Modularity in Health and Social Services: Perspectives on Organization and Management

Organizations that provide health and social services operate in a complex and constantly changing environment. Changes occur, for example, in ageing, technology and biotechnology, and customers’ expectations, as well as the global economic situation. Organizations typically aim to adapt the changes by introducing new organizational structures and managerial practices, such as process and lean management. Only recently has there been an interest in evaluating whether organizations providing health and social services could apply modularity in order to respond to some of the changes. The concept of modularity originates from manufacturing, but is applied in many other disciplines, such as information technology and logistics. However, thus far, the literature concerning modularity in health and social services is scarce. Therefore the purpose of this thesis is to increase understanding concerning modularity and the possibilities to apply modularity in the health and social services context. In addition, the purpose is to shed light on the viewpoints that are worth taking into account when considering the application of modularity in the health and social services context. The aim of the thesis is to analyze the way in which the modular structures are applied in the health and social services context and to analyze what advantages and possible barriers, as well as managerial concerns, might occur if modularity is applied in the health and social services context. The thesis is conducted by using multiple methods in order to provide a broad aspect to the topic. A systematic literature review provided solid ground for pre-understanding the topic and supported the formulation of the research questions. Theoretical reasoning provided a general overview of the special characteristics of the health and social services context and their effect on application of modularity. Empirical studies concentrated on managerial concerns of modularity particularly from the perspective of health and social services for the elderly. Results of the thesis reveal that structures in products, services, processes, and organizations are rather modular in health and social services. They can be decomposed in small independent units, while the challenges seem to occur especially in the compatibility of the services. It seems that health and social services managers have recognized this problem and they are increasingly paying attention to this challenge in order to enhance the flexible compatibility of services. Advantages and possible barriers of modularity are explored in this thesis, and from the theoretical perspective it could be argued that modularity seems to be beneficial in the context of health and social services. In fact, it has the potential to alleviate several of the challenges that the health and social services context is confronting. For example, modular structures could support organizations in their challenging task to respond to customers’ increasing demand for heterogeneous services. However, special characteristics of the health and social services context create barriers and provide significant challenges in application of modularity. For example, asymmetry of information, negative externalities, uncertainty of demand, and rigid regulation prevent managers from extensively drawing benefits from modularity. Results also reveal that modularity has managerial implications in health and social service. Modularity has the potential to promote and support new service development and outsourcing. Results also provide insights into network management and increases managerial understanding of different network management strategies. Standardization in health and social services is extensive due to legislation and recommendations. Modularity provides alternative paths to take an advantage of standardization while still ensuring the quality of the services. Based on this thesis, it can be concluded, both from a theoretical perspective and from empirical results concerning modularity in health and social services, that modularity might fit well and be beneficial. However, the special characteristics of the health and social services context prevent some of the benefits of modularity and complicate its application. This thesis contributes to the academic literature on the organization and management of health and social services by describing modularity as an alternative way for organizing and managing health and social services. In addition, it contributes to the literature of modularity by exploring the applicability of modularity in the context of health and social services. It also provides practical contribution to health and social services managers by evaluating the pros and cons of modularity when applied to health and social services.

Macroeconomic success and social vulnerability: lessons for Latin America from the Celtic Tiger

Includes bibliography

The church and social reforms /

"This little book is the outcome of lectures delivered by the writer."

Decision support system for project selection

The evaluation and selection of industrial projects before investment decision is customarily done using marketing, technical, and financial information. Subsequently, environmental impact assessment and social impact assessment are carried out mainly to satisfy the statutory agencies. Because of stricter environment regulations in developed and developing countries, quite often impact assessment suggests alternate sites, technologies, designs, and implementation methods as mitigating measures. This causes considerable delay to complete project feasibility analysis and selection as complete analysis requires to be taken up again and again until the statutory regulatory authority approves the project. Moreover, project analysis through the above process often results in suboptimal projects as financial analysis may eliminate better options as more environment friendly alternative will always be cost intensive. In this circumstance, this study proposes a decision support system which analyses projects with respect to market, technicalities, and social and environmental impact in an integrated framework using analytic hierarchy process, a multiple attribute decision-making technique. This not only reduces duration of project evaluation and selection, but also helps select an optimal project for the organization for sustainable development. The entire methodology has been applied to a cross-country oil pipeline project in India and its effectiveness has been demonstrated. © 2008, IGI Global.

