ALBERT

Notes: Purpose - The purpose of this article is to report preliminary outcome and cost-benefit results for a patient safety quality improvement program intended to improve outcomes for patients aged 75 or more visiting the Emergency Department (ED). The program uses the Identification of Seniors at Risk (ISAR) scale to screen, and refers patients at high risk for appropriate intervention. Design/methodology/approach - The Plan-Do-Study-Act improvement cycle was used as a framework. Simple outcomes have been assessed by comparing patient sub-groups based on risk status and interventions received. Cost and benefits were assessed based on estimated program outcomes and average costs. Sensitivity analysis was performed to test alternate assumptions. Findings - The screening tool appears to be accurate, and screening and referral appears to have a positive impact, reducing length of stay, returns to the ED, and subsequent admissions to hospital. However, most results are not statistically significant at the 95 percent level. The value of avoided care exceeds program costs under most assumptions. Originality/value - Screening and referring all eligible patients has still not been achieved; these are areas for future investigation and improvement. Screening and referral appear to be effective in improving outcomes but because program costs were low, net benefits may have been achieved; however given global budgeting for hospital care improvements in the use of resources (rather than budgetary savings) would be expected. The methods for improvement (the Plan-Do-Study-Act framework; process evaluation; multidisciplinary working group meetings; outcome assessment) are practical and useful for improving quality and safety in a small community hospital with limited resources.

Notes: Purpose - This paper seeks to investigate how patients perceive service quality in Egypt's public and private hospitals. The paper also tests the SERVQUAL dimensions in hospitals within an Arab, non-Western context. Design/methodology/approach - The author used a cross-sectional questionnaire survey, performed in 2005. A sample of 332 patients from 12 hospitals in Egypt participated in the study. Findings - The results highlighted a three-factor solution for the SERVQUAL instrument with 67 per cent of variance explained. This result does not support the five-components original SERVQUAL. A discriminant function was estimated for patients who selected public hospitals and those who selected private hospitals. The model was found to be significant in explaining patients' choice of the type of hospital. Research limitations/implications - The use of quantitative methods alone is valuable in establishing relationships between variables, but is considered weak when attempting to identify the reasons for those relationships. Patients may have a complex set of important beliefs that cannot be captured in the questionnaire. Therefore, using qualitative research along quantitative methods in future studies may enhance the findings of this study. Originality/value - This article will be of interest to both public and private hospitals wishing to determine what patients expect from the quality of service provided to them.

Notes: Purpose - The purpose of this article is to present one example of how the strategies of total quality management (TQM) and continuous improvement are being used by US health care providers to meet the challenges of the future. Design/methodology/approach - This article presents an application utilizing the strategies of TQM and continual and rapid improvement in the area of assessing internal customer satisfaction in the health care arena. Satisfaction information concerning internal processes is critically important to the health care provider, and this article presents the development and application of an instrument designed to provide timely and relevant internal customer satisfaction information to individual health care providers. This provides information on problem identification and improvement opportunities for a world-class continuous improvement program. Findings - The article finds that customer satisfaction is increasingly being recognized as an appropriate measure for determining how well a particular organization is accomplishing its mission and, while customer satisfaction surveys provide valuable information and may be used to improve the entire operation, they provide limited insight into the details of the inner workings of each cost center. Each of the measures discussed in this article is potentially equally insightful and may provide more directly usable information when applied to internal customers. Originality/value - This article provides useful information on providing customer satisfaction in the health care arena.

Notes: Purpose - The purpose of this article is to investigate the performance of scales to assess the work environment of hospital professional staff, other than nurses or physicians. Design/methodology/approach - A survey was conducted among professional (non-nursing or medical) staff at a 300-bed urban, university-affiliated Canadian hospital. A total of 24 work environment items were adapted from a scale previously validated among nursing staff. Scales were developed based on a principal components analysis, and were compared among four groups of staff. The relationships between the scales and the following measures were then explored using univariate and multivariate analyses: satisfaction with the work environment, perceived quality of patient care, perceived frequency of patient/family complaints, work-related injuries, and verbal abuse of staff. Findings - The survey response rate was 154/200 (76.6 percent). Four scales were identified (with corresponding Cronbach's alpha), assessing the following aspects of the work environment: supervisory support (0.88), team-work (0.84), professionalism (0.77), and interdisciplinary relations (0.64). In multivariate analyses, there were significant differences between the job groups in all four scales. One or more of the scales was significantly associated with overall satisfaction, perceived quality, and adverse incidents, even after adjustment for other staff characteristics. Research limitations/implications - Limitations include: the cross-sectional design, subjective measurement of quality of care, small sample sizes in some groups of staff, and the single study site. Practical implications - The scales developed in this study may be used by managers to assess hospital staff perceptions of the work environment. Originality/value - The four proposed scales appear to measure meaningful aspects of the working environment that are important in determining overall satisfaction with the work environment and are related to quality of care.

Notes: Purpose - Business process reengineering has been touted in the literature as a dramatic improvement necessary for organization competitiveness, but in practice there are many unsuccessful cases. Thus, there is need for a more systematic and rigorous assessment of the factors deemed important to project success. The main objective of this study is to examine this issue. Design/methodology/approach - For this research, success has been defined as the benefits the hospital has derived from the BPR project, according to top managers' opinions. A sample of 192 hospital administrators shared their organizations' experience with their last BPR project implementation, where the changes have been operational for at least one year. Findings - Based on the results, recommendations are made for hospital managers to focus attention and resources on factors important to BPR project success. In general, hospitals are not emphasizing some of the most important activities and tasks recommended in the BPR literature, such as changes to customer/market-related business processes, the value-added element of every business activity, and applying the right innovative technology. Originality/value - Based on the findings as a whole, it behoves top managers not to engage in BPR before ensuring the presence of the success factors found to be important.

Notes: Purpose - The rising operating cost of providing healthcare is of concern to health care providers. As such, measurement of procurement performance will enable competitive advantage and provide a framework for continuous improvement. The objective of this paper is to develop a procurement performance measurement system. Design/methodology/approach - The paper reviews the existing literature in procurement performance measurement to identify the key areas of purchasing performance. By studying the three components in the supply chain collectively with the resources, procedures and output, a model is been developed. Additionally, a balanced scorecard is proposed by establishing a set of generic measures and six perspectives. A case study conducted at the Singapore Hospital applies the conceptual model to describe the purchasing department and the activities within and outside the department. Findings - The results indicate that the material management department has already made a good start in measuring the procurement process through the implementation of the balanced scorecard. Research limitations/implications - There are many data that are collected but not properly collated and utilized. Areas lacking measurement include cycle time of delivery, order processing time, effectiveness, efficiency and reliability. Though a lot of hard work was involved, the advantages of establishing a measurement system outweigh the costs and efforts involved in its implementation. Practical implications - Results of balanced scorecard measurements provide decision-makers with critical information on efficiency and effectiveness of the purchasing department's work. Originality/value - The measurement model developed could be used for any hospital procurement system.

Notes: Purpose - Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach - Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. "Patient awareness" was studied by content analysis. Findings - In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value - The importance of "patient awareness" within DTCs must be further explored.

Notes: Purpose - Quality has an established history in health care. Audit, as a means of quality assessment, is well understood and the existing literature has identified links between audit and research processes. This paper reviews the relationships between audit and research processes, highlighting how audit can be improved through the principles and practice of social research. Design/methodology/approach - The review begins by defining the audit process. It goes on to explore salient relationships between clinical audit and research, grouped into the following broad themes: ethical considerations, highlighting responsibilities towards others and the need for ethical review for audit; asking questions and using appropriate methods, emphasising transparency in audit methods; conceptual issues, including identifying problematic concepts, such as "satisfaction", and the importance of reflexivity within audit; emphasising research in context, highlighting the benefits of vignettes and action research; complementary methods, demonstrating improvements for the quality of findings; and training and multidisciplinary working, suggesting the need for closer relationships between researchers and clinical practitioners. Findings - Audit processes cannot be considered research. Both audit and research processes serve distinct purposes. Originality/value - Attention to the principles of research when conducting audit are necessary to improve the quality of audit and, in turn, the quality of health care.

Notes: Purpose - To assess the relationship between quality management and employee commitment. Design/methodology/approach - Analysis of the state of affairs with respect to (T)QM programs in The Netherlands based on the literature and interviews with key informants. Findings - Description of an approach that tries to integrate employee commitment and quality management based on the concept of employees' psychological contracts with their organization (ideas about mutual obligations between them and their employer). Research limitations/implications - The interviews with key informants provide limited information; the study is done in only one country. Research in a broader context and on a larger scale would give a more general overview. Practical implications - The crucial factor in making quality management work can be better described by "quality fails when employees' psychological contracts are neglected" than by "quality fails when system fails". Originality/value - This paper highlights the essential relationship between quality management and employee commitment and offers suggestions on how to approach this issue.

Notes: Purpose - To obtain preliminary data on the short- and medium-term effects and personal acceptability of appreciative inquiry (AI) in staff development in health care. Design/methodology/approach - AI is a non-problem-solving management approach focusing on developing current successes into the future through reflection at individual and group level. Individual one-hour interviews were undertaken with nursing staff on a national paediatric liver in-patient ward. They were asked to recount stories based on their experiences of successful delivery of health care, with active listening, followed by reflection on the process. A total of 32 staff members took part with only two refusals. Data were written and analysed by an open coding method. Follow up was obtained two years later using a written, open question method. Findings - The process was emotional but well received. Staff described quality in interpersonal interactions, preventing errors and engaging their personal values in their work. No improvement in recruitment or retention was shown but a high level of sickness absence fell significantly during the period of the project. Two years later, significant positive effects were recalled and attributed to the interviews by many respondents. AI appears a cost-effective way of connecting professionals' motivation toward quality in their work with strategic intentions. Research limitations/implications - The interviewer was a medical consultant and ward manager, implying either that the interviews could have worked as a form of managerial supervision or improvements could be a Hawthorne effect. Other unknown influences were likely to be occurring on the ward during the study period. Practical implications - Short AI interventions on an individual basis can change sickness absence, at least while the interventions are continuing. It is an important tool for staff motivation with the potential for connecting strategic with micro-operational levels. AI is an approach to NHS management with wide application including appraisal, personal development and mentoring. It can be a positive introduction to reflective practice. Originality/value - AI is gaining recognition for its value in staff and service development in health care. The paper shows service and personal effects, cost-effectiveness and illustrates how to use AI for these purposes.

Notes: Purpose - There are many examples of consumer involvement in NHS research but few studies have examined the impact of this on service development or the research process. This study, involving service user and carer researchers working alongside professional researchers, aimed to examine the development of one service user and carer research group in a mental health Trust. Dersign/methodology/approach - The research involved a review of existing literature on consumer involvement in research, a review of user involvement in research in South West Yorkshire Mental Health NHS Trust, a survey of consumers and NHS staff in the Trust, and a skills audit and training needs analysis of consumers. Findings - The study identified the range and extent of consumer involvement and the impact of this on consumers and the Trust. Service users and carers were involved in a range of projects, mainly on the level of consultation or collaboration. The benefits for consumers were principally on a personal level and included gaining knowledge and experience, improved sense of well-being, self esteem, and confidence. The benefit for the Trust was in having a service user perspective and focus. However, there is a tendency to omit service users from planning and setting priorities. Practical implications - The study pointed to the need to build the evidence base on consumer involvement in research, particularly in terms of how consumers can impact on setting research priorities and selecting appropriate methods. It identifies the need for more training for consumers and for NHS staff and for a more coherent strategy. Originality/value - This article will be of value to anyone who is at the start or in the early stages of their journey of consumer involvement. It identifies some of the practical issues faced by consumers and staff in working collaboratively, but also points to the benefits for all the stakeholders.

Notes: Purpose - Falls are the most frequently reported adverse event in hospitalised patients and carry a risk of great harm for the frail elderly. This intervention aimed to prevent high-risk in-patients on an acute aged care ward from falling. Design/methodology/approach - Patients assessed at high falls risk were accommodated in a room staffed by volunteer companion-observers. The volunteers engaged them in conversation, played cards, opened meals and used the call bell to summon nurses if patients attempted to move from the bed or chair without assistance. Because of occupational health and safety considerations, the volunteers did not assist patients to ambulate. Findings - The falls rate in the acute aged care ward decreased by 44 percent (p〈0.000). No patients fell in the observation room when volunteers were present. Relatives of participating in-patients expressed appreciation of the volunteer role, in terms of increased safety and also companionship. Volunteers exercised initiative in determining their pattern of work and developing resources to support their role. Research limitations/implications - Because volunteers are not present around the clock, other strategies are needed to prevent wandering, frequently confused older in-patients from falling during the night. Practical implications - In a context where frail elderly patients need constant supervision, using volunteers is a reasonable strategy. Originality/value - This intervention used an inexpensive, human resources-based approach to significantly reduce the incidence of falls in the population at highest risk of falling. The additional benefits to patients in terms of cognitive improvement bear further investigation.

Notes: Purpose - To compare patients' views on quality of care in different countries using a theory-based instrument, while at the same time controlling for the following potential confounders: type of care system (private vs public), type of care (kind of health problem), gender, age, and subjective wellbeing. Design/methodology/approach - Patients capable of communicating in wards (medical and surgical departments) and day surgery departments in England, France, Norway, and Sweden were recruited consecutively, to participate in a programme run by the health-care company Capio. Ward patients: England (n =1,236), France (n =1,051), Norway (n =226), and Sweden (n =428). Day surgery patients: England (n =887), France (n =544), Norway (n =101), and Sweden (n =742). Average response rate across settings: approximately 75 per cent. Patients evaluated the quality of the care they actually received and the subjective importance they ascribed to different aspects of care. The questionnaire "Quality from the patient's perspective" (QPP) was used (modified short version). Findings - Cross-national comparisons were made within each of the two care contexts (wards and day surgery) separately for men and women. Quality of care evaluations were adjusted for age and subjective wellbeing. English and French patients scored significantly higher than Norwegian and Swedish on both kinds of ratings (perceived reality and subjective importance), in both kinds of care contexts, and in both sexes. Originality/value - Cross-national comparisons of patients' views on care can give meaningful guidance for practitioners only if they are context-specific and if well-known confounders are controlled for.

