Formal Objectives Research Articles

Contribution of Coordination Theories to the Determination of Human Factors Associated With Operating Room Perceived Performance.

The efficient and fluid organization of surgical interventions in an operating room (OR) and operating suite (OS) is important as these are among the most expensive units to run in medical-surgical facilities. The complexity of OS organization requires careful coordination, defined here as the directing of individuals' efforts toward achieving common and explicitly recognized goals. There is currently sparse literature on OS coordination, especially in the French context. This study aimed to respond to this gap by reporting on the coordination mechanisms associated with the perceived performance of OS across 4 facilities in an urban setting in France. We used a qualitative comparative case study based on ethnographic methodology to explore 4 facilities (2 teaching, 1 general, and 1 private). Several investigation techniques were used for data collection (semistructured interviews, participant and nonparticipant observations, and informal interviews) in the OR, the OS, the regulation council (dedicated to adapting the necessary resources to specific procedures and patients' health status), and the OS council (dedicated to strategic and operational OS transformations and adaptations, and responsible for finding solutions to organizational problems). Analysis was guided by Okhuysen and Bachky's theoretical framework on coordination and multi-team systems theory. Data were compared across the 4 facilities and triangulated using the different techniques to ensure coherence and accuracy. Overall, 48 interviews with health care providers and hospital managers and 200 hours of direct observations were performed. The OR exhibited a high degree of coordination, whereas improved perception of performance in the OS depended on managerial competency, trust, and authority. Perceived performance in the regulation council and OS council, on the other hand, depended on the identification of formal objectives by all stakeholders and the development of common understanding (developing agreement, direct information sharing, creating common perspective, substitution, bringing groups together, and storing of knowledge). Based on existing literature on multi-team systems (as represented in the OS organization), this study identifies success factors influencing OS coordination. These include the OS manager's leadership skills; the identification of formal system objectives; and professional differentiation between stakeholders (absence/decrease of a sense of belonging to a multi-team system). This differentiation was related to the high degree of specialization within OS teams, each bringing different norms, cultures, and contingencies that induce dissonance in organization and task performance. Interventions targeting these success factors might improve coordination, and thus performance, in the OS.

Health sciences librarians' instructional engagement in continuing education: a scoping review.

Healthcare professionals (HCPs) have an ongoing need for continuing education (CE) while Health Science Librarians (HSLs), accustomed to supporting a range of learning needs in a variety of contexts, are well situated to provide CE that addresses information retrieval, literacy, management, and more. To better understand the extent of HSL delivered CE activities, we undertook a scoping review to determine how HSLs instruct practicing HCPs in support of their CE. We searched for published and unpublished literature sources including PubMed (NCBI), Embase (Elsevier); Dissertations and Theses Global (ProQuest); CINAHL (EBSCO); Library, Information Science and Technology Abstracts (EBSCO); and Library Literature and Information Science Full Text (EBSCO). To identify unpublished sources, we searched the internet using Google and contacted two health sciences library listservs. We also performed backwards and forwards searching of our included sources. Our database searches yielded 4842 sources, and we retrieved an additional 579 sources through supplementary retrieval methods. After duplicate removal and screening, we included 105 sources in this review. The included sources were published between 1970 to 2021 and covered a range of topics such as searching methods and tools, critical appraisal, and many more. Those related to evidence-based practice (EBP) appeared around 2001 and bibliometrics and bioinformatics arose after 2016. Publications depicting HSLs teaching CE most commonly occurred in academic settings. The most common population taught was nurses, followed by physicians. Most sources did not report using an information literacy framework or instructional design model, undertaking needs assessments, or reporting formal objectives or assessment. While HSLs are active supporters of EBP, we need to apply the same principles to our own professional practice. Formal structure of programming and program assessment combined with clear, detailed reporting can help to build a more robust evidence base to support future CE provision.