Modelo de análisis organizativo para la mejora del desempeño de empresas sociales

La empresa social es un modelo organizativo que presenta un interesante potencial para resolver problemáticas sociales. La empresa social ha despertado interés tanto en países industrializados como en economías en vías de desarrollo porque representa un modelo dentro del capitalismo que persigue objetivos sociales mediante la realización de actividades de mercado (compra y venta de productos y/o servicios principalmente). A pesar de sus raíces lejanas en el tiempo se trata de un campo de conocimiento relativamente joven, donde la literatura académica presenta escasez de estudios empíricos. El desarrollo teórico para buscar claridad conceptual ha sido el principal caballo de batalla de los últimos años, y por tanto, se ha prestado poca atención a generar evidencias sobre cómo funcionan las empresas sociales y sobre sus claves de su éxito. Se considera que la mejora en la comprensión de este modelo organizativo pasa por la construcción de herramientas para que académicos y practicantes mejoren su conocimiento sobre los mecanismos internos de las empresas sociales. En este contexto nace la presente tesis doctoral sobre empresa social, que tiene por objetivo la creación de un marco de análisis que permita el estudio de las empresas sociales desde una dimensión organizativa, es decir, que aborde los elementos clave que describen el funcionamiento de este tipo de organizaciones. Para ello, en este trabajo se aborda la construcción del modelo para el análisis organizativo de las empresas sociales a partir del análisis semántico de las 45 principales definiciones de empresa social. A partir de este análisis se identifican dos dimensiones de análisis de la empresa social: -Cuatro principios, comunes a todas las manifestaciones del fenómeno, que recogen la esencia del concepto. -Ocho elementos organizativos específicos de la empresa social que describen la forma en la que cada iniciativa se implementa en un contexto determinado. Es decir, elementos de diseño presentes en diferente medida que dan lugar a tipologías de empresa social diferentes. Estos elementos son: la proposición de valor social, la búsqueda de impacto a largo plazo, la cultura organizativa, la conexión con los beneficiarios, el liderazgo emprendedor y los mecanismos de gobernanza, el ecosistema colaborativo, la estrategia empresarial y la orientación a la autosuficiencia económica. A partir de este marco de análisis, se construyen dos herramientas de diagnóstico que permiten su aplicación al estudio de empresas sociales: una tabla de indicadores para el análisis externo (por parte de un investigador ajeno a la organización) y un cuestionario de diagnóstico para el análisis interno (a través del personal de la empresa social objeto de estudio). Las herramientas intentan dar respuesta a la necesidad de desarrollar constructos para el estudio empírico de las empresas sociales. Para analizar la utilidad del modelo y de las herramientas se llevaron a cabo tres estudios de caso: -La empresa social ACCIONA Microenergía Perú que proporciona energía eléctrica a comunidades rurales aisladas en la región peruana de Cajamarca. -La empresa social Integra-e que propone un mecanismo de inserción socio-laboral en Madrid para jóvenes en riesgo de exclusión a través de la formación en Tecnologías de la Información y la Comunicación (TIC). -Un conjunto de redes de telecentros pertenecientes a la red LAC de la fundación Telecentres.org que proporcionan acceso a servicios de información (Internet entre otros) en diferentes países de Latinoamérica. La aplicación de las herramientas mostró ser útil en los tres estudios de caso para obtener una relación de evidencias con las que analizar la proximidad de una organización al ideal de empresa social. El ejercicio de análisis también resultó interesante como ejercicio reflexivo para las entidades participantes. Los resultados del cuestionario fueron especialmente interesantes en los telecentros de la Fundación Telecentre.org ya que al ser un estudio multicaso se pudo realizar un rico análisis estadístico sobre el funcionamiento de los telecentros y su desempeño. El estudio permitió identificar relaciones interesantes entre los ocho elementos de diseño del modelo propuesto y el desempeño de la organización. En particular, se detectó que para todos los casos estudiados: -La dimensión económica es la componente del desempeño que mayor desafíos plantea. -La existencia de una alta correlación entre el desempeño y siete de los ocho elementos organizativos del modelo. -La importancia de la cultura organizativa como elemento que explica el desempeño global de la organización y la satisfacción de los empleados. El campo de la empresa social presenta importantes retos de futuro, como la claridad conceptual, el desarrollo de estudios empíricos y la medida de su impacto social. El conocimiento de las claves organizativas puede ayudar a diseñar empresas sociales más robustas o a que organizaciones con fines sociales que no se basan en mecanismos de mercado consideren la posibilidad de incorporar éstos en su estrategia. ABSTRACT Social enterprise is an organizational model with a strong potential to help solving social problems. Recently, interest for the model has risen in both industrialized and developing countries because it is organized to achieve altruistic or social goals through market activities (mainly sales of products and services). Despite its historic roots, it is a relatively young field of research, where academic literature has little empirical data to accompany the theoretical development of social enterprise. Conceptual clarification has been the main challenge during the recent years, and there has been little attention given to generate evidence on how social enterprises operate and their keys to success. Progress in empirical study involves the construction of tools for researchers, in order to increase understanding of the internal mechanisms of social enterprises. This thesis aims to create a conceptual framework to study social enterprises from an organizational point of view, by analyzing the key elements that explain the operation and organization of this organizational model. The framework for the organizational analysis of social enterprises was built supported by the semantic analysis of 45 main definitions of social enterprise. The framework is divided into two dimensions: -There are four principles which capture the essence of the social enterprise concept, and are present in the manifestations of cases. -There are eight design elements which help analyze the characteristics of each particular social enterprise initiative: the social value proposition, social impact orientation, organizational culture, links to beneficiaries, entrepreneurial leadership, collaborative ecosystem, entrepreneurial strategy and orientation to economic self-sufficiency. Two diagnostic tools were developed to apply the framework to case studies: a scoreboard of indicators (to be used by the researcher during external analysis of the organization) and a questionnaire (to be answered by the social enterprise staff). The dissertation undertakes the study of three case studies: -ACCIONA Microenergia Peru, a social enterprise that provides electricity to isolated rural communities in the Peruvian region of Cajamarca. -Integra-e, a social enterprise located in Madrid that promotes socioprofessional integration of young people through training in ICT. -A sample of telecenters of the LAC network that provide access to information services (such as Internet) in Latin America. Applying the tools proved to be useful in all three cases, because it helped to obtain evidence to compare the proximity of an organization to an ideal type of social enterprise. In all the cases studied, the economic sustainability proved to be the biggest challenge for the organizations. The application of the questionnaire to the telecenters was especially informative because it was a multicase study which provided a rich statistical analysis on the performance of call centers. The study identified unique relationships between the model elements and the organziation performance. A statistical analysis shows a high correlation between performance and seven organizational elements described in the model. The organizational culture seems to be an important factor in explaining the overall organizational performance and employee satisfaction. The field of social enterprise has significant future challenges -such as conceptual clarity, the development of empirical studies and social impact assessment. A deep understanding of key organizational aspects of social enterprises can help in the design of more robust organizations and to bring success to social-purpose organizations.