Notes: Purpose - The paper reports on the conceptualization and measurement of the employee satisfaction construct at North East Alabama Regional Medical Center (RMC), Anniston, Alabama. The study sought to take a global attitudinal measure of employee satisfaction. Design/methodology/approach - The employee satisfaction construct was evaluated through the use of an amended Brayfield-Rothe Index (BRI). The Index, in its original form, comprises an 18-item five-point Likert scale with items listed in both positive and negative format. The amended instrument comprised an additional 12 items addressing such issues as organizational culture and satisfaction with existing orientation, human resource policy and practice. The sample was drawn from all employees of the North East Alabama Regional Medical Center, Anniston, Alabama over a two-week period in November 2003. Findings - The results have proved beneficial in revealing those core dimensions that comprise the employee satisfaction construct, at least as defined through the use of BRI at RMC. The Center has been able to identify those areas where performance should be maintained at present levels and those where improvement is needed. Research limitations/implications - The research is limited by the fact that it was cross-sectional in nature and in order to track real change/improvement over time, it should be repeated annually. It should also be stressed that the BRI was used to provide a global attitudinal measure of employee satisfaction only. When used as such, the author would recommend a certain amount of qualitative follow-up with willing participants in a focus group forum. This should allow for a richer interpretation of the results. Practical implications - The results have proved beneficial in revealing those core dimensions that comprise the employee satisfaction construct, at least as defined through the use of BRI at RMC. The Center has been better placed to identify those areas where performance should be maintained at present levels and those where improvement is needed. Originality/value - The research demonstrates the value and relative simplicity of the BRI method.

Notes: Purpose - This paper aims to introduces a measure to assess the perceived effectiveness of multi-hospital organizations (MOs). Design/methodology/approach - A sample of top managers of non-profit hospitals serves as the study setting. Data were collected via mail surveys. Usable responses were obtained from 189 hospitals. The measure was developed by considering the instrumentality and effect components of a set of relevant motives for joining an MO. During the course of the study, three alternative formulations were examined. Findings - Results show that the measures based on effect alone and a multiplicative combination of effect and instrumentality demonstrate sound psychometric properties. The recommendation here is to adopt the latter measure. Research limitations/implications - The study was limited to a particular sample. Replications among other samples are needed to validate the current findings. Also, because the exact content of the objective function of a hospital for joining an MO is not necessarily constant over time, there is a need to conduct similar studies on a periodic basis. Practical implications - The measure recommended here uses multiplicative/weighted instrumentality and effect scores as opposed to only the instrumentality or effect scores. This makes it possible to go beyond the mere "why" or "how" questions. Simultaneous consideration of instrumentality and effect dimensions affords a richer and more relevant understanding. Originality/value - Valid and reliable measures of performance are critical for both managerial and research purposes. The measure proposed in the current study could be used in structural equation models to investigate the effect of individual actions on performance and the impact of performance on other outcome measures (e.g. intentions to stay in an MO).

Notes: Purpose - Given the enormous size of the health care industry, the problem of developing high-quality, cost-effective health care delivery systems is growing in importance. There is general consensus that health care systems require a continuous process of quality improvement (QI). Less agreement, however, surrounds the mechanisms to be implemented so that such a process is effective. This study aims to bring empirical evidence to support the hypothesis that a QI program in a general hospital - a special context of the health care delivery system - does not necessarily lead to better overall organizational performance results. Design/methodology/approach - The study was done at the hospital level, and included all acute care hospitals in Israel. Data was collected in 16 of the country's 23 hospitals, a 70 percent response rate. The study compared hospital performance before and after the QI program implementation. Findings - The study shows that QI creates meaningful improvement events. In addition, the research supports the hypothesis that increasing the number of QI activities (items) included in the QI program brings about more improvement events. The results do not support the hypothesis that high, rather than low, intensive implementation of QI activities leads to more improvement events. Originality/value - The special context of general hospitals decreases the effects of a QI program on overall hospital performance, whereas QI activities function as triggers in initiating improvement events.

Notes: Purpose - To explore and evaluate how hospital staff respond to patient complaints. Design/methodology/approach - A teaching hospital with 1,500 beds in Taiwan was purposefully chosen as a case study of hospital response to patients' complaints. Data was obtained through interviews with quality surveying managers (n=53), government managers (n=4), staff of non-government organizations (n=3) and a senior social worker, as well as analysis of documents (September 2001-April 2002). Findings - Using the managerial-operational-technical framework developed by the researchers, the study demonstrated problematic aspects of handling complaints at the case hospital. It was revealed that: complaint handlers were not sufficiently empowered, information sharing was limited within the organization, communication among professional staff and with management was inadequate, the physical safety of workers had been threatened, and improvements could not be sustained. Moreover, it became apparent that the case study hospital generally responded to patient complaints in a reactive and defensive manner. Originality/value - It is evident that the hospital did not use patient complaints as a source of learning that could have promoted higher standards of care. The case study reveals some of the constraints and identifies requirements for appropriate use of information and feedback from patients. The study raises some issues requiring further research to ensure more appropriate use of patient complaints to improve quality of care.

Notes: Purpose - Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims to assess quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals to show weakness and gaps areas in the care procedure for future improvement intervention programs. It is a descriptive study to assess quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, in 2003. Design/methodology/approach - Using quota sampling, 60 healthy women were recruited for the study. Data were collected using three forms including a questionnaire with demographic and obstetrics questions, a check-list for the postpartum care and education quality assessment. Control of vital signs, uterus assessment, perineum assessment, leaving bed, urinary system assessment, digestive system assessment, breast examination, extremities assessment, psychological assessment, as well as education about perineum self-care, breast-feeding, infant care, education before discharge and educational method. Validity and reliability of the questionnaire and checklist were assessed prior to use. Data were analyzed using SPSS. Findings - Results showed compatibility of provided postpartum care with the standards as follows: method of patient's education (52.68 per cent); control of vital signs (43.21 per cent); education about breast-feeding (26.06 per cent); care in getting out of bed (25.83 per cent); psychological care (19.36 per cent); urinary system assessment (16.66 per cent); education about perineum care (13.12 per cent); uterus assessment (10.6 per cent); digestive system assessment (9.69 per cent); patient's education before discharge (7.99 per cent); education about infant's care (7.81 per cent); perineum assessment (6.72 per cent); breast examination (1.11 per cent); and assessment of extremities (0.81 per cent). The study demonstrated that weak postpartum care was provided in 82 per cent of cases but also that mothers were satisfied with provided care in all domains of care. Mothers were very satisfied with facilities and less satisfied with personnel interaction with their visitors in hospital. There was no significant correlation between quality of services and clients' satisfaction (Spearman test, p〈0.05). Originality/value - For the first time in Iran, this study has evaluated quality of care in postpartum wards of hospitals based on the defined standards. The study provided a defined standard for postpartum care, which is necessary for regular monitoring and evaluation and so evidence-based intervention programs to improve the system of care. It was also postulated that mothers' satisfaction with care is not always a good indicator of services quality.

Notes: Purpose - This article aims to show how communities with severe river flooding can develop sustainable flood plans that remediate environmental problems caused by previous river straightening and other structural flood controls. Design/methodology/approach - The article builds on a case study of the nationally recognized Napa River Flood Protection Project (USA), which incorporates an ecological living river strategy and builds on strong community participation to restore a river and its floodplain. After discussing the drawbacks of structural flood control measures, and especially of river straightening, reviews the contents of the Napa Flood Project and the public participation process necessary for its design, approval and implementation. Findings - The key lessons learned from Napa's flood project are that: undoing past structural works is difficult but feasible; ecological criteria can and should be used to design modern flood projects; involvement of a wide and diverse group of stakeholders is crucial to developing and implementing an environmentally sustainable flood management project; and the US Army Corps of Engineers can work with communities and depart from its typical, structural flood control approaches. Research limitations/implications - Information on straightened rivers is extremely limited. Furthermore, this study focuses on flood planning for US rivers, and may therefore be less useful elsewhere in the world where the frequency of river straightening may differ. Originality/value - This case study provides a critique on river straightening, which is a poorly documented but fairly frequent approach to flood control. This article helps to fill gaps in the knowledge of how communities can, and are, addressing environmental concerns associated with flood controls and river straightening.

Notes: Purpose - This paper aims to investigate the safety practices in some selected agro-allied industries in south-western Nigeria with a view to analysing the degree of safety awareness; adequacy of safety equipment; extent of enforcing safety rules; effectiveness of safety-related activities and economics of safety programme. Design/methodology/approach - A case study method of investigation, field study guidelines and binary variable were used and information gathered from 36 industries was documented. The data collected were analysed using mean, percentage and standard mathematical models. The analyses carried out on the data gathered are presented on the following: occurrence of accidents, causes of accidents, damages resulting from accidents, accident prevention activities and economic implications. Findings - Three classes of accidents are identified as fatal, serious, and minor. The results showed that minor accident has the highest frequency of occurrence of 304, while fatal accident has the least frequency of occurrence of 17. However, serious accident has the greatest economic implication, accounting for annual average loss of $4.97 millions. Also, nine causes of accidents are identified, out of which faulty equipment is common to all industries. And eight accident prevention activities are identified, amongst which standard operating procedure, good housekeeping and on-the-job training are commonly being practised, while provision of safety handbook and policy is least practised. Originality/value - This paper has described the safety practices in 15 agro-allied industries with an organised safety programme in South Western Nigeria. The study has investigated the extent of enforcement of safety rules; safety awareness; and economic implication of accidents from this sector for the national economy.

Notes: Purpose - The following conceptual exposition is presented in light of the growing number of scholars who indicate need for a comprehensive and coherent approach to disaster reduction, while practitioners seem to be continually faced with dynamic and seemingly contradictory goals and strategies. Design/methodology/approach - This article reviews arguments from an assorted collection of literature in order to increase theoretical understanding of disasters and attempts to integrate various concepts, paradigms and policy proposals. Findings - The discussion points out the strengths and weaknesses of alternative viewpoints about disasters, and suggests that a broad conceptualization of vulnerability may be best suited to assimilate findings for academia and simplify policy guidance for professionals in the field. Research limitations/implications - Because this is a cursory exploration of the casting of vulnerability management in terms of liability reduction and capacity building, additional research on the matter will undoubtedly be needed. Nonetheless, it is hoped that this article may pull together diverse academic frameworks, in order to avert recurring mistakes among those designing and implementing policy. Originality/value - By updating the author's prior work in this area with additional considerations regarding the natural hazards, civil defense, risk management and homeland security schools, this article may be useful for scholars and practitioners interested in reversing the trend of more frequent and intense disasters.

Notes: Purpose - The purpose of this paper is to review research findings on the effects of a variety of disasters, including the events of 9/11, on the general public and members of organizations. Design/methodology/approach - A literature search was undertaken. Three areas were targeted: impact on public attitudes and morale, on organizations and human resource management, and on organizational resilience. Findings - Four conclusions were drawn. First, disasters such as 9/11 have immediate negative effects on emotions and behaviors. Second, with the passage of time these effects dissipate for most people. Third, organizations directly affected by 9/11 immediately stopped functioning. Fourth, fortunately many of these firms bounced back surprisingly quickly. Research limitations/implications - Relatively little research has been conducted on the effects of 9/11, limiting our understanding of it. Practical implications - The people in these resilient firms, those more directly affected by the terrorist attacks, made the difference. Human resource management practices and cultural values already in place were the key factors in bringing about a speedy recovery. These factors can also be developed in other organizations as a precaution. Originality/value - This paper explores important yet still under-researched areas of management and organizational responses to terrorism.

Notes: Purpose - To review the experience of managing two patients with identical names in the same ward during a five-month period. Design/methodology/approach - The records of the patients were reviewed to look for incorrect entries, errors in specimens sampling, administration of blood products and chemotherapy, and misplacement of clinical notes. Doctors and nurses involved were also invited to complete a questionnaire study to comment on the usefulness of the measures implemented for correct patient identification. A random sample of 60 patients was also selected to see if their full names were shared with other patients attending the same hospital. Findings - Among the 1,442 sheets of hospital records from the two patients, no errors pertaining to the clinical activities were found. However, 13 (0.9 per cent) sheets of the hospital records were misplaced. The 21 doctors and nurses participating in the questionnaire study gave positive support to all the additional measures implemented for safeguarding patient identification, of which the automated alerting feature in the electronic clinical management system received the highest scores. A total of 32 (53 per cent) of the 60 sampled patients shared a common full name with one to 101 other patients attending the same hospital. Originality/value - Patients with identical names staying in the same ward present a unique challenge to acute health-care settings. The situation is especially relevant in communities where most people's names are not unique. Specific guidelines and measures are needed to prevent patient misidentification. Errors in filing of patient notes and laboratory reports to the hospital record deserve further attention.

Notes: Purpose - This article aims to describe the research process, and the development of the instrument now employed in auditing patients' perceptions of quality improvement in a community health care trust in a coastal town in Essex, England. Design/methodology/approach - The new instrument is currently being implemented and the findings thus far are described. Findings - The instrument has measured health outcomes in terms of quality improvement from the users' perspective, and has also highlighted gaps between what the service offers in terms of quality and users' perceptions of what is delivered. The study demonstrates the importance of the professional role in quality improvement. Originality/value - Patient-centred quality improvement audit should be undertaken regularly so that both non-clinical managers and health care professionals can establish whether or not they are providing services that are patient-friendly and effective from the user's viewpoint. In the course of their work, professionals and managers discuss patients and speak on their behalf in various forums, and knowing what patients actually expect and perceive before speaking on their behalf may be of great benefit in such instances.

