Connecticut digest of administrative reports to the Governor.

Report year 1956/57-1958/59 ends June 30.

Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic ( or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction ( AMI) ( n = 3427), or stroke ( n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals ( long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups ( same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided. Conclusions: Diagnosis-outcome indicators based on administrative data require validation as markers of significant risk adjusted SV. Validated indicators allow quantification of realisable outcome benefits if all hospitals achieved best performer levels. The overall level of quality of care within single institutions cannot be inferred from the results of one or a few indicators.

Public reporting of hospital outcomes based on administrative data: risks and opportunities

In the wake of findings from the Bundaberg Hospital and Forster inquiries in Queensland, periodic public release of hospital performance reports has been recommended. A process for developing and releasing such reports is being established by Queensland Health, overseen by an independent expert panel. This recommendation presupposes that public reports based on routinely collected administrative data are accurate; that the public can access, correctly interpret and act upon report contents; that reports motivate hospital clinicians and managers to improve quality of care; and that there are no unintended adverse effects of public reporting. Available research suggests that primary data sources are often inaccurate and incomplete, that reports have low predictive value in detecting outlier hospitals, and that users experience difficulty in accessing and interpreting reports and tend to distrust their findings.

Evaluating cost efficiency in central administrative services in UK universities

This paper describes an attempt to evaluate cost efficiency in UK university central administration. The funding councils of higher education institutions have progressively evolved elaborate systems for measuring university performance in teaching quality and research. Indeed, funding of universities is linked to their performance in research. The allocation of resources between academic and administrative activities, on the other hand, has so far not been subject to scrutiny. Yet, expenditure on administration is typically some 30% of that allocated to academic activities. This paper sets up a data envelopment analysis (DEA) framework to identify practices leading to cost-efficient central administrative services in UK universities. The problems in defining the unit of assessment and the relationship between the inputs and the outputs are clearly demonstrated. © 2005 Elsevier Ltd. All rights reserved.

The development and evaluation of distance learning materials for administrative personnel in a multi-national company

There has been substantial research into the role of distance learning in education. Despite the rise in the popularity and practice of this form of learning in business, there has not been a parallel increase in the amount of research carried out in this field. An extensive investigation was conducted into the entire distance learning system of a multi-national company with particular emphasis on the design, implementation and evaluation of the materials. In addition, the performance and attitudes of trainees were examined. The results of a comparative study indicated that trainees using distance learning had significantly higher test scores than trainees using conventional face-to-face training. The influence of the previous distance learning experience, educational background and selected study environment of trainees was investigated. Trainees with previous experience of distance learning were more likely to complete the course and with significantly higher test scores than trainees with no previous experience. The more advanced the educational background of trainees, the greater the likelihood of their completing the course, although there was no significant difference in the test scores achieved. Trainees preferred to use the materials at home and those opting to study in this environment scored significantly higher than those studying in the office, the study room at work or in a combination of environments. The influence of learning styles (Kolb, 1976) was tested. The results indicated that the convergers had the greatest completion rates and scored significantly higher than trainees with the assimilator, accommodator and diverger learning styles. The attitudes of the trainees, supervisors and trainers were examined using questionnaire, interview and discussion techniques. The findings highlighted the potential problems of lack of awareness and low motivation which could prove to be major obstacles to the success of distance learning in business.

Abolishing the Audit Commission:framing, discourse coalitions and administrative reform

The abolition of the Audit Commission in England raises questions about how a major reform was achieved with so little controversy, why the agency lacked the institutional stickiness commonly described in the literature on organisational reform and why it did not strategise to survive. In this paper, we apply argumentative discourse analysis to rich empirical data to reveal the pattern and evolution of storylines and discourse coalitions, and the ways in which these interact with and affect the practices of Parliament, the media and the Audit Commission itself. Our analysis shows that the politics of administrative reform are as much about discursive framing and the ability of pro-reformers to gain discursive structuration and institutionalisation as they are about the material resources available to a newly elected government and its ministers. Questions of technical feasibility are unlikely to derail a reform initiative once its promoters gain discursive ascendency.

Florida International University Appoints College of Medicine Founding Dean, Former Chancellor of LSU's Health Sciences Center boasts Impressive Research and Administrative Experience

Press Release from Florida International University 's Office of Media Relations announcing the appointment of Dr. John Rock as founding Dean of Florida International University 's College of Medicine.

Assessing administrative and political factors in implementing a living wage ordinance

Since 2000, the number of living wage ordinances has steadily increased throughout the country. While most of the current research has focused on the beneficial outcomes of living wages, little has been published on their administrative practices. To address this shortcoming, this study focused on the identification of key administrative and political factors involved impacting the implementation of living wage ordinances in Miami-Dade and Broward Counties. The study utilized a triangulation of interviews, surveys, and direct observation. The author conducted interviews of administrators and members of the living wage oversight boards in both counties and observed the monthly meetings held by each county's oversight board from January 2006 to June 2007. These findings were buttressed with a national survey of senior staff in other living wage communities. The study utilized descriptive statistics, Chi Square, Cronbach's Alpha, and Spearman's Rank Correlation Coefficient (Spearman's rho). Interviews indicated that administrators in Dade and Broward are seriously under-staffed and budgeted. Ambiguities in the enabling ordinances have lead to loopholes that undermine implementation and accountability for participating contractors. Survey results showed that policy ambiguity, organizational politics, and a lack of organizational capacity were significant negative factors in the implementation process while an organizational culture emphasizing consistent enforcement was a positive factor. Without the proper inputs, an organization hinders itself from meeting its outputs and outcomes. This study finds that Broward and Miami-Dade Counties do not provide the necessary administrative support to implement a living wage effectively – in stark contrast to the high hopes and strong political support behind their passage. For a living wage to succeed, it first needs an organizational culture committed to providing the necessary resources for implementation as well as transparent, consistent accountability mechanisms.