The Nicaragua Canal. Is the Assessment in line with National Environmental Law?

In 2013, the Government of Nicaragua approved the concession for a 173-mile canal to the Hong Kong Nicaragua Canal Development Investment Group. As the Western Hemisphere's second poorest nation, Nicaragua is attracted the promises of economic growth that may come as a result of the Canal Project. However, potential economic benefits may be offset by environmental and social damages that would likely occur as a result of the project. The Canal would bisect 16 watersheds, 15 protected areas, and 25 percent of Nicaragua’s rainforest, which would have high impacts on biodiversity, watershed services, and indigenous communities. In 1996, Law No. 217 was enacted to standardize the use and conservation of the environment and natural resources of Nicaragua. My research compares the Environmental and Social Impact Assessment of the Nicaragua Canal to the Environmental provisions of Law No. 217. This analysis can help understand the legal viability of the ESIA under Nicaragua environmental laws.

Sustainable Tourism and Eradication of Poverty (Step): impact assessment of a tourism development program in Brazil

This paper aims to evaluate the social impacts of the Tourism Development Program (Prodetur) in the northeastern town of Porto Seguro, Bahia, Brazil. The method used is based on the difference in difference technique applied to the 1991 and 2000 Census microdata. The results suggest social advances following from poverty relief based on income - where the benefits are distributed, generally, in a relatively equal manner between the native and migrant population. There is a relative deterioration in the sanitary situation, which consists of a very serious problem in the mid- and long-term, whose costs are mostly borne by the native population. Therefore, maintaining the natural capital is the main aspect that distances Porto Seguro’s tourism supply from the concept of sustainability. The article also relies on difference in difference estimators to assess the impacts of local public policies related to the sector.