Notes: Purpose - Aims to describe the growing importance of information and its governance within public services. The paper starts by considering how scandals in three national public health systems have focused public attention on information issues. It describes a theoretical framework for improving information governance, and its practical implementation as a management tool. The paper concludes with a discussion of the benefits of the approach, and the consequences of not improving information governance. Design/methodology/approach - The framework brings together a number of existing methodological approaches, principally the maturity model approach to process improvement, first described in the Software Engineering Institute's capability maturity model, and the novice-to-expert approach to competency. Findings - The paper describes how these approaches can be synthesised into an integrated framework to manage organisational change and how that can be used to improve information governance within public sector organisations. Research implications - The paper compares the framework and its practical implementation with existing solutions, arguing that existing solutions provide only partial solutions. Originality/value - Considers how plans for future service improvements will be restricted unless information governance issues can be addressed.

Notes: Purpose - The aim of the present study was to assess the prescribing pattern of general practitioners (GPs) in Kerman province of Iran. Design/methodology/approach - A total of 45,384 prescriptions issued in one year (2002) by GPs in ten cities of Kerman province were investigated for the number of drugs/prescription, drug name, drug category and route of administration. The mean number of drugs/prescription was 3.43. Findings - Overall most of the drugs (97.2 per cent) were prescribed by generic name. The most frequently prescribed drugs were antibiotics (33.95 per cent), sedative/hypnotics (19.56 per cent), non-steroidal anti-inflammatory drugs (NSAIDs) (19.2 per cent) and corticosteroids (11.2 per cent). About 42.4 per cent of the patients received an injectable drug. Originality/value - The results of this study showed inappropriate prescription of antibiotics, NSAIDs, corticosteroids and injectable drugs. So intervention methods should be chosen to change physicians' prescribing behavior, through education of rational drug prescription, to improve the quality of prescribing practice of GPs.

Notes: Purpose - The present study seeks to present a case study over four years following an implementation process of total quality management (TQM) on an ICU (intensive care unit). Design/methodology/approach - The aim was to describe consequences shown in the organisational climate, workload and staff wellbeing. A case study design was employed using a longitudinal method of data collection. Findings - Downsizing due to diminishing resources was a parallel process probably disturbing the TQM implementation. The workload increased by 20 per cent, whereas organisational and individual variables remained stable over time. However, sick leave increased dramatically and was higher than the general level within the Swedish population. The ICU had the capacity to adapt successfully by regulating working hours to workload. It is speculated that another cause behind sickness absence exists other than the general opinion. The literature used for the discussion departs from the relation between people's understanding and acting, sensemaking, and organisational theories describing complex adaptive systems emphasizing attraction patterns. Organisational ambiguity was a main finding in an earlier study that was used for interpretation of the result in the present study. As ambiguity seems to be a major and increasing problem, it has consequences for management as well as for continuous quality development. Originality/value - The implication of the study is the need to be able to successfully work in an ambiguous situation and use the quality system as a device in day-to-day work.

Notes: Purpose - Hidden camera television documentaries filmed in care home settings have shown evidence of the abuse of vulnerable adults, been widely discussed in the mass media and have brought the attention of the mass population to the importance of these issues. Governmental documents have also emphasised the need to protect vulnerable adults. It is therefore known that vulnerable adults exist and require protection from abuse in any shape or form. However, this paper aims to argue that protecting vulnerable adults and the current mechanisms for encouraging such individuals to make their views known to services are not mutually compatible. The main technique vulnerable adults may use, the complaints procedure, currently may not be sufficient to enable vulnerable adults to express themselves and their anxieties adequately. Design/methodology/approach - The paper provides a case study which clearly demonstrates the nature of the problems, and then recognises and describes a number of levels which could be explored to learn more about these issues. Research limitations/implications - Potential solutions are explored by the authors, who draw conclusions about the need for further research into this area. Originality/value - This paper defines a gap between adult protection and complaints procedures, questioning both their efficacy and abilities to meet their stated aims. The paper also highlights that the nature of these may not sufficiently enable complaining vulnerable adults to express their views of services.

Notes: Purpose - Proposes to analyze known case studies of information systems failure. Design/methodology/approach - Uses the organizational failure diagnosis model. Findings - Finds that there is the need to assess the organization's "health" prior to information systems development and to raise the organization's actual capacity for systems development to the necessary levels for success. Originality/value - Previous studying of these cases has underplayed the role of technical problems as the surface manifestations of deeper-rooted organizational pathologies causing the failure. The usefulness of the organizational failure diagnosis model is shown in recognizing these deeper-rooted issues and a number of suggestions are made for the prevention of failure.

Notes: Purpose - The purpose of this paper is to review the changes made to civil protection in the UK, both legislative and capacity building, that aim to make the UK more resilient. Design/methodology/approach - Reviews the background to changes in UK civil protection and compares these with the work being done by the broader disaster management community on the meaning and development of resilience to a range of threats. Findings - Finds that the UK approach has been deflected by the terrorist attack of 11 September 2001 and is clearly focused on organisational resilience. This top-down approach does not augur well in terms of promoting a more resilient society. The paper also questions if it is time to take a broader view of what constitutes an emergency. Originality/value - The recent changes in UK civil protection are in many ways welcome. But the promotion of more resilient communities requires a bottom-up as opposed to a top-down approach. Government funding is aimed mainly at institutional resilience. This raises the question of how to promote a broader agenda of more resilient societies able to respond to a broad range of threats.

Notes: Purpose - It is observed that the slow onslaught disasters do not normally catch media attention as these often do not result in human casualties. Inadequate media attention results in insufficient rehabilitation support for the victims. The paper aims at highlighting the problem of ground subsidence in the Himalayan terrain together with the hardships of the victims. Design/methodology/approach - The paper is based on the detailed field investigations carried out by the author in the remote Himalayan habitations of Garbyang in Dharchula block of Pithoragarh, Talla Dhumar and Umli-Bhandarigaon in Munsyari block of Pithoragarh and Bagi in Uttarkashi district in the state of Uttaranchal in India. All these habitations are being affected by ground subsidence and the inhabitants of these villages are facing severe resource crisis. Findings - Garbyang village in Central Himalaya is observed to be situated over the varve deposits laid down in the proglacial lake abutting against Chialekh ridge and is witnessing the problem of ground subsidence resulting in the destruction of the once thriving and prosperous habitation. The studies relate the subsidence at Garbyang with the seismicity in the region as also the subsequent toe erosion and downslope mass movement. The other sites discussed in the paper are witnessing the problem of ground subsidence due to the active toe erosion by rivers and streams. Research limitations/implications - There exist no records of the exact date of initiation of the ground subsidence in the investigated areas and these are grossly based on the information provided by the village elders. Originality/value - The article would help in making the disaster managers responsive to the problems the masses are facing due to ground subsidence in this fragile zone and this would result in mustering resources for reducing the hardships of the masses.

Notes: Purpose - To highlight the failure of the tsunami early warning system and the challenges of successfully responding to, and managing a transnational catastrophe of this nature. The paper also highlights unique challenges in the management of this catastrophe and suggests potential strategies for good disaster response and management in this response and beyond. Design/methodology/approach - Primary data collection was by telephone interviews with experts in the South and South-East Asian region, supplemented by a comprehensive literature review of scholarly journals, reports from relief agencies and United Nations situation reports and bulletins amongst others. The scope of the paper is limited to the issue of a warning not been passed onto appropriate authorities in the region, the unique challenges of the relief response and the rehabilitation and reconstruction of the affected communities. Findings - From the study, there is a need for further investigation into the catastrophic warning failure; as reasons proffered by the early warning officials for their inability to pass on a warning to authorities in the affected area appear weak at this stage. The study also found unique geographical, political, economic and social challenges facing the international relief and reconstruction effort. Specifically some of the challenges include the management of the media and information, logistics and coordination, needs and damage assessment, donations and safety and security issues amongst others. In summary, the author found that there is also a need for foreign assistance agencies to be seen to be fair, to build trust and ownership of relief and reconstruction efforts amongst the local populace, as well as use local people as much as possible. Research limitations/implications - The study was conducted only 21 days (three weeks) after the tsunami catastrophe of 26 December 2004, hence it is a snapshot of events in the days immediately after the catastrophe. The relief action is an on-going event and there may be changes as new information emerges from the field. Practical implications - A world wide network of integrated submarine earthquake and tsunami monitoring and early warning system should be set up. Critical warning information in any potential disaster should be shared as inclusively as possible. Relief workers must be seen to be politically and religiously neutral, especially in the civil conflicts of Banda Aceh Indonesia. Finally relief and aid should be given on the basis of sound humanitarian principles such as need, not just on wider economic criteria. Originality/value - The study highlights specific potential challenges which relief organisations must deal with in responding effectively to the disaster, and in assisting to reconstruct the region. The paper proffers specific strategies for effective management of the international assistance effort. Finally, the study adds to the literature on developing countries and is valuable for governments, emergency and relief workers, policy makers in both developed and developing countries.

Notes: Purpose - This paper aims to initiate a conversation within the disaster community about the applicability of "critical reflection" to the professional work of firefighters. "Critical reflection" is a term commonly used within the nursing and teaching professions. Although it has contested meanings, it generally conveys the sense of purposeful enquiry about one's professional conduct, ethics and decision making. Fire fighting labor is no longer blue collar, and firefighters in western fire fighting agencies require increasingly complex capabilities and accountabilities. Could "critical reflection" be added to post-incident debrief as a core professional capability? Design/methodology/approach - The paper draws on the concept of "critical reflection" as it has been developed within the professional fields of nursing and teaching. It then considers the applicability of and importance of this concept to the professional field of firefighting. Findings - The meanings and applications of "critical reflection" vary, but the inclusion of dialogue about it exists within many nurse and teacher education courses. It can be argued to provide professionals with an opportunity to engage in dialogue about their labor, and thereby scrutinise their professional conduct and the ethical dilemmas of their work. Practical implications - This paper calls for a paradigmatic shift in the approach taken by educators who work with firefighters. It argues that instructional methods based on rote learning, chalk and talk, and show and tell training are insufficient as a means of developing firefighters capable of responding and adapting to the complex demands implicit within increasingly professionalized firefighting labor. Future firefighters will need to be adaptive, reflective and accountable; able to demonstrate discursive and inquisitive capabilities; and engage in reflected actions both on and off the incident ground. Originality/value - High originality. This is the first time the intellectual traditions and debates implicit within "critical reflection" have been linked to the work of firefighters.

Notes: Purpose - Given the widespread lack of homogeneity, consistency and quality control in emergency planning, this paper sets out to offer some suggestions, guidelines and models for the processes of drawing up, testing, revising and utilising an emergency plan. Design/methodology/approach - The paper considers some definitions of the term "standard" and discussing the utility of the concept with respect to emergency planning. The subsequent analysis is based on the application of logical and observational criteria to the process of systematically building a framework on which to base a planning standard. Findings - The paper enumerates 18 principles that can be used to judge the quality of emergency plans. The principles are treated as basic criteria to be used when formulating a standard. Next, the paper reviews existing standards in civil protection, risk management, emergency preparedness and humanitarian relief. After a brief discussion of the consultative process used in preparing an instrument for measuring quality, the paper presents a draft standard for an emergency plan. This is broadly focused on the local authority level and on the generic, "all-hazards" approach. Finally, the paper describes a category-based methodology for applying the standard. Research limitations/implications - Standards may be viewed as unnecessarily restrictive and overly prescriptive. However, they can instead be regarded as a useful means of helping to guarantee the quality, content and relevance of plans. Practical implications - The application of a standard to the emergency planning process will help to make plans more functional and relevant and will ensure that their content is adequate for the task of predisposing resources during emergencies. It will also guarantee compatibility between plans made for different purposes or jurisdictions. Originality/value - As few model standards exist in emergency management and planning, this paper offers one of the first attempts to provide a set of generic, comprehensive guidelines for the process of creating, testing, using and revising plans.

Notes: Purpose - To develop a decision model supporting employee involvement in industrial vulnerability reduction. Design/methodology/approach - A synthesis review of some of the relevant extant literature on technological/industrial vulnerability, and their application within a normative decision-making model (i.e. the "Vroom-Yetton model"). Findings - The insights on vulnerability drawn from the literature are highly amenable to a systematic decision-making model for employee involvement. Various aspects of vulnerability, specifically with regard to substantial, social and temporal dimensions may be included in such a model. Research limitations/implications - New insights about the context-dependent aspects of vulnerability are offered by considering these within a contingency decision model. This suggests that vulnerability categories are not absolute, but have to be assessed in relation to a specific decision-making framework. Practical implications - The developed model provides a way of weighting various dimensions of vulnerability and making more appropriate decisions regarding leadership style in a range of circumstances. Originality/value - While decision models exist for assessing risk in organizations, no contingency model for employee involvement in vulnerability assessment has been presented to date.

Notes: Purpose - Over the past 50 years India has been experiencing rapid population growth, causing the migration of a large part of the population to the cities looking for livelihood. This resulted in massive increments of population in the cities that has led to the increase of pollution. Gujarat, being a highly industrialized state, is a case in point. The systems for treatment and water disposal of this state are highly challenged. The north-western state of Gujarat has no effective systems for treatment or disposal of waste water. The purpose of this article is to address this problem, introducing a geographic information system (GIS) approach to record the characterization, analyze the needs and generate a conceptual GIS database in the state. Design/methodology/approach - This paper outlines the background, suggested methodology for the development of a GIS database pollution dependent control of water pollution in the state of Gujarat in India. The present research is to install a document management system that has been developed in providing organizing chart, sorting, querying and retrieving of key data. A computerized laboratory information system on monitoring of quality of ambient air has been developed. Findings - An integrated GIS database has been generated involving creation of pollutant contours, querying and visualizing the query output in spatial and non-spatial form. Originality/value - The authors have created a complete geo-spatial database for the environmental monitoring for the whole state of Gujarat. They have dealt with nearly 36,000 different files from different sources and put them together to create the database. A computerized laboratory information system on monitoring of quality of ambient air has been developed. Front-end application programs have been developed in Visual Basic and the back-end database to integrate the laboratory data and the existing data in oracle database.