Comparative administrative reform: The rhetoric and reality of the Civil Service reform programs in Uganda and Tanzania

Administrative reform is a challenging endeavor for both developed and developing countries alike. For developing countries, the challenge is greater because numerous reforms are implemented concurrently sometimes under conditions of resource scarcity and political instability. So far there is no consensus as to what makes some reforms succeed and others fail. The current study seeks to fill that gap by offering an empirical comparative analysis of the administrative reforms initiated in Uganda and Tanzania since the early 1990s. The purpose of the study is to explain the similarities and differences, and give reasons for the successes and failures of the reform programs in the two countries. It focuses on four major areas; the size of the civil service, pay reform, capacity building, and ethics and accountability. Data were collected via in-depth face to face interviews with 35 key government officials and the content analysis of various documents. The results indicate that the reforms generated initial substantial reduction in the size of the public services in both countries. In Uganda, the traditional civil service was reduced from 140,500 in 1990 to 41,730 in 2004; while in Tanzania Ministries, Departments, and Agencies were reduced by 25%. Pay reform has generated substantial increases in civil servants' salaries in both countries but in Uganda, the government has not been able to abide by the pay strategy while in Tanzania the strategy guides the increments. Civil Service capacity building efforts have focused on enhancing the skills of the personnel. Training needs assessments were undertaken in all ministries in Uganda and a training policy was formulated. In Tanzania, the training needs assessments are still under way and a training policy has not yet been developed. Ethics and accountability are great challenges in both countries, but in Tanzania, there is more political will and commitment to improve the integrity of the civil service. The findings reveal that although Uganda started the reform with much more rigor and initial success, Tanzania has surpassed it and has a more stable, consistent, and promising reform record. This is because Uganda's leadership lacks political legitimacy. The country has since the late 1990s experienced a civil war in the northern and western parts of the country while Tanzania has benefitted from relative peace and high level political legitimacy.

Collective bargaining and faculty unionization: An administrative perspective

The purpose of this qualitative case study was to gain insight into the perspectives of experienced higher education administrators regarding faculty unionization, the collective bargaining process, and the interpersonal relationships between higher education faculty members and administrators. ^ The primary method of data collection was semi-structured face to face interviews with nine administrators from two community colleges and two universities in the south Florida area. All of the study participants worked with unionized faculty members and had direct experience participating in bargaining negotiations. ^ Upon the completion of each interview, the researcher listened to the taped audio recording of the interview several times and then transcribed all of the information from the audiotape into a Word file. Data collection and analysis for each participant were performed concurrently. Using a modified concept mapping approach, the research questions were written on large yellow sticky notes and placed in the middle of a wall in the researcher’s home with nine descriptive categorical themes written on smaller sticky notes placed around the study questions. The highlighted quotes and key phrases were cut from each transcript and placed under each of the descriptive categories. Over the course of a few months repeatedly reviewing the research questions that guided this study, the theory of symbolic interactionism, and relevant literature the categorical descriptive themes were refined and condensed into five descriptive themes. ^ Study findings indicated that the administrators: (a) must have a clear understanding of what it is that the faculty does to be an effective representative at the bargaining table, (b) experienced role ambiguity and role strain related to a lack of understanding as to their role at the bargaining table and a lack of organizational support, (c) were not offered any type of training in preparation for bargaining, (d) perceived a definite “us versus them” mentality between faculty and administration, and (e) saw faculty collective bargaining at public institutions of higher education in Florida as ineffectual. ^

Essays on administrative protection and trade deflection

This dissertation analyzes the trading effects and the politics of antidumping. The first essay empirically examines the influence of partisanship on antidumping. I show that an increase in the leftist orientation of the government makes labor intensive industries less likely to file an antidumping petition. I also demonstrate that the increase in the leftist orientation of the government is associated with an increase in the likelihood of an affirmative antidumping outcome for the petitions of labor intensive industries. The second essay investigates the effect of past exporting relationships of the firms, whose products are targeted by antidumping duties, on their export flows to alternative markets. My estimations show that facing an antidumping duty on a product leads to a 18% increase in the exports of the firm for that product to the alternative countries where the firms previously exported the same product and a 8% increase to the countries where the firms exported another product. On the contrary, I fail to find a significant effect of antidumping duties on the exports of the particular product to third countries to which the firm did not export before. Further, I show that a firm’s probability to start exporting the duty imposed product in a different destination increases by 8–10% if the firm already exported another product to that destination. However, I find no such evidence for the countries to which the firm did not export before. The third essay empirically analyzes the effect of potential antidumping claims, resulting from an antidumping investigation in the domestic market, on the quality of exported products to the target countries. My findings suggest that retaliation threats increase the quality of firms’ shipments for the named industries’ products to the target countries by 11%. This effect is also significantly increasing in the share of the exports of the named industries’ products shipped to the target country in the firms’ total exports. Further, I show that this effect is 4% higher for the exporters serving the developed countries and 3% higher for ones serving the heavy antidumping users.