The Mirror Room Project: A Critical Ethnographic Program Evaluation of a Teaching Personal and Social Responsibility Based Youth Development Program

Amongst a host of other benefits, proper physical education has the possibility to create a safe place where responsibility can be transferred from the teacher/facilitator, to the student. This is especially true with an underserved population. This critical program evaluation of the program CHARM was done for the purpose of program improvement. This research was a place for participants to share their experiences of the program. The participants were 5 underserved youth, 5 undergraduate students, 3 teachers and 1 graduate student. Observations, interviews, and document analysis were used to gather data. Data was analyzed using a first level read-through, and two second-level analyses. Summaries were written, and cross-case analyses were completed. The main finding of the research was the development of a Handbook, which is a guide to running the program. Secondary findings include issues of program structure, goal setting, meaningful relationships, roles, SNAP, and an outlier in the data.

Sources of selection bias in evaluating social programs: An interpretation of conventional measures and evidence on the effectiveness of matching as a program evaluation method

This paper decomposes the conventional measure of selection bias in observational studies into three components. The first two components are due to differences in the distributions of characteristics between participant and nonparticipant (comparison) group members: the first arises from differences in the supports, and the second from differences in densities over the region of common support. The third component arises from selection bias precisely defined. Using data from a recent social experiment, we find that the component due to selection bias, precisely defined, is smaller than the first two components. However, selection bias still represents a substantial fraction of the experimental impact estimate. The empirical performance of matching methods of program evaluation is also examined. We find that matching based on the propensity score eliminates some but not all of the measured selection bias, with the remaining bias still a substantial fraction of the estimated impact. We find that the support of the distribution of propensity scores for the comparison group is typically only a small portion of the support for the participant group. For values outside the common support, it is impossible to reliably estimate the effect of program participation using matching methods. If the impact of participation depends on the propensity score, as we find in our data, the failure of the common support condition severely limits matching compared with random assignment as an evaluation estimator.

Social impact bond feasibility study: Children and youth at risk: the Projecto Família program

Social impact bonds are an increasingly popular method of unlocking typical social investment barriers and fuelling social innovation. This feasibility study aims to understand whether a social impact bond is a suitable tool for decreasing unnecessary foster care placements in Portugal, which have been proven to cause significant social and financial damage to societies. This research question is answered through a financial model which combines the costs of this social problem with Projecto Família’s intervention model, a leading intensive family preservation service. Main findings suggest using SIB funding for a 5-year project with the goal of generating the proper impact measurement metrics lacking in the field.

The impact of urban noise on primary schools: perceptive evaluation and objective assessment

This paper aims to assess the impact of environmental noise in the vicinity of primary schools and to analyze its influence in the workplace and in student performance through perceptions and objective evaluation. The subjective evaluation consisted of the application of questionnaires to students and teachers, and the objective assessment consisted of measuring in situ noise levels. The survey covered nine classes located in three primary schools. Statistical Package for Social Sciences was used for data processing and to draw conclusions. Additionally, the relationship of the difference between environmental and background noise levels of each classroom and students with difficulties in hearing the teacherâ s voice was examined. Noise levels in front of the school, the schoolyard, and the most noise-exposed classrooms (occupied and unoccupied) were measured. Indoor noise levels were much higher than World Health Organization (WHO) recommended values: LAeq,30min averaged 70.5 dB(A) in occupied classrooms, and 38.6 dB(A) in unoccupied ones. Measurements of indoor and outdoor noise suggest that noise from the outside (road, schoolyard) affects the background noise level in classrooms but in varying degrees. It was concluded that the façades most exposed to road traffic noise are subjected to values higher than 55.0 dB(A), and noise levels inside the classrooms are mainly due to the schoolyard, students, and the road traffic. The difference between background (LA95,30min) and the equivalent noise levels (LAeq,30min) in occupied classrooms was 19.2 dB(A), which shows that studentsâ activities are a significant source of classroom noise.

Evaluation of the impact of a therapeutic drug monitoring program in a Swiss University Hospital