External inspection approaches and involvement of stakeholders’ views in inspection following serious incidents - a qualitative mixed methods study from the perspectives of regulatory inspectors

ObjectiveThe objective was to gain knowledge about how external inspections following serious incidents are played out in a Norwegian hospital context from the perspective of the inspectors, and whether stakeholders’ views are involved in the inspection.MethodsBased on a qualitative mixed methods design, 10 government bureaucrats and inspectors situated at the National Board of Health Supervision and three County Governors in Norway, were strategically recruited, and individual semi-structured interviews were conducted. Key official government documents were selected, collected, and thematically analyzed along with the interview data.ResultsOur findings overall demonstrate two overarching themes: Theme (1) Perspectives on different external inspection approaches of responding and involving stakeholders in external inspection following serious incidents, Theme (2) Inspectors’ internal work practices versus external expectations. Documents and all participants reported a development towards new approaches in external inspection, with more policies and regulatory attention to sensible involvement of stakeholders. Involvement and interaction with patients and informal caregivers could potentially inform the case complexity and the inspector’s decision-making process. However, stakeholder involvement was sometimes complex and challenging due to e.g., difficult communication and interaction with patients and/or informal caregivers, due to resource demands and/or the inspector’s lack of experience and/or relevant competence, different perceptions of the principle of sound professional practice, quality, and safety. The inspectors considered balancing the formal objectives and expectations, with the expectations of the public and different stakeholders (i.e. hospitals, patients and/or informal caregivers) a challenging part of their job. This balance was seen as an important part of the continuous development of ensuring public trust and legitimacy in external inspection processes.Conclusions and implicationsOur study suggests that the regulatory system of external inspection and its available approaches of responding to a serious incident in the Norwegian setting is currently not designed to accommodate the complexity of needs from stakeholders at the levels of hospital organizations, patients, and informal caregivers altogether. Further studies should direct attention to how the wider system of accountability structures may support the internal work practices in the regulatory system, to better algin its formal objectives with expectations of the public.

Good Saves: How Emergency Medicine Residents are Learning From Success.

The practice of learning from medical errors is well-established and well-researched in the literature on morbidity and mortality conferences. However, durable learning from case-based education occurs not only through the analysis of medical errors but also through the evaluation of how critical decisions were made to result in a positive clinical outcome, what we will call a "good save." The aim of the current study is to provide an overview of how US-based emergency medicine residencies are teaching using "good saves." A national survey of emergency medicine (EM) residency leadership was distributed through the Council of Residency Directors (CORD) and the Society of Academic Emergency Medicine (SAEM) listservs. A descriptive analysis of the results was undertaken. Residency leadership representing 67 different US EM training programs participated in our survey. Of these, only 19 programs use formal learning objectives and dedicated education time to teach from "good saves." Thirty-six programs provide informal recognition, often in the form of a "shout-out." Residency leadership is motivated to provide this recognition and learning through efforts to promote wellness and resiliency among EM residents. Notably, the use of prizes and awards is not necessary. Some EM residencies in the United States are making targeted efforts to promote the recognition of successful clinical care. This recognition and education are being used as tools both to promote wellness and to teach resiliency. However, there is wide heterogeneity in approaches. Our survey provides examples of the many ways that "good saves" can be incorporated into any EM residency curriculum with the potential for significant impact.

Constructing Seamless Learning Through Game-Based Learning Experiences

The goal of this paper is to explore how game-based experiences can be leveraged through mobile technology to activate learner engagement and achieve a seamless connection between formal and informal learning. The paper presents a mobile game authoring tool that enables educators to create gamified lesson paths, drawing on the concept of atomic learning. Preliminary evaluation revealed three main findings. First, mobile games constitute a key driver in seamlessly blending informal, unguided learning that is driven by natural human curiosity with learning experiences which are driven by defined, formal learning objectives. Second, ensuring learning elements are suitable for direct use, and reuse, within game-based tools, requiring learning content with high granularity. Third, the success of gamified learning depends on visual and audio impact, along with an appropriate blend of challenges, rewards, learning content, and assessment units that form the narrative backbone.