Notes: Purpose - Many villages in the vicinity of the hill township of Mussorie in the Indian Himalayas are witnessing signs of an impending disaster. These villages are witnessing active wastage that might take an heavy toll of human interest during the monsoon season and therefore the paper proposes examining this subject. Design/methodology/approach - A detailed study was undertaken in the area of Mussorie. Findings - It is suggested that a series of prevention and mitigation measures (both structural and non-structural) with the involvement of the local community are required for ruling out the possibility of any mishap in the area. Originality/value - This paper highlights the importance of having a disaster management strategies for the region and involving the community with these.

Notes: Purpose - The purpose of this paper is to present a new approach in viewing the control of safety at crude oil exploration platforms. Design/methodology/approach - The approach utilized in this work is the fusion of artificial neural network and fuzzy logic. The approach is adopted in view of the better presentation of solutions to the safety control problem that neuro-fuzzy exhibits. It is better than the individual application of either artificial neural network or fuzz logic to the problem at hand. The model captures uncertainties and imprecision that are prevalent in the quantification or data gathering stage of safety control measurement. Findings - It was demonstrated that the application of neuro-fuzzy is feasible. The results seem applicable to similar settings with similar system characteristics. Practical implications - Since more confidence is obtained with the use of this more effective tool, there is improvement in decision making based on reliance on the model. Thus, the improved quality of decision made would positively affect lives of workers at the oil platforms or the materials or equipment used for exploration purposes. Originality/value - The work is original in that it is the first time the neuro-fuzzy methodology would be applied to offshore oil platform safety control.

Notes: Purpose - To follow the modern movement of using "positive feedback" to explain companies' behaviour with special focus on historical accidents. Design/methodology/approach - To contribute to the emergence of new complexity theory as applied to management and prove that historical accidents matter, combining and bringing together literature sources. Findings - The concept of unique equilibrium has been seriously disputed - the selection process is shown, as is the path dependent process using probability theory. Practical implications - A location theory as case study is outlined - great for those fond of unique equilibrium. Originality/value - To show another theory, which is dynamic, non-linear, and complex as reality; to apply it to management underlying at the same time the role of historical accidents (random process).

Notes: Purpose - The purpose of this paper is to consider the analysis of the September 11, 2001 terrorist attacks provided by the US National Commission on Terrorist Attacks upon the USA from the points of view of behavior analysis and systems analysis. The 9/11 Commission provides a detailed and provocative account of the structural flaws in the US security systems that enabled the 9/11 terrorists to completely subvert efforts to detect and prevent their attack. This paper considers the role of private-sector organizations in prevention of future attacks. Design/methodology/approach - This conceptual/theoretical paper explores how understanding verbal networks and the nature of verbal rules might contribute to understanding the issues involved in re-engineering work cultures in the face of continued terrorist threats. Findings - An understanding of verbal networks and ambiguous communications aids the re-design of management systems and emergency response processes so that adaptive organizational responses to terrorist threats are enabled. Originality/value - Private-sector leaders might conduct behavioral systems analyses and probe the limitations of their operations and seek to detect weak points and create contingencies that sustain more effective security and emergency response repertoires.

Notes: Purpose - The primary aim of this research is to investigate the application of open source geographic information system software, geographical resources analysis support system (GRASS) for landslide hazard assessment. Design/methodology/approach - Five parameters affecting landslide occurrence derived from topographical, geological and land use maps of Cameron highland were used for the assessment. Findings - The results showed that about 93 percent of the study area falls under zone II that is of low hazard, with less than 7 percent on zone III with moderate hazard and only less than 1 percent falls under zone IV, which is of high hazard. Research limitations/implications - The accuracy of the landslide hazard map needs to be assessed by cross-correlation with landslide occurrence in the field. Practical implications - The map produced showed the potential application of GRASS as a tool for producing landslide hazard assessment map. Originality/value - The major outcome of this research is the possible use of open source GIS software in the application of landslide hazard assessment. The capability of GRASS in performing such environmental assessment will certainly attract many researchers and organizations with limited budgets, especially in developing countries such as Malaysia.

Notes: Purpose - Maintaining a high level of situation awareness (SA) is considered one of the most essential elements for safe and effective flight operations. In a study of accidents among major air carriers, 88 per cent of those involving human error could be attributed to problems with SA. In complex domains such as aviation, SA is inherently distributed over multiple people and groups and over human and machine agents. The purpose of this paper is to present an alternative perspective to the hegemony of the cognitive approach to SA that focuses on the systemic nature of SA. Design/methodology/approach - An alternative approach to the hegemony of the cognitive perspective of SA has been presented, that focuses on a systemic or holistic conceptualisation of SA through the application of Somerville's actor network theory (ANT). By advocating a seamless web composed of actors, the actor network approach dissolves the dichotomous relationship between humans and machines and society and technology into a non-anthropocentric framework. This paper further develops this systemic perspective of SA through an analysis of the tragic 2002 mid-air collision over Überlingen, Germany case study. Findings - The application of ANT to this case study brings to light some insights with wide ranging consequences for how we think of SA and accident aetiology. Practical implications - The systemic perspective of SA has far-reaching design implications with regard to complex socio-technical systems. Originality/value - This paper facilitates the perspective that looks at the inter-connectedness of the heterogeneous elements characterized by the technological and non-technological (human, social, organizational, political) elements of complex socio-technical systems.

Notes: Purpose - Aims to report the key results and learnings of a pilot test of an ISO-based integrated management systems approach to security, environmental, health, and safely (SEH&S) at one industry site in the USA. Design/methodology/approach - First, the rationale for and brief overview of a five-step integrated SEH&S management systems approach is presented. Second, a descriptive reporting of the process, results, and implications of the initial steps of the integrated SEH&S approach at a water and sanitation district in the USA is provided. Findings - Provides a description of the process of how an integrated SEH&S approach is implemented and reports results such as the following. First, the major vulnerabilities and risks associated with the water district's major infrastructure assets are assessed. Second, the various risks are evaluated, prioritized, and ranked in terms of their security and environmental, health and safety (EH&S) aspects. Third, recommendations are offered to mitigate major vulnerabilities. Finally, an overall assessment of the applicability of the integrated SEH&S approach to security and risk management is presented. Research limitations/implications - The study was conducted in one organization and involved only the first portion of the proposed integrated SEH&S management system approach. Originality/value - This manuscript should inform executives and managers of the SEH&S functions concerning how their organizations can use the newly proposed integrated approach to address both security and overall organizational risks in a more comprehensive and cost-effective manner.

Notes: Purpose - This paper aims to deal with disaster and recovery systems, introducing the catastrophe matrix as a disaster-preventing tool. Design/methodology/approach - A new model is proposed which is proved to be a classical assignment problem. It is solved based on well-known optimization methods. Research is presented for the danger risk of the system and a fully automated recovery system with a minimum cost is presented. Findings - Research accepts the fact that a catastrophe has already been activated on the system. Research limitations/implications - The difficulty of solving the proposed model of the threat and countermeasures still remains. Originality/value - The proposed models show a new original way to confront dangers and overcome the existing classical models based on risk management.

Notes: Purpose - This paper seeks to review the geophysical threats generated by volcanic activity and reports on the technological and social management techniques available to counter those threats. Design/methodology/approach - The information presented was derived from a review of case studies of response to volcanic eruptions in the USA, Europe and Japan. The studies reviewed included both technical papers from geologists and volcanologists and research by social scientists. Findings - The unique relationship between human settlements and volcanoes was described. This was done in the context of special features of volcanic hazards that set them apart from other natural hazards: time frame, multiple impacts, magnitude of destructive potential and predictability. Based on pairing geophysical threats with human safety concerns, three critical social management techniques were described: public education, access controls and evacuation systems. The social science and geophysical principles that underlie the effectiveness of these techniques are described. Practical implications - The review brings together the results of numerous case studies over the years and highlights the hazard management issues that were common across them. Then, with respect to each of the techniques identified, a critique of issues associated with implementation was conducted that draws upon both the geophysical literature and social science literature. In particular, patterns of citizen resistance to public education, access controls and evacuation are described and approaches to implementation that minimize such resistance are suggested. Originality/value - There are many discussions in the geophysics literature of the types and nature of volcanic eruptive behavior. In the social science literature there are discussions of public education strategies for hazards, controlling access to dangerous locations and evacuation systems. This paper pairs geophysical threats with appropriate techniques for protecting populations, specifically within the unique context of volcanic eruptions. There is also discussion of common problems that have arisen when the different techniques have been used in the past and suggestions for ways to avoid those problems. The paper is aimed at professional emergency managers and planners who are faced with managing dangers to populations from volcanicity.

Notes: Purpose - Survival strategy of the masses has led to the evolution of area-specific, locally pertinent and effective ways of mitigating natural disasters. This vital knowledge base is, however, often ignored and is being fast eroded. The paper aims at highlighting the relevance of these practices that put forth most cost-effective and acceptable means of mitigating disasters. Design/methodology/approach - The paper is based on the extensive field studies and in-depth probe of the traditional resource management practices of the people of the remote Himalayan terrain by the author and it reflects his belief in the acumen of the masses. Findings - The paper discusses the relevance of the various disaster management practices of the region. During the course of their habitation in the disaster-prone Himalayan terrain the indigenous people through experience, experimentation and accumulated knowledge devised ways of reducing their vulnerability to natural hazards. Studies show that their understanding was fairly evolved in the areas of earthquake, landslide and drought management and had devised efficient ways of mitigating the effects of these. Research limitations/implications - The paper reflects the author's individual understanding and interpretation of the practices based on his interactions with the masses. Practical implications - Improvisation on the traditional practices of disaster management has a major role to play in putting forth cost-effective and sustainable means of shielding the community against the impact of natural disasters. This article puts forth an alternative approach of interpreting the traditional practices of the masses and would lead to appropriate innovations for better disaster management in the region. Originality/value - This paper represents a useful attempt to reinforce the importance of local knowledge in mitigating natural disasters, which is often ignored and is quick to erode.

Notes: Purpose - Aims to bring attention to the problems faced by rural Bangladeshis. Several objectives for the paper were identified. First, to illustrate that Bangladeshis suffer from acute levels of poverty, a lack of clean drinking water and regular flooding and cyclonic conditions. Second, to establish the failure of western "handout" aid provision to address these problems. Third, to evidence the possibilities for the production of more durable building materials utilising regionally available waste materials and proven solar technologies. Finally, to present strategies in which solar technologies could contribute to the reduction of poverty and improvements in health standards. Design/methodology/approach - The ongoing development and testing of the innovative solar technology concepts reported in the paper were informed by a literature review covering solar cookers and solar kilns. The methodology and detail of the testing of that solar technology is currently considered commercially sensitive. With regard to the poverty alleviation strategies proposed within the paper, their development was underpinned by a methodology combining a thorough review of the relevant literature with input from practitioners in Bangladesh. Findings - Utilising aid moneys for the establishment of solar technology-based small-scale production of vernacular building materials could address poverty by affording access to wealth-generating activities in the sale of goods and clean drinking water from rainwater harvesting. Additionally, such activities would enable Bangladeshi society to be better able to withstand and then recover from natural disasters, by possessing more resistant shelters, and being more economically resilient. Research limitations/implications - The experimental component of the research is ongoing and considered commercially sensitive. No limitations have thus far been identified within this component. The implications of the research regarding solar technologies are potentially considerable in that the innovative approach under examination, if underpinned by positive results, represents a new area of activity and has both social and technical implications. Practical implications - Current aid is not significantly alleviating the problems experienced by Bangladeshis resulting from poverty, arsenic contamination of deep water aquifers and regular flooding. The technology and strategies proposed address the fact that the current vernacular shelters provide little resistance to flooding, and are unsuitable for rainwater harvesting, whilst also allowing participation in wealth-generating activities. Such a combination has the potential to reverse the trend for Bangladesh to increasingly rely on "hand-out" aid. Originality/value - The value of the paper is largely in the area of bringing new possibilities to the attention of the research and practitioner communities dealing with both solar technologies and developing world poverty alleviation.

Notes: Purpose - The paper aims to discuss the causes of the landslide event at Amparav in Kumaun Himalaya (Nainital district of Uttaranchal in India) and attempts to bring forth the importance of mass awareness regarding the past disaster events in their surroundings. Design/methodology/approach - On the aftermath of the landslide tragedy of 23 September, 2004 field investigations were carried out to probe the causes and lapses that resulted in tragedy at a place where a detailed mitigation plan had been implemented. Findings - The investigations reveal that a detailed landslide management strategy was prepared and implemented to protect this zone almost a century ago, with a thorough understanding of the mass wastage processes. Implementation of this plan safeguarded this zone for a long time, but the lack of awareness among the masses led to the violation of the very spirit of this plan. This culminated in the Amparav tragedy that took three human lives, besides the loss of a huge public and private infrastructure. Research limitations/implications - The old study that led to the landslide management strategy could not be assessed and the article is based on information provided by the village elders. Practical implications - The paper is an attempt to bring forth the finer details of the landslide management plan enacted in the region almost a century ago. It suggests the need for detailed surveys and planning in enacting any disaster management plan. Originality/value - This paper would bring forth the importance of documenting the disaster management strategies of the region and sharing the significance of these with the masses so that they are deterred from even unintentionally violating the spirit of these plans.