Background and objective: Therapeutic Drug Monitoring (TDM) has been introduced early 1970 in our hospital (CHUV). It represents nowadays an important routine activity of the Division of Clinical Pharmacology and Toxicology (PCL), and its impact and utility for clinicians required assessment. This study thus evaluated the impact of TDM recommendations in terms of dosage regimen adaptation. Design: A prospective observational study was conducted over 5 weeks. The primary objective was to evaluate the application of our TDM recommendations and to identify potential factors associated to variations in their implementation. The secondary objective was to identify pre-analytical problems linked to the collection and processing of blood samples. Setting: Four representative clinical units at CHUV. Main outcome measure: Clinical data, drug related data (intake, collection and processing) and all information regarding the implementation of clinical recommendations were collected and analyzed by descriptive statistics. Results: A total of 241 blood measurement requests were collected, among which 105 triggered a recommendation. 37% of the recommendations delivered were applied, 25 % partially applied and 34% not applied. In 4% it was not applicable. The factors determinant for implementation were the clinical unit and the mode of transmission of the recommendation (written vs oral). No clear difference between types of drugs could be detected. Pre-analytical problems were not uncommon, mostly related to completion of request forms and delays in blood sampling (equilibration or steady-state not reached). We have identified 6% of inappropriate and unusable drug level measurements that could cause a substantial cost for the hospital. Conclusion: This survey highlighted a better implementation of TDM recommendations in clinical units where this routine is well integrated and understood by the medical staff. Our results emphasize the importance of communication with the nurse or the physician in charge, either to transmit clinical recommendations or to establish consensual therapeutic targets in specific conditions. Development of strong partnerships between clinical pharmacists or pharmacologists and clinical units would be beneficial to improve the impact of this clinical activity.

The cost of hunger: Social and economic impact of child undernutrition in the Plurinational State of Bolivia, Ecuador, Paraguay and Peru

The Economic Commission for Latin America and the Caribbean (ECLAC) jointly with the World Program of Food (WFP) and recognized experts of the region developed a methodology that, using secondary information, estimate the opportunity cost derived from undernutrition. This methodology has been successfully applied in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama and the Dominican Republic, where the cost of undernutrition was estimated at 6.7 billion dollars in 2004. The present study covers four countries in South America: Bolivia, Ecuador, Paraguay and Peru. The results indicate that the cost of the malnutrition in these countries reached 4.3 billion dollars in 2005, which is equivalent to 3.3 per cent of the GDP of these countries. The results strongly point out that child undernutrition is not only a problem of health or an unacceptable situation ethically, but it is a national problem, given the enormous social costs and the loss of opportunities that it imposes on the national economy.

Impact of definitions of loss to follow-up (LTFU) in antiretroviral therapy program evaluation: variation in the definition can have an appreciable impact on estimated proportions of LTFU

OBJECTIVE To examine the impact of different definitions of loss to follow-up (LTFU) on estimates of program outcomes in cohort studies of patients on antiretroviral therapy (ART). STUDY DESIGN AND SETTING We examined the impact of different definitions of LTFU using data from the International Epidemiological Databases to Evaluate AIDS-Southern Africa. The reference approach, Definition A, was compared with five alternative scenarios that differed in eligibility for analysis and the date assigned to the LTFU outcome. Kaplan-Meier estimates of LTFU were calculated up to 2 years after starting ART. RESULTS Estimated cumulative LTFU were 14% and 22% at 12 and 24 months, respectively, using the reference approach. Differences in the proportion LTFU were reported in the alternative scenarios with 12-month estimates of LTFU varying by up to 39% compared with Definition A. Differences were largest when the date assigned to the LTFU outcome was 6 months after the date of last contact and when the site-specific definition of LTFU was used. CONCLUSION Variation in the definitions of LTFU within cohort analyses can have an appreciable impact on estimated proportions of LTFU over 2 years of follow-up. Use of a standardized definition of LTFU is needed to accurately measure program effectiveness and comparability between programs.

An evaluation of the impact of Inner City Development's Cooperative Home School: An educational alternative program to increase the quality and level of education in San Antonio's West Side community

The research study was intended to evaluate the effectiveness of Inner City Development's (I.C.D.) Cooperative Home School, an educational alternative program to the Title I public schools of San Antonio's West Side community. The study investigated students', parents' and tutors' perception of parental involvement and educational resources. The study also investigated each student's academic achievement. ^ The study found that students progressed toward expected math proficiency at a faster rate than they did in reading proficiency. However, because the target population size was small and a comparison group was not used, the results of this study are only suggestive. This research also indicated that study subjects believed students' quality and level of education increased substantially since program exposure. Study subjects mainly attributed the students' strides in academic performance to the increased amount of individualized attention students received in the small twelve-student class size. Study subjects were more satisfied with the home school's educational resources than those of the Title I public schools. Study subjects also perceived that parental involvement both at home and at school increased since enrollment in the home school program because: (1) there were more opportunities for involvement in the home school; and (2) parents felt closer to the tutors than the teachers in public school. ^ This evaluation also suggested improvements to program operations. With the help of additional volunteers, I.C.D. program operators could improve collection and organization of academic records. Furthermore, as suggested by program participants, science could be added to the curriculum. Lastly, a formal tutor orientation could be implemented to familiarize and train tutors on classroom management procedures. ^