Conflict Management inside EAEU to Preserve Its Forum

Eurasian Economic Union members: The Eurasian Economic Union consists of five member states: Russia, Belarus, Kazakhstan, Kyrgyzstan, and Armenia.
 What is the Eurasian Economic Union?
 The Eurasian Economic Union (EEU or EAEU is a project for the economic integration of the former Soviet region. Its formal objectives are to create a common market much like the European Union (EU). There are four targets of this forum, i.e:1) coordinating economic policy, 2.) eliminating non-tariff trade barriers,3) harmonizing regulations, and 4).modernizing the economies of its five member states. While the whole population of EEU member states is estimated 180 million people.
 The EEU has some institutions inside it, i.e: the Eurasian Economic Commission in Moscow as its regulatory body, and a Court of the Eurasian Economic Union based in Minsk. The Commission's power is limited. Member states disagreeing with its judgments can appeal to other bodies, and the Commission has no power to bring a member state before the Court in a case of non-compliance. Disputes are often resolved bilaterally rather than via EAEU institutions.
 Bureaucratic forms of the EU have not been fully copied by the EAEU, which seems a slow phase of its development so far. This is might be caused by EAEU GDP in 2019 being the majority Russian economy (87%). Russia is by far the largest member state and dominates the Union. This domination means that Russia is easily able to act unilaterally within the union [1].

Social formation for interaction in international mobility programmes: a case of Danish students in China

ABSTRACT From a social cultural learning perspective, the study explored the social formations for interactions of Danish students during a short-term international mobility study programme in China, using multiple qualitative data sources. Although a variety of patterns of strategies, practices and discourses were identified, the findings suggest that the students socialised most with co-nationals and little with local Chinese. Although their internal socialisations created some opportunities to learn from each other and learn about Chinese culture, they were mainly found to be constraints to learning due to limited interaction with locals and stereotyping the local ‘others’, risking misunderstandings. The outcomes of the study identify a gap between the ideal of the mobility study programme’s formal objectives and the practice of its implementation, which challenges prevailing political initiatives to increase internationalisation through student mobility. Also questioned is the effectiveness of sociocultural learning design in the short-term mobility context.

Detecting formal and informal interests in forest governance

To reveal the interests of actors in forest governance, this paper proposes a power-based interest identification (PII) approach. Based on the assumption of intentional action, the benefits that actors derive from policy impacts are the result of interest-driven actions. This paper further proposes a theoretical definition of interests that includes formal goals at the social and ecological levels, as well as informal political, economic, and strategic interests. Researchers need to identify powerful actors by identifying power mechanisms and resources, and can then observe actors' formal goals through interviews and documents. For informal interests, the actor observes the informal gains of powerful actors in policy impacts, which are then coded according to political, economic, and strategic interests. Combining these steps, actors can infer the formal and informal interests of powerful actors.•Researchers can verify actors’ formal objectives by interview and documents.•Among policy impacts, researchers can observe influences at the social and ecological levels, as well as changes in actors' control, economic gains, and dissemination of ideas.•Researchers can infer informal interests of powerful actors from observation of policy impacts.

Forest set-aside policy for International biodiversity targets? Obstructive bureaucratic territoriality in Germany and Sweden

Under the auspices of the Convention on Biological Diversity, the Aichi Biodiversity Target 11 requires setting aside vast currently managed areas for conservation purposes. Following bureaucratic politics theory, forestry and environmental domestic bureaucracies use these international targets in their struggle for power and territoriality over forested areas. Against this background, this study aims to analyze the resulting politics on setting aside forest areas from active forest management in Germany and Sweden. Employing a qualitative case study design and empirical data from policy documents and key informant interviews, our results indicate that bureaucracies prioritize instruments that are well aligned with their formal objectives, the interests of their informal constituencies, and their territorial interests. Such struggles dominate the development of policy instruments in both countries obstructing political compromise which results in a logjam in the development of substantial forest set-aside policy. We conclude that unless domestic politics and key bureaucracies provide conducive political conditions international commitments will be very difficult to achieve, even if they are formulated into clearly measurable international targets.

