and new approaches introduced. Our study explores the use of Investment Management Systems (IMS) in facilitating compliance arrangements. Our motivation is to understand the new logics and the part played by IMS in supporting these approaches. The study adopts an institutional logics perspective to explore the use of such systems at eight financial organizations. The study found new logics for organizing compliance include consolidation, centralization, harmonization and consistency and that the IMS plays an important role in supporting and enabling related activities.

The art of shooting the moving goal - explorative study of EA pilot

Enterprise Architecture (EA) has been recognised as an important tool in modern business management for closing the gap between strategy and its execution. The current literature implies that for EA to be successful, it should have clearly defined goals. However, the goals of different stakeholders are found to be different, even contradictory. In our explorative research, we seek an answer to the questions: What kind of goals are set for the EA implementation? How do the goals evolve during the time? Are the goals different among stakeholders? How do they affect the success of EA? We analysed an EA pilot conducted among eleven Finnish Higher Education Institutions (HEIs) in 2011. The goals of the pilot were gathered from three different stages of the pilot: before the pilot, during the pilot, and after the pilot, by means of a project plan, interviews during the pilot and a questionnaire after the pilot. The data was analysed using qualitative and quantitative methods. Eight distinct goals were recognised by the coding: Adopt EA Method, Build Information Systems, Business Development, Improve Reporting, Process Improvement, Quality Assurance, Reduce Complexity, and Understand the Big Picture. The success of the pilot was analysed statistically using the scale 1-5. Results revealed that goals set before the pilot were very different from those mentioned during the pilot, or after the pilot. Goals before the pilot were mostly related to expected benefits from the pilot, whereas the most important result was to adopt the EA method. Results can be explained by possibly different roles of respondents, which in turn were most likely caused by poor communication. Interestingly, goals mentioned by different stakeholders were not limited to their traditional areas of responsibility. For example, in some cases Chief Information Officers' goals were Quality Assurance and Process Improvement, whereas managers’ goals were Build Information Systems and Adopt EA Method. This could be a result of a good understanding of the meaning of EA, or stakeholders do not regard EA as their concern at all. It is also interesting to notice that regardless of the different perceptions of goals among stakeholders, all HEIs felt the pilot to be successful. Thus the research does not provide support to confirm the link between clear goals and success.

Rapid qualitative and quantitative analysis of proanthocyanidin oligomers and polymers by UPLC-MS/MS.

This paper presents the development of a rapid method with ultraperformance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) for the qualitative and quantitative analyses of plant proanthocyanidins directly from crude plant extracts. The method utilizes a range of cone voltages to achieve the depolymerization step in the ion source of both smaller oligomers and larger polymers. The formed depolymerization products are further fragmented in the collision cell to enable their selective detection. This UPLC-MS/MS method is able to separately quantitate the terminal and extension units of the most common proanthocyanidin subclasses, that is, procyanidins and prodelphinidins. The resulting data enable (1) quantitation of the total proanthocyanidin content, (2) quantitation of total procyanidins and prodelphinidins including the procyanidin/prodelphinidin ratio, (3) estimation of the mean degree of polymerization for the oligomers and polymers, and (4) estimation of how the different procyanidin and prodelphinidin types are distributed along the chromatographic hump typically produced by large proanthocyanidins. All of this is achieved within the 10 min period of analysis, which makes the presented method a significant addition to the chemistry tools currently available for the qualitative and quantitative analyses of complex proanthocyanidin mixtures from plant extracts.