Notes: Purpose - The purpose of this paper is to make explicit why security needs to be viewed as a core activity and why senior management need to view security from a holistic perspective. Reference is made to various activities carried out by computer hackers and the costs associated with computer related crime. Design/methodology/approach - A literature review was undertaken and a conceptual security model was produced. The key elements of the activities associated with security were highlighted and the links between the activities were made clear. Findings - Organized criminal syndicates and international terrorist groups are increasing their level of activity. Senior managers within companies need to put in place an intelligence and security strategy to counter the activities of criminals and terrorists. Furthermore, senior managers will in the future have to work more closely with law enforcement representatives and industry representatives. They will also have to develop an appreciation of the strategic intelligence objectives of various governments. There is also evidence that senior management need to pay greater attention to identifying future threats associated with advances in internet technology. Research limitations/implications - More attention will need to be given to how facilitating technology such as the internet is providing computer hackers and criminals with ways to either disrupt business activities or extend the range of criminal activities that they are engaged in. Practical implications - Senior management will need to refocus on the capability of staff vis-à-vis corporate intelligence and security work. The learning organization concept can be embraced and can be used to assist staff to identify the advantages associated with effective knowledge management. Scenario analysis and simulation exercises can be used to train staff in emergency work, and disaster management and prevention. Originality/value - A diverse range of topics is covered and integrated into a security-oriented context. Attention is focused on the link between organized criminal syndicates and international terrorist groups, and why senior managers in companies need to be engaged in disaster management recovery planning. The material highlights why senior managers in companies need to develop business contingency plans and embrace the counterintelligence concept.

Notes: Purpose - To analyze recent and future terrorism in the world from the viewpoint of the USA. Design/methodology/approach - Actions companies can take to help prevent and manage the negative effects of terrorist attacks are also discussed. A review of the literature from journals, the popular press and government sources was stressed to provide an official and public view of terrorism. Findings - It was found that "terrorism" is pervasive around the world although maybe more concentrated in the Middle East at present. It is seen as annually increasing in number and severity of events. There were minor terrorist events in the USA in the 1990s, but the terrorist attacks of September 11, 2001 in New York forever changed the view of terrorism by US citizens. The USA subsequently changed its administrative structure, economic infrastructure, beliefs, behaviors, and relations to others in the world. The USA is seen as the main terrorist target in the world and Al-Qaeda, one of 40 foreign terrorist organizations, is seen as the main group attacking it. Iran, North Korea, Cuba, Sudan, Cuba, Libya, and Syria are seen as the main countries supporting terrorism. The main terrorist weapons are explosives, guns, biological, chemical, radiological, psychological, and to a lesser extent, nuclear. Research limitations/implications - Although future events and subsequent research must bear it out, it appears that cyber terrorism and radioactive explosives may be used more in the future. Executives can improve their odds of withstanding terrorist attacks by understanding past and present aspects of terrorism. Future dealings with terrorists are seen as problematic, but there are actions companies can take, such as adding working crisis management plans, to help prevent and manage the negative effects of terrorist attacks. Originality/value - This paper is an attempt to present and understand "terrorism" from a US perspective so that others in the world can better understand US motivations, actions, and rationale.

Notes: Purpose - This article aims to highlight the importance of a complete and accurate medical record as it pertains to potential risk exposure in the outpatient physical therapy profession. Design/methodology/approach - Basic charting rules, correction and alteration recommendations, documentation of telephone conversations, informed consent, exculpatory release forms and incident reports are discussed. Basic risk management strategies are reviewed that may reduce outpatient physical therapy practitioners' malpractice exposure. Findings - The authors contend that quality and thorough documentation is as important as the quality of the care that is delivered to patients, since medical records are legal documents and serve as valuable evidence as to what transpired between patients and the healthcare providers. Originality/value - Practical documentation strategies are described in a manner that will inform physical therapists of their legal obligations relating to patient care.

Notes: Purpose - The main aim of the study is to provide an empirical analysis of quality management practice among Malaysian Ministry of Health hospital employees, ranging from medical specialists to health attendants. Design/methodology/approach - Self-administered questionnaires collected data and cluster sampling used to select hospitals, while stratified random sampling selected employee respondents. The research was limited to peninsular Malaysian public health care. Findings - A total of 23 public hospitals participated in the survey, including the National Referral Centre, which is based in Hospital Kuala Lumpur. Eight quality management practices were identified in Malaysian public hospitals: continuous improvement, strategic planning, quality assurance, teamwork, leadership and management commitment, employee involvement and training, management by fact, and supplier partnership. Support for quality management was found to be lowest among the physicians. Originality/value - The article fills a lacuna in the health care quality management empirical research literature. The main recommendation is for the Malaysian Ministry of Health to garner physicians' support in its quality endeavours.

Notes: Purpose - To strengthen the middle manager role in a hospital quality improvement (QI) program, with a view to increasing and sustaining organisational QI implementation. Design/methodology/approach - Case study based action research project, combining pre- and post-action quantitative and qualitative data collection, relating to a QI program intervention in an Australian metropolitan specialist teaching hospital. A model for enhancing the middle manager role in QI was developed and then implemented as the action over a 12-month period. Findings - Middle manager understanding and ownership of the QI program and organisational QI implementation significantly increased, although their perceived enjoyment of being involved in QI decreased. Research limitations/implications - This case-study based action research project was limited to one organisation of a specific type - a large specialist metropolitan teaching hospital. The composition of the middle manager group, therefore, is necessarily limited to particular specialties. It is acknowledged that findings from case study and action research methodologies are limited in their generalisability, but assist in the development of knowledge and principles that can be adapted to different settings. Practical implications - This QI implementation model can increase levels of organisational QI implementation by effecting a positive change in middle manager attitude to and involvement in QI. Originality/value - There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.

Notes: Purpose - This article aims to explore the relationship between technology and quality management for enhancing Thai hospital service quality. Design/methodology/approach - The paper presents the findings of an exploratory study that investigates service quality from the customer and service provider perception. In-depth interviews were conducted with respondents in Thai hospitals. The interviews explored service-related factors that patients and service providers perceive to be important for hospital services. The first interview group consisted of professionals as internal customers in direct contact with external customers, while the second group consisted of external customers of the same hospitals. Findings - The study's outcomes clearly suggest factors that make significant contribution to service quality. These factors can be categorized according to five SERVQUAL dimensions (reliability, responsiveness, assurance, empathy, and tangibility), although some factors required slightly different interpretation. Originality/value - The findings suggest that hospitals can develop an appropriate approach to their advantage, which can yield sustainable improvement in service quality as perceived by patients and professionals. Hospitals can make better quality decisions based on structured measurement and knowledge. It is recommended that managers apply this knowledge for successful implementation of activities related to service quality in their organizations.

Notes: Purpose - In the USA, health maintenance organizations (HMOs) have pledged to control health care costs. Many patients have complained about the quality of care under the HMO regime and limits imposed on them, particularly access to care. Has quality of care been degraded under the HMO regime, resulting in an impact on patient satisfaction? There have been many studies that have compared the satisfaction of HMO patients with that of patients in the traditional fee-for-service payment system. The aim of this paper is to review HMO patient satisfaction. Design/methodology/approach - A review of patient satisfaction under managed care arrangements with a focus on HMOs. The article describes the US history of managed care and its effect on the satisfaction of several patient categories including the general population, vulnerable patients and the elderly. Findings - There is much information available on patient satisfaction with their insurers and most surveys indicate the lack of choice of a provider - a major source of discontent. Therefore, patient protection laws are necessary to avoid abuse. Originality/value - Patients have little ability or are not willing to rely on the information available when selecting a provider. The paper discusses patient awareness regarding satisfaction surveys and how the latter can be used when patients are seeking care.

Notes: Purpose - To provide insights into the current supply chain for original equipment manufacturers (OEM) in the radiology diagnostic imaging equipment business. As is common in many manufacturing and service firms, the rationale of bridging suppliers of OEMs is the ability to leverage technology, software, and accessories pertaining to the various pieces of equipment. Design/methodology/approach - Several models of e-procurement and e-commerce related to the health care industry are presented. Findings - Although the radiology capital equipment market presents numerous idiosyncrasies that must be addressed to successfully implement an e-business strategy effectively, incredible opportunities exist all along the supply chain for e-business strategies to both eliminate costs and acquire strategic initiatives. Those firms that most successfully listen to their customers and address the barriers to efficiency (B2E) will help move the industry toward more effective utilization of the benefits e-business can create and also obtain first mover advantages. Originality/value - Although the efficiencies that e-business provides are extremely important in the radiology capital equipment market, the main value of e-business in this industry of high-priced and relatively infrequently purchased equipment may well be the value-added benefits the technology brings to its customers, as illustrated in the modeling process. The OEMs that eventually market their finished product directly to hospital and imaging centers via a direct sales force can best take advantage of the connectivity and accessibility of e-commerce.

Notes: Purpose - The purpose of this article is to present a case study that documents how management science techniques (in particular data envelopment analysis) can be applied to performance improvement initiatives in an inpatient physical therapy setting. Design/methodology/approach - The data used in this study consist of patients referred for inpatient physical therapy following total knee replacement surgery (at a medium-sized medical facility in the Midwestern USA) during the fiscal year 2002. Data envelopment analysis (DEA) was applied to determine the efficiency of treatment, as well as to identify benchmarks for potential patient improvement. Statistical trends in the benchmarking and efficiency results were subsequently analyzed using non-parametric and parametric methods. Findings - Our analysis indicated that the rehabilitation process was largely effective in terms of providing consistent, quality care, as more than half of the patients in our study achieved the maximum amount of rehabilitation possible given available inputs. Among patients that did not achieve maximum results, most could obtain increases in the degree of flexion gain and reductions in the degree of knee extension. Research limitations/implications - The study is retrospective in nature, and is not based on clinical trial or experimental data. Additionally, DEA results are inherently sensitive to sampling: adding or subtracting individuals from the sample may change the baseline against which efficiency and rehabilitation potential are measured. As such, therapists using this approach must ensure that the sample is representative of the general population, and must not contain significant measurement error. Third, individuals who choose total knee arthroplasty will incur a transient disability. However, this population does not generally fit the World Health Organization International Classification of Functioning, Disability and Health definition of disability if the surgical procedure is successful. Since the study focuses on the outcomes of physical therapy, range of motion measurements and circumferential measurements were chosen as opposed to the more global measures of functional independence such as mobility, transfers and stair climbing. Applying this technique to data on patients with different disabilities (or the same disability with other outcome variables, such as Functional Independence Measure scores) may give dissimilar results. Practical implications - This case study provides an example of how one can apply quantitative management science tools in a manner that is both tractable and intuitive to the practising therapist, who may not have an extensive background in quantitative performance improvement or statistics. Originality/value - DEA has not been applied to rehabilitation, especially in the case where managers have limited data available.

Notes: Purpose - This study sought to evaluate the impact and sustainability of the Leading Empowered Organisations (LEO) programme on the role of G Grade Nurse Managers, their colleagues and therefore on patient care at CHS. Design/methodology/approach - A qualitative, inductive research methodology, which employed 360-degree research evaluation, was used. A purposive sample of four G Grade Nurse Managers was included. Each G Grade and eight of each of their colleagues were interviewed. Data were analysed according to the principles of thematic analysis. Findings - There was evidence of a sustained impact of the LEO programme on G Grade Nurse Managers in relation to competence, action plans, delegation, communication strategies, problem solving, risk taking, leadership and management. The study also revealed a number of significant personal and contextual factors that affected the implementation of the LEO principles. Empowerment, or a lack of it, underpinned much of what occurred in the implementation of the LEO principles by the G Grades into practice. Originality/value - The findings indicated that both organisational and individual action is necessary to achieve leadership development. Organisations need to ensure that investment in leadership is not restricted to the LEO programme, but that it becomes a strategic priority.

Notes: Purpose - The issues surrounding the measurement and provision of service quality in a health care setting are becoming increasingly important to nursing. This research study aims to apply the SERVQUAL measurement instrument in a Scottish colposcopy clinic. Design/methodology/approach - The study involved adapting the SERVQUAL instrument to the colposcopy setting and asking a sample of patients to complete the questionnaire. Patient expectations of service were obtained on first attendance at the clinic. Patient perceptions of service received were obtained on completion of treatment. Perceptions and expectations are then compared to identify where the largest service gaps exist. Findings - Although patient satisfaction with the overall service provided was generally high, the instrument provided evidence of where specific service improvements were needed. The largest service quality gap was for the reliability of service. The research also revealed the need for improved premises. Research limitations/implications - Although the study has a limited sample size, it does appear that the SERVQUAL instrument has a useful diagnostic role to play in assessing and monitoring service quality in nursing, enabling nursing staff to identify where improvements are needed from the patients' perspective. The study has raised a number of issues which would form the basis for useful further research. Practical implications - Service quality from the patients' perspective should be routinely monitored and assessed. Originality/value - The findings should be useful to nursing staff seeking to assess, and improve, service quality.

Notes: Purpose - To describe the process of development of standards for health promotion in hospitals, including pilot study, method and results. Design/methodology/approach - A set of standards for health promotion in hospitals was developed by a task force of the International Network of Health Promoting Hospitals, following the recommendations of the ALPHA programme. The standards were pilot tested and assessed qualitatively and quantitatively in 36 hospitals in nine European countries. Subsequently, standards were reviewed by representatives from the piloting hospitals. A self-assessment tool was produced to evaluate whether hospital managers and professionals perceive the standards to be relevant and applicable and whether they are currently met. Participants provided comments from their national health system perspective and rated the standards. Findings - General comments and specific comments were provided for each standard regarding its relevance, applicability and current level of compliance. A total of 35 standards' criteria were assessed and 86 per cent (30/35) were rated 〉80 per cent relevant and applicable, while 14 per cent (5/35) were rated 〉60 per cent relevant. The degree of current fulfilment of the criteria, however, was low. Research limitations/implications - While the standards should be applicable to other regions (South America, Africa, Asia) additional testing may be required to adapt them to prevailing health care challenges. Practical implications - The pilot test revealed that the standards are applicable and were considered relevant, and showed that current compliance is low. It also showed that there is a clear need to facilitate continuous monitoring and improvement of compliance. The standards are regarded as being public domain, are applicable to other organisations and can be incorporated into existing quality systems. Originality/value - Standards are a common tool for quality assurance in health care, but so far have considered health promotion activities only partly, if at all. The standards for health promotion in hospitals developed by WHO fill this important gap.