Comparison of Clerkship Directors' Expectations of Physical Examination Skills with Point-of-care Ultrasound Skills Using the RIME Framework.

Background: The expectations of point-of-care ultrasound (PoCUS) in undergraduate clerkship at the University of Ottawa has not been described. We compared clerkship directors' expectations of physical examination skills with PoCUS skills, before and after completing the clerkship rotation. Methods: A pilot-tested, expert developed, bilingual on-line survey consisting of 15 questions was sent to all clerkship directors (23) in December 2019. The survey included questions regarding the expectations of medical students with respect to physical examination and PoCUS using the RIME Framework: none, reporter, interpreter, manager, educator. Results: The response rate was 60.9% (14/23). With regards to physical exam skills, 82.8% of directors had no expectations or expected students to be reporters when starting clerkship. At graduation, 77.5% of directors expected students to be interpreters, managers, or educators. For PoCUS, 100.0% of directors had no expectations or expected students to be reporters when starting clerkship. At clerkship completion, 33.0% of directors felt that students should be interpreters or managers for PoCUS skills. Conclusions: Clerkship directors have low expectations of PoCUS skills for entering and graduating clerks when compared with their physical examination skills despite formal pre-clerkship PoCUS objectives. Enhanced communication and targeted education of directors could improve the PoCUS curriculum.

Bureaucratic politics in protected areas: The voided power projection efforts of conservation vis-à-vis forest bureaucracies in Patagonia, Argentina

The Protected Areas in Latin America, beyond the preservation of nature, have been central for government control over spatial resources. The weaknesses of the domestic bureaucracies in this region results in a gap between their formal rules and the expected outcomes. Forest management is an issue of competition between production and environmental bureaucracies all over the world. Bureaucracies search for new fields of responsibility, increased budgets and resources for assuring their positions, expanding their territory. The administrative bodies that regulate forests and protected areas can direct the behaviour of subordinate agencies as a power projection strategy to provide formal jurisdiction over forest reserve instruments. Hence, the aim of this study is to analyse the different strategies used by domestic bureaucracies to increase their power in light of a new forest law in the province of Rio Negro, Argentina. Data was obtained through semi-structured interviews with key actors and document analysis using process tracing and actor centred power methodologies. Our results show that, after the approval of the national forest law, the provincial environment administration increased rank and expanded into forest territories. The consolidated presence of a new outpost office gained power and resulted in a rivalry with its counterparts. However, the ongoing changes in the institution’ structure and the production bureaucracy's long-term presence affected the environmental bureaucracy's consolidation leading it to an instability. Moreover, our results strengthened the tourism and real market informal interests behind the weakness of the formal objectives of the environmental bureaucracy’ hypothesis.

Responder Safety - Evolving Safety Systems, Processes, and Behaviours in an International Oil Spill Response Cooperative

Abstract Oil Spill Response Limited (OSRL) is a United Kingdom based industry cooperative for emergency oil spill response and preparedness. The company provides emergency surface and subsurface response to oil spills on a global basis. The nature of emergency oil spill response requires responders to understand and deal quickly with the safety risks arising from working in new and unfamiliar surroundings. The risks derive from the physical nature of the incident, the geographical locations, the local weather conditions as well as working with new colleagues and organisations. OSRL was originally established in the United Kingdom in 1985 and now employs 265 people in 9 countries. This growth has been the result of mergers with response cooperatives in the United States and Singapore and the introduction of a new subsea well capping services division. A common understanding and alignment on safety in an organisation with a range of nationalities and cultures as well as local compliance requirements is critical to safeguarding employees. To ensure this, OSRL began a programme to review safety management systems, processes and procedures as well as employee behaviours. An Operations Excellence Management System, known as ‘The Blueprint', was introduced to provide structure and control in corporate documentation as well as providing better navigation to employees in locating specific procedures. The introduction of the Blueprint prompted a major overhaul of OSRL's core safety procedures, in particular, risk management. While the basic principles of risk assessment were similar, there was a difference across the company in how risk assessments were prepared, approved and presented. The International Association of Oil & Gas Producers (IOGP) Life Saving Rules were introduced. The Rules provide clear guidance on how to prevent accidents known to have caused industry fatalities in the past. OSRL also undertook a review, with employee participation, of the company's values that led to a new corporate ‘Values Compass' with safety at the centre. Employees are encouraged to take personal ownership of their own safety and that of colleagues. Awareness is promoted by setting formal objectives, linked to remuneration, on hazard identification and behavioural safety observations. This paper will show the strategies and initiatives applied to develop a framework of rules, processes and behaviour to support and protect OSRL responders from the range of safety risks encountered when responding to an oil spill.

Pacifist utopias: humanitarianism, tragedy and complicity in the Second World War

Pacifist utopias: humanitarianism, tragedy and complicity in the Second World War

Lack of Pregraduate Teaching on the Associations between the Built Environment, Physical Activity and Health in Swiss Architecture and Urban Design Degree Programs.

Background: Lack of physical activity (PA) is the fourth risk factor for all-cause mortality. Regular PA reduces noncommunicable disease (NCD) and mortality risk. The built environment (BE) is a determinant of spontaneous daily PA. Professionals who plan and build the BE therefore affect public health. We tested the hypothesis of a lack of formal pregraduate training about associations between the BE, PA and health in architecture, landscape architecture, and urban design academic degree programs (DPs) in Switzerland. Methods: We reached out to all DPs in Switzerland to ask if and how these associations are taught. For those declaring to teach the topic, the program syllabus and course material were inspected. Results and discussion: For 30 out of 33 identified programs, information for the analysis was obtained. A total of 18 declared teaching the BE, PA and health associations, but this could be confirmed for only 5 after verifying the course content. Teaching principles of building PA-promoting BE represents an underutilized potential for public health promotion. Conclusions: There is a need to introduce formal learning objectives in architecture, landscape architecture, and urban design DPs in Switzerland on the associations between BE, PA and health. It is likely that similar needs exist in other countries.

Governance for excellence and diversity? The impact of central and regional affiliation for the strategic positioning of Chinese top universities

Through analysis of the strategic ambitions of China’s top universities, this article studies the relationship between governance structures at the system level and strategic institutional adaptations. In China, some top universities are governed directly by the national authorities while others have regional affiliations. By analyzing the strategic plans of a sample of universities in both categories the article examines how these differences in governance modes may impact the formal ambitions and objectives of the universities and discuss the potential system implications of these different governance modes, especially related to issues of excellence and diversity. The article find that differences in governance modes do affect the strategic positioning of Chinese universities, and different ways in which governance arrangements can be used to foster both excellence and diversity in a system perspective are discussed.

Beyond ‘empty’ forms of formalization: The credibility of a renewed attempt at forest titling in Southwest China

Whereas the prospective benefits of formalization programs are well-understood and received, less attention has been placed on the feasibility of such actions. This paper studies titling under China’s Collective Forest Tenure Reform. We employ the Formal, Actual, and Targeted (FAT) Institutional Framework, based on the ‘credibility thesis’, to examine whether titling increases tenure credibility. To do so, we draw upon interviews and surveys collected in the Wuling Mountain Area (Southwest China), and compare formal policy objectives to households’ targeted (desired) preferences and actual forest rights. Our findings show divergences between formal and targeted versus actual rights. While titles were widely issued, socially supported, and farmers deemed boundaries and plot sizes clear, there is a paradox: (i) half of forest titles did not record boundaries; (ii) boundaries were not uniformly recorded; (iii) no on-site surveying had taken place; (iv) plot data were based on replicating older data, estimates, or averages; (v) titles had not been issued in contested areas; (vi) farmers had a weak legal understanding of ownership and lease rights. We argue that due to pressure from the central government to complete titling in five years, forest registration has emerged as an 'empty institution': an institutional compromise where spatial complexities were disregarded and neglected during implementation. Although seemingly credible at present, such outcomes of formalization bear the risk that future changes could easily dampen the reform’s institutional efforts and intentions.