Notes: Purpose - To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically. Design/methodology/approach - Systematic review of the literature. Findings - Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non-technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence). Originality/value - This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing-oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

Notes: Purpose - Malaysia, which is in an intermediary phase of development and industrialization, has experienced various magnitudes of disasters ranging from biological, structural collapse, fires and explosions, landslides to meteorological incidents. The first major disaster that could be linked with the development of the country was the collapse of a four-storey building in 1968. This article describes how, by applying a grounded theory approach, examination and analysis of archival data were conducted to identify the phases and latent errors of this landmark disaster. Design/methodology/approach - Grounded theory approach was utilized to develop a substantive theory of socio-technical disaster preconditions. Findings - Data indicated that the disaster had developed in phases as found by other disaster scholars. Regulatory failures were found to be one of the main causes of the disaster. The disaster appeared to be an inevitable consequence of the inability of the laws and regulations to keep in tandem with the rate of development and industrialization of the nation. Originality/value - The discussion of the implications of the disaster will be of particular value for developing nations.

Notes: Purpose - The purpose of this introduction is to review some of the major issues that arose after 9/11 and set the stage for the articles that follow. Design/methodology/approach - A literature review was undertaken using both academic and mass media sources. Findings - The events of 9/11 have produced potentially positive as well as negative consequences, some anticipated and others unforeseen. Research limitations/implications - Relatively little research has been conducted on the events following 9/11, making it difficult to arrive at solid conclusions at this time. Practical implications - This special issue links the events of 9/11 with the management of organizations, a topic that has received little attention, and hopefully will encourage more scholarship in this area. Originality/value - It is important to more fully understand why 9/11 happened and what measures need to be taken to reduce the likelihood of future terrorist attacks, as well as improve the resiliency of both citizens and their organizational employers in dealing with the aftermath of such attacks should they occur again.

Notes: Purpose - To examine the availability and quality of clinical guidelines on perioperative diabetes care in hospital units before and after a randomised clinical trial (RCT) and international accreditation. Design/methodology/approach - Interventional "before-after" study in 51 units (38 surgical and 13 anaesthetic) in nine hospitals participating in a RCT in the greater Copenhagen area; 27 of the units also underwent international accreditation. Findings - The proportion of units with guidelines increased from 24/51 (47 percent) units before to 38/51 (75 percent) units after the trial. Among the 27 units without guidelines before the trial, significantly more accredited units compared to non-accredited units had a guideline after the trial (9/10 (90 percent) compared to 5/17 (29 percent). The quality of the systematic development scale and the clinical scales improved significantly after the trial in both accredited units (both p〈0.001) and in non-accredited units (both p〈0.02). The improvement of the systematic development scale was significantly higher in accredited than in non-accredited units (p〈0.01). Originality/value - The combination of conducting both the DIPOM Trial and international accreditation led to a significant improvement of both dissemination and quality of guidelines on perioperative diabetic care.

Notes: Purpose - To describe how The Red Cross Hospital in Beverwijk, The Netherlands implemented an ISO 9000 quality management system throughout the entire organisation, obtained an ISO 9002:1994 and subsequently an ISO 9001:2000 certificate. Design/methodology/approach - First, a global implementation plan was written concerning the process obtaining in each department. Once improved, each process was subjected to a procedure, and specific protocols effected. On completion the Quality Manual was put together. Quality management was completed by implementing an internal audit system involving 50 co-workers. Findings - A number of advantages are found from using ISO. The focus on patients has been re-established. All processes are identified and subject to continuous improvement. Performance measurements were introduced and give an integrated picture of results. Measurements subsequently lead to improvement of quality of care and to quality system improvements. The documentation system serves the organization's needs without leading to bureaucracy. Positive effects on patient safety could be demonstrated compared with ten other hospitals. Originality/value - Given the need for adequate quality management tools in health care and the need for demonstrating quality, the positive effects reported in this article show how ISO is expected to become more prevalent in health-care organisations.

Notes: Purpose - To assess the quality of anticoagulation control at an out-patient clinic and to investigate patterns of deviation from therapeutic ranges. Design/methodology/approach - Records for 36,157 clinic visits (2,050 patients) were studied. The quality of anticoagulation control was assessed by comparing the measurement of pro-thrombin time recorded at each clinic visit, expressed as an international normalised ratio (INR), with the target therapeutic range for that patient, also recorded at the time of the clinic visit. Each INR measurement was classified according to the relevant patient's therapeutic range and the signed difference between the INR measurement and the centre of the therapeutic range was calculated. For each patient the percentage of their INR measurements that lay within their therapeutic range was calculated. Findings - Of the measurements, 52.3 per cent were within the relevant therapeutic range. The proportion of individual patients' INR measurements within range varied greatly (median 52 per cent, inter-quartile range 40-65 per cent). The quality of anticoagulation control, as measured by the proportion of patients within their therapeutic range, changed little with patient follow-up time. Originality/value - The quality of anticoagulation control reported is comparable with that at other centres. The vast majority of patients spend periods outside the therapeutic range for their condition. There may be considerable room for improvement.

Notes: Purpose - Aims to establish the critical score and screening accuracy of the CAGE Questionnaire in three treatment settings - primary health care, walk-in (triage) clinic and the emergency room. Design/methodology/approach - Taguchi methods are applied to three screens of the CAGE questionnaire. Findings - Analysis of the sensitivity and specificity data of three CAGE screens by leveling factor (p'), signal-to-noise ratios (S/N, SS/N) and their dependent relation resulted in critical CAGE scores of 1, 1 and 2; and high screening accuracy levels of 98.44, 97.20 and 94.92 percent, respectively. The illustrated method yielded excellent (=95 percent) screening accuracy values for primary health care, emergency room and walk-in clinic patients. Originality/value - To reduce misclassification rates of alcohol abuse, screening systems should concentrate first on developing ways to standardize protocols. Further work is needed to establish high screening accuracy in other clinical settings, and particularly in those at risk of alcohol abuse in the general population.

Notes: Purpose - To evaluate various designs for a quality assurance system to detect and control human errors in a national screening programme for diabetic retinopathy. Design/methodology/approach - A computer simulation was performed of some possible ways of sampling the referral decisions made during grading and of different criteria for initiating more intensive QA investigations. The effectiveness of QA systems was assessed by the ability to detect a grader making occasional errors in referral. Findings - Substantial QA sample sizes are needed to ensure against inappropriate failure to refer. Detection of a grader who failed to refer one in ten cases can be achieved with a probability of 0.58 using an annual sample size of 300 and 0.77 using a sample size of 500. Originality/value - An unmasked verification of a sample of non-referrals by a specialist is the most effective method of internal QA for the diabetic retinopathy screening programme. Preferential sampling of those with some degree of disease may improve the efficiency of the system.

Notes: Purpose - To assess the relationship between quality management and employee commitment. Design/methodology/approach - Analysis of the state of affairs with respect to (T)QM programs in The Netherlands based on the literature and interviews with key informants. Findings - Description of an approach that tries to integrate employee commitment and quality management based on the concept of employees' psychological contracts with their organization (ideas about mutual obligations between them and their employer). Research limitations/implications - The interviews with key informants provide limited information: the study is done in only one country. Research in a broader context and on a larger scale would give a more general overview. Practical implications - The crucial factor in making quality management work can better be described by "quality fails when employees' psychological contracts are neglected" than by "quality fails when the system fails". Originality/value - This paper highlights the essential relationship between quality management and employee commitment and offers suggestions on how to approach this issue.

Notes: Purpose - This paper aims to examine the roots of public fear and often-distorted reality of risk, and proposes methods by which emergency management agencies can successfully manage fear, should a terror-based event occur within their jurisdiction. Design/methodology/approach - The October 2002 sniper crisis in Washington, DC is used to identify the processes by which public fear is generated, maintained, and managed. Findings - In the USA's post-9/11 era of terror-awareness, extreme actions of groups like Al Qaeda are no longer necessary to spark detrimental anxiety-based social reactions. The two snipers who placed the nation's capital under siege for three weeks with one rifle and a box of bullets confirmed this fact. Washington, DC's duct tape and plastic panic buying spree, spurred by a Terrorism Threat Index increase, illustrated how the mere hint of a future event can induce irrational behavior. Practical implications - Clearly, the emergency management community can no longer simply blame the media for such strong public sentiment. Controlling public fear is a public safety responsibility but fear management must be supported by the Federal government to be effective. There exists a rapidly-growing need for agencies to adopt formal fear management capabilities staffed by appropriately-trained, dedicated officials. In many cases of terrorism, fear is the greatest emergency that must be managed, and irresponsible or inadequate attempts to do so can actually increase public risk. This paper proposes methods by which emergency management agencies can successfully manage fear, should a terror-based event occur within their jurisdiction. Originality/value - This paper will assist emergency managers, administrators at the city, county, and national levels, and others involved in planning for the management of fear during emergencies that can occur in the aftermath of terror-based events.

Notes: Purpose - In the context of the Indian subcontinent, aims to examine the suitability of using microfinance for natural disaster risk reduction at the household and community level, and also of delivering it in the wake of a natural disaster. Design/methodology/approach - Explains microfinance strategies comprising: diversifying income source; designing new loan products; risk management; sustainability of microfinance institutions post-disaster; liquidity management post-disaster, etc. Findings - States that microfinance should be recognized as one of a series of measures within a disaster risk management strategy. Along with eco-friendly farming it can help overcome poverty in developing countries. Originality/value - Probably the first real attempt to explore the importance of microfinance interventions in natural disasters both at the personal level and generally.

Notes: Purpose - This paper aims to argue that, contrary to popular thinking, technological disasters are potentially predictable, and therefore amenable to risk assessment and mitigation. What is lacking at present is a more comprehensive understanding of the hazards, embedded in complex socio-technical systems, which lead to such disasters. Design/methodology/approach - The paper discusses several factors that contribute to hazard formation and development, including the interaction of human and mechanical components, ambiguity, evolutionary changes, innovation and poor communication in organisational systems. Two case studies of recent disasters in Australia are presented to provide illustrations of the complexity in socio-technical systems and the hazards and risks that they harbour. Findings - The paper finds that to progress, we need two things: better conceptual models and frameworks that reveal complexity and make systems more transparent, and more satisfactory approaches to risk management. Originality/value - The paper concludes with some suggestions as to how the risks might be better understood and managed proactively.

Notes: Purpose - To inform readers comprehensively and sufficiently about the new (July 1, 2004) legal regime of SOLAS/ISPS code concerning security of ports and ships. Design/methodology/approach - The paper estimates the code's impact on vessels' security and on ships' ownership and control as well as on seafarers. Findings - The maritime security measures costing $626 million (and $168 million per year) had to be seen as the third pillar of the international shipping policy and to facilitate instead of obstructing free flow of international sea transport. Research limitations/implications - The very recent implementation of ISPS code made this paper prognostic in nature. Originality/value - This is the first account of the new regime and is of interest to shipowners and ports, US and EU seafarers.

Notes: Purpose - The purpose of this paper is to investigate whether the Herald of Free Enterprise disaster was due to the ship or the management, using the modern management theory of complexity. Design/methodology/approach - The 75 pages investigation of the court has been studied and codified to the main aspects and mistakes producing the accident. After the mistakes were identified, a procedure adopted in analysis B to show how these could be avoided if a different management theory has been adopted. Findings - The main finding was that management was responsible for the accident on shore mainly and on board and that a special communication mean which is called "dialogue" in complexity theory parlance had to be adopted. Practical implications - Any shipping company and ship can identify itself through the common mistakes mentioned and adopt the proposed theory to improve safety and management's effectiveness. Originality/value - The paper provides a concise analysis of the accident. A new theory is presented and linked to this case study. The study will be useful to management on shore and on board and for IMO of Flag administrations and departments of transport and others.

Notes: Purpose - The purpose of this paper is to extend the earlier application of the behavioral response model which analyzed the behavioral response to September 11, 2001, to analyzing the organizational response of the US Federal Government during the ensuing years. Design/methodology/approach - Qualitative methodology is used in which the organizational response is assessed to determine if that which has been observed parallels organizational chaos typical in natural disasters. Findings - Findings suggest the literature applicable to behavioral and organizational response to natural disasters is quite appropriate to describing the post "September 11" actions of the USA. Research limitations/implications - The argument presented suggests that the organizational response was typically chaotic and is counter-productive in defeating the long-term goals of the terrorists. While the author extends the application of the behavioral and organizational response model to the policy decisions of the US Government, some may debate his conclusion. Practical implications - Government decision makers should consider the implications of the observations shared in the paper to avoid taking the same, perhaps failed, road in the future. Originality/value - The new territory offered herein, is the application of the behavioral and organizational response model to public policy making by high government officials in the USA - analysis of organizational response issues at the highest level of government organization.

Notes: Purpose - Aims to demonstrate the importance of reporting IS management constructs rather than reporting and ranking the individual management issues; determine whether the ratings of IS management factors differ across organizational and personal variables; and benchmark the position of Kuwait's results on dimensionality and determinants of IS management issues with that of other previous studies. Design/methodology/approach - This field study considered only the opinions of the highest ranked executives of the IS functions within their organizations. A seven-page structured interview guide was used for data collection. Principal component factor analysis was performed on the issue ratings in order to determine underlying IS management factors. Confirmatory factor analysis was performed to further assess how well the factors fit the issue data and to test the fit of the resulting factor model. Finally, t-tests were performed to test whether the differences between factors were significant in order to demonstrate the discriminatory value of reporting IS management factor areas rather than individual issues. Findings - The key IS management factors identified by IS managers are the effective management of IS resources such as data, networks and applications; and managers' knowledge of IS. This study also found that most situational variables including nationality are not associated with differences in IS management factor ratings. Thus, the survey results are consistent across different types of organizations and respondents. The exception is organization size and IS department size. Size differences can lead to different opinions on the relative importance of various IS management factors. Originality/value - To demonstrate the importance of reporting IS management factors (constructs) as a benchmarking framework rather than reporting and ranking the individual management issues, and to use the derived conceptual benchmarking model to determine whether the ratings of IS management factors differ across organizational and personal variables.

Notes: Purpose - This paper attempts to propose a virtual case-based benchmarking system (VCBS) which incorporates computational intelligence technologies into partners' benchmarking process to support decision-making. Design/methodology/approach - The proposed system consists of three main modules: data repository module, OLAP module and case-based reasoning (CBR) module. The VCBS is a web-based application that enables users to access the system and submit information to the system in anywhere at anytime. The database repository, on the other hand, maintains and acquires the data that are generated in the transactions processes and other workflow processes. It also ensures the entire valuable data which are accessible for the management to make decisions. The OLAP and the CBR modules are considered as the brain of the VCBS. The CBR module is aimed for short-listing candidate, while the OLAP module is utilized for benchmarking the short-listed candidate. Findings - The VCBS is particularly useful in situations where multiple supply chain partners are involved to achieve the common objective to produce the products to the best satisfaction of customer demands with the lowest possible cost. Research limitations/implications - Since data warehouse does not update in real time it only performs update periodically during non-office hours to avoid network traffic. The solution provided to the company may not be the most updated information. Originality/value - The proposed system improves the current practice of partner selection by adopting the computational intelligence technologies into the traditional partner selection process with the assimilation of data repository, CBR and OLAP to form the integrated system for evaluation of potential partners prior to the final decision.

Notes: Purpose - To propose a conceptual framework that facilitates the benchmarking of strategic processes necessary for entrepreneurial survival and success. Design/methodology/approach - Drawing on extant literature on entrepreneurial survival, this paper considers the chaotic and emergent nature of the entrepreneurial organization and how benchmarking can contribute to a newly established firm's chances for survival and prosperity. The paper incorporates the concept of a sustainable competitive advantage in the discussion, and offers organizational culture as being the imperfectly imitable element which will contribute to the entrepreneurial firm's success. Findings - Four key processes are identified that contribute to entrepreneurial viability - cooperation, sharing founder's vision, time management, and developing organizational competencies - and suggestions are offered for developing appropriate benchmarks for these processes. The paper also highlights two instruments that may be useful in this endeavor. Research limitations/implications - The paper draws attention to the usefulness of benchmarking processes and not just metrics in fostering entrepreneurial survival. Key processes are identified, and suggestions are provided for researchers to begin work on developing the necessary benchmarks. Practical implications - The paper not only offers a theoretical discussion of the usefulness of benchmarking processes as opposed to focusing only on outcomes, but also helps the practitioner to implement such benchmarking activities by highlighting practical instruments for this purpose. Originality/value - This paper brings to bear literature from several streams of research. It takes benchmarking from its metric-oriented focus to a more process-focused approach, and applies it in the context of entrepreneurial survival.

Notes: Purpose - This paper aims to examine the use of benchmarking as a management technique in the Australian non-profit sector. Benchmarking has great potential benefit for the non-profit sector, particularly given the reliance of non-profit enterprises on effectively utilizing human capital; thus it might be expected that they would be enthusiastic about techniques such as benchmarking that can assist them in improving their performance. The non-profit sector is a large and important part of the economy in the developed world. Design/methodology/approach - To determine the use of benchmarking in the Australian non-profit sector, the following methods were used: a review of published industry surveys and case studies; interviews with 15 non-profit sector experts; and a review of more than 50 works on non-profit management. Findings - Research showed that benchmarking has been little used by non-profit organizations in Australia to date. This seems to mirror the experience of non-profits in other countries. Research limitations/implications - The paper argues that the limited use of benchmarking in the non-profit sector can be explained by: non-profit management culture; lack of industry and funder pressure; and a lack of targeted information on benchmarking for the non-profit sector. Any efforts to increase the use of benchmarking in the sector would need to ensure that these issues are overcome. Practical implications - A plan of action is suggested for promoting benchmarking to non-profit organizations. Originality/value - The paper assesses the use of a standard management technique in the emerging area of non-profit management. It should be of interest to those researching or managing in the Australian non-profit sector. The paper may also be of interest to the non-profit sector or human capital sector in other countries.

Notes: Purpose - The purpose of this research paper is to provide practitioners and researchers with guidance and ideas for benchmarking employee benefits in companies providing professional services. The research addressed employee benefits in multi-owner accounting firms. Design/methodology/approach - Data from a survey of a large number of multi-owner accounting firms (CPA firms) were analyzed to examine professional employee benefits and to look at the relationship between firm size and benefits offered. Findings - An analysis of survey results suggested that larger firms offer better benefits than smaller firms. Larger firms tend also to be more profitable. Various employee benefit metrics were examined. Research limitations/implications - The survey was limited to accounting firms in the United States, so the findings may have limited value for researchers and practitioners in other countries. Practical implications - The better benefits offered by larger accounting firms may allow them to attract better personnel, possibly accounting for their greater profitability. If this is indeed true, then a good benefit package may well be a key success factor for accounting firms, and possibly for other professional services. Firms seeking to improve their competitive position may, therefore, find it advantageous to benchmark their professional employee benefits against the benefit packages of larger more profitable competitors. Originality/value - This paper examines professional employee benefits in multi-owner accounting firms and identifies metrics that could be useful to practitioners in benchmarking those benefits. The metrics identified and other findings may provide practitioners with ideas for benchmarking benefits in other professional service organizations.

Notes: Purpose - To present the application of a business model for holistic uncertainty management for twenty-first century manufacturing enterprises. Design/methodology/approach - A questionnaire survey is carried out to UK manufacturing enterprises to collect relevant data, and analysis of variance (ANOVA), correlation analysis and cluster analysis are performed to infer the results. Findings - It can be concluded that different manufacturing environments suffer different effects of underlying causes of uncertainty on product tardy delivery. The product tardy delivery performance in make-to-order (MTO) manufacturing environment is found significantly affected by a wide range of underlying causes of uncertainty. It is interesting to find that mixed-mode (MM) manufacturing environment has an opposite outcome. Correlation results provide significant evidence that underlying causes of uncertainty do not have linear association with product tardy delivery. This finding reinforces the proposition that the effects of uncertainty are difficult to quantify due to the compound effect. The cluster analyses of the business environmental factors of the manufacturing enterprises in MM, make-to-stock (MTS) and MTO environments found that size of enterprise, product variety, product complexity, number of parts, ratio of buy vs make parts, the use of rough-cut capacity planning, and the use of buffering or dampening techniques in production, influence the effects of underlying causes of uncertainty on product tardy delivery. Research limitations/implications - Only UK manufacturing enterprises are investigated. The results will be relevant to MTO, MM and MTS manufacturing environments. Practical implications - The application of the business model has provided useful knowledge to MM, MTS and MTO manufacturing enterprises on which underlying causes of uncertainty are significantly affecting their product tardy delivery performance. Originality/value - A holistic approach such as the business model has given a solid foundation for the enterprises to evaluate their performance. Using the knowledge of significant underlying causes of uncertainty, the enterprises could then prioritise the effort and devise suitable buffering or dampening techniques.

Notes: Purpose - This paper aims to bring greater clarity to the debate on the merits (or demerits) of relative performance evaluation through a broad assessment of current UK National Health Service (NHS) benchmarking. It seeks to examine whether benchmarking is being used dynamically to disseminate best practice in healthcare, or whether it is primarily a government tool to enforce static competitive performance standards. Design/methodology/approach - Draws on recent literature and government pronouncements. It charts the development of the health care policy discourse that articulated a move from the internal market of the early 1990s to the metrics approach of New Labour. Findings - Benchmarking is one of the private sector-grown "managerialist" tools whose application and significance is rapidly increasing in the UK public sector. Despite its prevalence, the nature (competitive or comparative), the process (based on indicators or ideas) and the outcomes (standards or "best practice") of benchmarking in public services remain unclear. The findings reveal that benchmarking requirements, imposed by government policy, are articulated in terms of comparative ideas - benchmarking with the stated objective of "sharing best practice", but are operationalised and disseminated in the form of indicator league tables with standardised benchmarks for performance. Hence, there is an apparent "articulated policy - implemented practice gap". Concludes that, whilst benchmarking is a highly desirable policy instrument, its practical relevance to health care improvement is still in doubt. Originality/value - The findings are relevant to both NHS policy-makers and to NHS actors who must engage with the processes and outcomes of benchmarking practices.

Notes: Purpose - The pupose of this paper is to present an overview of the main conceptual and methodological issues that underlie our current understanding of benchmarking initiatives in the field of health. Design/methodology/approach - The paper is based on a pragmatic review of the literature and policy reports. It outlines some of the major conceptual problems associated with the use of benchmarking indicators and discusses how health policy research and practice is evolving to address the challenges raised, drawing examples from national and international benchmarking initiatives. Findings - Benchmarking has become an intrinsic part of most developed health care systems, yet the impact of benchmarking initiatives on improvements in system performance and their integration within existing policy processes still need to be elucidated. Several methodological challenges remain in the field of benchmarking, many of them related to the selection and quality of indicators used to make comparisons both within and between health care systems. Further research and applications are needed to ensure that benchmarking in health fulfils its objective, namely to further our understanding of where to focus policy efforts in order to improve the performance of health care systems. Originality/value - This paper poses the timely question of whether benchmarking initiatives are in fact guiding health policy towards the improvement of health care system performance. It draws from the policy literature and existing frameworks to offer an outline for the future evaluation of benchmarking initiatives by policy-makers.

Notes: Purpose - To review the application of the principles of benchmarking to the field of laboratory medicine. Design/methodology/approach - Review of the literature on performance management techniques employed in healthcare provision, and specifically in laboratory medicine, including benchmarking. Findings - The review identifies the main performance indicators employed in quality assurance and benchmarking programmes that have been developed in laboratory medicine. Some of these have a clear benefit in improving laboratory performance, whilst others are used for more general management purposes. The emphasis of these programmes is on improving analytical performance, together with pre- and post-analytical performance. The review highlights the fact that benchmarking in laboratory medicine is undertaken largely in isolation from the clinical setting in which it is applied. The benchmarking activities are, therefore, concerned with the process (dealing predominantly with efficiency and productivity) of producing laboratory results and do not probe into the way in which the laboratory services are employed in the care of patients (dealing with outcomes and value). Some examples of health outcomes studies are discussed, which demonstrate the value of the laboratory medicine service. They highlight the complexity of developing a more outcomes orientated approach to benchmarking of laboratory medicine services. These studies would show how the laboratory was used; they give a more holistic view of the role of laboratory medicine in healthcare provision. Originality/value - The review shows how a more comprehensive and integrated approach to benchmarking of laboratory medicine service would provide valuable information on the effectiveness of the laboratory services.

Notes: Purpose - This article aims to explore the value of deconstruction in the analysis of a health policy document. Design/methodology/approach - Following a brief overview of the philosophy and concepts of deconstruction, the historical and political context of the document Copying Letters to Patients: Good Practice Guidelines is clarified. Deconstructive techniques are employed to systematically analyse the document, pursuing concepts such as the identification and exploration of marginalisation within the text; analysis of figures of self-reference; the revelation of asymmetrical oppositions within the text; identification of tensions and instabilities within the text; and analysis of ways in which the text suggests a difference in emphasis from the apparent primary intention. Findings - Through utilisation of the key concepts of deconstruction, it is revealed how the policy document in question becomes freed from a passive acceptance of the words as fact, and its authority is brought into question. The masquerade of coherence and continuity within the article is dismantled and its inconsistencies and contradictions are exposed. The authors' stated attempts to prioritise the wishes and wellbeing of patients over the medical hierarchy are revealed as being subject to question and the influence of politics over health policy highlighted. Originality/value - This article reveals how, by using deconstruction as a focus, the linguistic means by which a text exercises its power can be interrogated and the ideological assumptions underpinning its production revealed. As such a new and informative perspective is added.

Notes: Purpose - This paper aims to investigate whether an organisation's configuration, with regard to its operating environment, could have a bearing on the learning that occurs within the organisation because the configuration can be considered an artefact capable of enabling learning and capable of facilitating the storage and utilisation of the results of learning. This raises an interesting question about the ability of organisations to shape the configuration that enables and facilitates them, which in turn would shape the learning itself. Design/methodology/approach - Reported in this paper is research in healthcare organisations in Brazil and Australia that use a multidisciplinary model of care delivery which test these relationships. Findings - The paper's findings indicate that in the Brazilian case learning has to do with the formal acquisition of knowledge for use within professions, by professionals who are in practice and teaching. In the Australian case learning has to do with the flexible acquisition of knowledge across professions, within and between teams. Originality/approach - This paper is useful to those wishing to facilitate learning in an organisation.

Notes: Purpose - The primary purpose of this paper is to critically explore managers' experience of work identity in the National Health Service (NHS). Design/methodology/approach - This paper is unconventional in that it uses an auto-ethnographic approach and poetry as the empirical data from which the conceptual framework evolves. The concepts of identity, power and self are analysed in relation to the narrative utilising a post-structuralist, critical management lens, particularly drawing from Foucault. Findings - The paper reflects and critiques the challenges of undertaking auto-ethnography, not least the publication and exposure of a "vulnerable aspect" of the author but also identifies this as a powerful method to explore how one uses narrative to create meaning and constitute oneself; the challenges of such textual representation and the various ways one adapts, resists and survives the challenge of the "multiphrenic" world. Originality/value - The contribution this paper makes is an "outing" of the dynamics of being a manager in the NHS and an opening of a debate on current management discourse and practice. The further value of this paper is the experimentation of critically evaluating an auto-ethnographic approach to researching management identity work.