Are they ideological renegades? Fathers' experiences on taking parental leave and gender dynamics in Korea: A qualitative study

Despite their fear of repercussions on career advancement and gender identity, Korean fathers taking parental leave have continually increased. Why do Korean fathers take parental leave in spite of the risk of being stigmatized as less masculine and less ideal workers? Are they willing to be ‘ideological renegades' to be new involved fathers? In‐depth interviews with fathers who took parental leave provide interesting answers. Overall, taking parental leave does not make fathers become ideological renegades since it is mainly utilized in a manner that accommodates the work devotion schema, deviating from the formal policy objectives. This deviant utilization is encouraged and even valued by organizations. This may be part of a psychological contract between organizations and employees, ensuring that employees are dedicated to their career even during parental leave. Furthermore, beyond the legal eligibility of uptake, informal but powerful ‘organizational eligibility' such as high performance or their contribution to the organization, makes not only the likelihood but also the aftermath of taking up different across fathers. As a result, a hierarchy among fathers with class connotations emerges. This hierarchy among fathers, combined with the traditional gender hierarchy, may reinforce the masculine fabric of ideal workers as the norm.

The state of nutrition in medical education in the United States.

Despite the significant impact diet has on health, there is minimal nutrition training for medical students. This review summarizes published nutrition learning experiences in US medical schools and makes recommendations accordingly. Of 902 articles, 29 met inclusion criteria, describing 30 learning experiences. Nutrition learning experiences were described as integrated curricula or courses (n = 10, 33%), sessions (n = 17, 57%), or electives (n = 3, 10%). There was heterogeneity in the teaching and assessment methods utilized. The most common was lecture (n = 21, 70%), often assessed through pre- and/or postsurveys (n = 19, 79%). Six studies (26%) provided experience outcomes through objective measures, such as exam or standardized patient experience scores, after the nutrition learning experience. This review revealed sparse and inconsistent data on nutrition learning experiences. However, based on the extant literature, medical schools should build formal nutrition objectives, identify faculty and physician leadership in nutrition education, utilize preexisting resources, and create nutrition learning experiences that can be applied to clinical practice.

Introducing "captaining": How to best combine group work with individual achievement within higher education examination

This paper deals with the problem of making group work and individual achievement meet in the context of combined examination at universities. The underlying idea of this research derives from the policy that is increasingly gaining power at many university departments, namely that it is inappropriate to examine students on the basis of group work alone, while at the same time limited departmental resources cannot allow for increasing the number of individual examinations. This paper attempts to square this paradox by elaborating on new ways to individualize compulsory group work so that it fulfils both formal and educational objectives, but also so it feels meaningful, motivative and fair to the students. This multifaceted challenge is captured in a novel methodological approach named “captaining”. By drawing on existing theoretical frameworks, own experiences and subsequent evaluation, “captaining” is presented as a promising alternative to the individualism vs. collectivism dilemma, as well as to extra-educational factors impacting the implementation of best examination practices.

The national strategy for Roma inclusion in Italy: between contradictions and loss of responsibilities

ABSTRACT After decades of emergency initiatives and a widespread institutional disengagement, in 2012, Italy adopted the National Strategy for the inclusion of Roma, Sinti and Caminanti communities, which opts for a unifying approach to dealing with the Roma presence. Even though in its formal objectives, the Strategy aims at overcoming the fragmentation of the policies focused on the Roma, seven years after its implementation only disconnected, often inconsistent, interventions have followed. The article examines whether and to what extent the implementation of this document has represented a break with the ambiguities and contradictions that characterised the structure of the relevant policies aimed at Roma integration in Italy before 2012. The analysis highlights a failed activation of the beneficiaries of the strategy in terms of both empowerment and participation in the decision-making arena. Although the strategy represents an unavoidable step – at least from a formal point of view – towards a coordinated approach to a controversial issue, it has failed to trigger virtuous circles able to affect the life conditions of the Roma, which remain alarming.