Notes: Purpose - A recurring theme in Government policy documents has been the need to change the culture of the NHS in order to deliver a service "fit for the twenty-first century". However, very little is said about what constitutes "culture" or how this culture change is to be brought about. This paper seeks to focus on an initiative aimed ostensibly at "empowering" staff in an English Primary Care Trust as a means of changing organisational culture. Design/methodology/approach - It presents findings from an ethnographic study which suggests that this attempt at "culture change" is aimed at manipulating the behaviour and values of individual employees and may be interpreted as a process of changing employee identity. Findings - Employees reacted in different ways to the empowerment initiative, with some resisting attempts to shape their identity and others actively engaging in projects to bring their unruly self into line with the ideal self to which they were encouraged to aspire. Originality/value - The challenges presented by the need to respond to conflicting Government policies created tensions between individuals and conflicts of allegiance and identity within individual members of staff. Alternative forms of selfhood did not merely replace existing identities, but interacted with them, often uncomfortably. The irony is that, whilst Government seeks to promote culture change, the frustrations created by its top-down target-driven regime acted to mitigate the transformational and reconstitutive effects of a discourse of empowerment aimed at achieving this change.

Notes: Purpose - Mainstream health economics labours under a misleading understanding of the nature of the topic area and suffers from a concomitant poverty of thinking about theory and method. The purpose here is to explore this critical position and argue that health economics should aspire to being more than a technical discipline. It can, and should, engage with transformative discourse. Design/methodology/approach - It is argued that the hermeneutic sciences, emphasising interpretation not instrumentality or domination, offer a route into the change to which one seeks to contribute. The article specifically focuses on the way Habermas provides insights in his approach to knowledge, reason and political economy. How he emphasises complexity and interaction within cultural milieu is explored and primacy is given to preserving the life-world against the encroachments of a narrow rationalization. Findings - The argument for a critical re-imagining of health economics is presented in three stages. First, the antecedents, current assumptions and critical voices from contemporary economics and health economics are reviewed. Second, the way in which health is best understood via engaging with the complexity of both the subject itself and the society and culture within which it is embedded is explored. Third, the contribution that hermeneutics, and Habermas's critical theory, could make to a new health economics is examined. Originality/value - The paper offers a radical alternative to health economics. It explores the shortcomings of current thinking and argues an optimistic position. Progress via reason is possible if one reframes both in the direction of communication and in the appreciation of reflexivity and communality. This is a position that resonates with many who challenge prevailing paradigms, in economics and elsewhere.

Notes: Purpose - This paper seeks to explore a critique of the limitations of mainstream leadership research and publications and offers a critical management analysis through drawing on a feminist reading of leadership in organizations. Design/methodology/approach - There has recently been witnessed a growing interest in the promotion of effective leadership within both organizational studies literature and organisational policy as the route to ensuring employee commitment and enhanced organisational performance and the achievement of ever demanding goals and targets. This turn to leadership is represented in both an upsurge of research studies and a proliferation in the promotion of leadership as the organisational panacea. An analysis of the literature on leadership was undertaken, giving due consideration to mainstream and more critical accounts in relation to illustrations drawn from the UK National Health Service (NHS). Findings - This paper explores mainstream literature on leadership and finds it wanting, in terms of its failure to deliver a common understanding of the concept, in its generally uncritical accounts, and its inability to expose the androcentric nature of the core assumptions within hegemonic discourses of leadership. Drawing on critical feminist readings in relation to the UK NHS, a more critical account of leadership is presented. Practical implications - Greater awareness is required for the adoption of culturally sensitive and locally-based approaches that take account of individuals' experiences, identities and power relations and that allows for the presence of a range of masculine and feminine workplace behaviours. Originality/value - This paper provides an overview of the dominant themes within the literature on leadership as they relate to the UK NHS, and presents a feminist critique of the more subtle ways in which notions of leadership in organisations fail to consider their potential for bias.

Notes: Purpose - To introduce the articles in this special issue, discussing emotion in the in health-care organisations. Design/methodology/approach - Discusses such topics as what makes health care different, editorial perspectives, how health care has explored emotion so far, and the impact of emotion on patients and the consequences for staff. Findings - Health care provides a setting that juxtaposes emotion and rationality, the individual and the body corporate, the formal and the deeply personal, the public and the private, all of which must be understood better if changes in expectations and delivery are to remain coherent. Originality/value - The papers indicate a shared international desire to understand meaning in emotion that is now spreading across organizational process and into all professional roles within health care.

Notes: Purpose - To explore the issues surrounding the falling rates of MMR vaccination following the publication of a controversial study by Wakefield et al. Design/methodology/approach - In order to take a fresh look at the MMR crisis, the Greek tragedy, Antigone, was used as a "strong plot" to de-contextualise the underlying social and political issues. In this short paper, two themes are explored that emerge from reading Antigone with respect to the unfolding crisis of public confidence in the MMR vaccine: first, the challenge to government in the form of a decrease in public trust in government and government policies; and second, how such a challenge assumes significance and, arising from that, the question of how one might respond to the challenge. Findings - The MMR debate throws issues of importance to society into relief - for example, public trust in government and science; and notions of public good versus rational choice in public policy on vaccination, However, much of the debate has been polarised into good versus evil - good and evil being subjective positions that are interchangeable, depending on the side one favours. It is argued that the issues are more complex than this, and are as much to do with political consent and the bargain between citizen and state. Originality/value - Using "strong plots" to theorise about current issues is powerful because it allows one to explore them from different angles and challenge one's understanding. Antigone provides us with a way of standing back from the MMR crisis and re-conceptualising the issues to capture the essence of the underlying debate.

Notes: Purpose - It is commonplace to talk of the UK's National Health Service (NHS) as having its inception in 1948 in an Act of Parliament which brought together many hundreds of widely dispersed organisations into one, new organisation, "the" NHS. This paper aims to challenge the concept of "a" National Health Service and to argue that the (seeming) accomplishment of this "organisation" is the daily task of health managers. Design/methodology/approach - The paper develops a theoretically-based analysis of how an "organisation" is accomplished through ongoing processes of construction. First, critiques of the ontological status of this thing called "organisation" are considered. Then Laclau and Mouffe's discourse theory of political action, inspired by Derrida and Gramsci is used, to try to understand this apparent "thing" and the work of those charged with its management. Findings - There has been little application of this theoretical perspective to understanding management in general and health management in particular but, given the highly politicised nature of health management, their theoretical perspective seems more than apposite. Application of Laclau and Mouffe's theory to the NHS leads to the conclusion that there is no such "thing" as the NHS. There is, rather, a presumption of the thingness of the NHS and one of the major tasks of managers working "within" this organisation is to achieve this sense of thingness. Research limitations/implications - This is "work in progress" - these ideas continue to evolve, but feedback from readers is necessary. Originality/value - This is the first time that Laclau and Mouffe's work has been used to analyse health organizations. The value of the paper is mostly for people working to develop critically-informed understandings of how organizations work.

Notes: Purpose - To describe the meaning of emotion. Design/methodology/approach - Describes how emotion has recently become a popular concept for discussion, but it is not often recognised that human beings are, in essence, meaning-creating creatures and that emotion is one of the forms of meaning they create. Findings - What one experiences as "I", "me", "myself", that is, one's sense of being a person, is a meaning-structure, which has developed through one's interaction with one's environment. One's physiological make-up is such that all the meanings are guesses about what is going on. Consequently the sense of being a person is always in danger of being invalidated by events. Emotions are meanings, which relate to the validation or invalidation of one's sense of being a person. It is necessary to survive both physically and as a person, but, if there is to be a choice between these two ways of surviving, one almost always chooses to survive as a person and let one's body go. This is seen in acts of heroism and in suicide. Originality/value - Emphasises how the need to survive as a person is so important that children as young as 16 months are able to understand and respond to the emotional meanings of their parents and siblings even though they do not develop an intellectual understanding of the theory of mind until they are about four years old. All interactions between people in health-care management involve validation and invalidation.

Notes: Purpose - This ethnographic investigation of a general hospital aims to critically analyse a much lauded corporate culture. Rather than accepting the managerial and academic claims concerning the mobilisation of corporate culture at face value, this study builds upon a labour process analysis and takes a close look at how it actually seems to work. Design/methodology/approach - The paper explores and describes how executive managers seek to design and impose corporate culture change and how it affects the nursing employees of this organisation. This was achieved by means of a six month field study of day-to-day life in the hospital's nursing division. Findings - The results lend little support to the official claims that, if managerial objectives are realised, they are achieved through some combination of shared values and employee participation. The evidence lends more support to the critical view in labour process writing that modern cultural strategies lead to increased corporate control, greater employee subjection and extensive effort intensification. The contradiction this brings into the working lives of the employees leads to the conclusion that the rhetoric of corporate culture change does not affect the pre-existing attitudes and value orientations of nursing employees. However, there were considerable variations in how employees received the managerial message and thus, by their degree of misbehaviour and adaptation, affected the organisation itself as well as using the cultural rhetoric against the management for their own ends. Originality/value - The paper concludes that an extended labour process analysis is necessary to challenge the way in which corporate culture change is explored and described by management academics and practitioners.

Notes: Purpose - This study seeks to provide an examination of a health policy network operating in a single, small community along the US-Mexican border. The purpose of the paper is to discuss why and how this network evolved, and then to present findings on how the network was structured. Analysis will focus especially on agency involvement, or "embeddedness" in the network, and its relationship to attitudes held by network members regarding trust, reputation, and perceived benefit. Design/methodology/approach - Data were collected from 15 public and nonprofit agencies trying to work collaboratively to influence local policy and services regarding the prevention of obesity-related chronic disease, especially diabetes. Embeddedness was measured in three different ways and both confirmed and unconfirmed networks were assessed. Network analysis methods were utilized as well as nonparametric correlation statistics. Findings - The network was found to be densely connected through unconfirmed linkages, but much less so when these links were confirmed. Strongest findings were found for shared information. Measures of agency embeddedness in the network were strong predictors of agency reputation, but findings for trust and perceived benefit were generally weak. Originality/value - From a practice perspective, the study points to the problems in building and sustaining community-based chronic disease health networks, especially in a small community with substantial health needs. The research also contributes to theory on embeddedness and to methodology for collecting and analyzing data on community health networks.

Notes: Purpose - To put forward the, to date, unidentified viewpoint that organisational action research and project management have many shared properties - making it a useful exercise to compare and contrast them in relation to organisational management structures and strategies. Design/methodology/approach - A conceptual exploration, drawing on a wide range of supporting literature, is used here. Findings - Project management represents a mainstay strategy for much of the organisational research seen in health care management - and has done for many years. More recently, the exploratory literature on project management has identified many limitations - especially when matched against "traditional" examples. Many health services have witnessed a more recent organisational management drive to seek out alternative strategies that incorporate less hierarchical and more participatory research methods. Action research certainly fits this bill and, on further examination, can be incorporated into a project management ethos and vice versa. Research limitations/implications - The views expressed here are of a theoretical construct and have not been implemented, as they are presented in this paper, in practice. The intention, however, is to do so in some of the author's future studies. Practical implications - If the management of health service organisations are to evolve to incorporate desirable structures that promote consumer-oriented empowerment and participation (where the consumers also include the workforce), then having a wider array of research tools at one's disposal is one way of facilitating this. Incorporating action research principles into project management approaches, or the other way round, or marrying them both to form a "hybrid" research strategy - it is argued here - represents an appropriate and representative way forward for future organisational management studies. Originality/value - In terms of originality, this represents a conceptual piece of work that puts forward constructs that have, to date, not featured in the health care literature. Its value lies in suggesting further options for organisational-oriented health care research.

Notes: Purpose - To describe the process of building partnerships between a health professional group (university-based researchers and organizations from within and outside the health sector) and the black communities, highlight the accomplishments and identify problems in the process. Design/methodology/approach - The description of the process of building partnerships with four black communities in Nova Scotia is organized in the following sections: the impetus for launching a Diabetes Primary Prevention for the Black Communities Project, its preparation, implementation, and evaluation. The accomplishments and the problems associated with the Project are analysed. Findings - Recruitment of participants for the focus groups was challenging. Response rate to survey questionnaire was moderate. Presentation of the Project results by one of the black Project assistants to the participant communities was well received. The Project was quite successful in encouraging community involvement by engaging community groups in several small-scale activities. Three issues related to project implementation were identified: recruitment of focus groups, participant disappointment, and survey return rates. Strategies incorporating the principles of involving a target audience, providing a service, empowering people and respecting cultural diversity with the aim to ensure successful partnership building with the black communities were proposed. Originality/value - This paper describes the process of forging partnership with the black communities. The results of the Project could serve as a paradigm for developing culturally sensitive and responsive strategies to lessen the burden of type 2 diabetes in other racial minority communities.

Notes: Purpose - To assess how the 2003 NICE guidelines about head-injured patients are implemented at a large district general hospital, and how the existing shortfalls might be improved. Design/methodology/approach - A six-month audit was performed and the care of all head-injured patients discharged or dying over a six-month period was assessed in the following fields: admission criteria, number of responsible consultants, number of wards receiving patients, timing of transfer to specialist centres and CT scanning and skull X-rays (SIGN guidelines were used for the latter as NICE currently recommends CT for all patients needing imaging), quality of neurological observations, criteria for re-scanning, transfer for rehabilitation, advice and arrangements for follow-up, and assignment of case managers. Findings - Imaging rates were poor, observation timing was inadequate and discharge information or follow-up arrangements were unsatisfactory. Care could be much improved by allowing one unit/ward and one firm to be in sole charge of head-injured patients. Originality/value - This case study provides practical advice for any busy hospital striving to maintain national standards in the care of head-injured patients.

Notes: Purpose - To provide an overview of a model for clinical governance in the National Health Service that incorporates continuous improvement and innovation as a core theme. Design/methodology/approach - The paper considers the core functions of clinical governance and how these are related to established structures and roles within the modern NHS. A case study approach is used to describe the implementation of a theoretical model in a large teaching NHS Trust. Findings - A clinical governance cycle is described that comprises three functional domains: accountability, assurance, and innovation. For each domain there is a definable outcome and a key role. Critical success factors for implementation of the model are described. Originality/value - This paper introduces a new model for clinical governance that focuses on continuous improvement. The paper will be of particular interest to managers and lead clinicians responsible for the development of robust systems for clinical governance and modernisation in the NHS.