Government Of Romania Research Articles

Timeliness and Continuity in Academic Ethics. The New Framework-code of University Ethics

In this paper, we will make a brief introduction regarding the elements of novelty and continuity brought by the new Framework-code of University Ethics and Deontology approved by the Government of Romania on April 4, 2024 and published in Monitorul Oficial on April 9, 2024. There will be made a series of observations regarding the name of the document (framework-code), the objectives of this normative act, its applicability, the constitutive and operational ethical values of the university activity legislated by this Code, as well as regarding the novelty elements that this code brings with regard to Romanian academic ethics. In this presentation, we seek to debate a series of concepts used by the legislator in this Code. We will also briefly present the principles applicable to university ethics and deontology contained in the ethics Framework-Code, insisting on the principle of independence from any moral, scientific, religious, political, economic influence or of any other nature, in the didactic or scientific activity, as well as and on the principle of respecting the rights and freedoms of the members of the university community.

Protocol no. 5 of March 12, 1932. A legal approach with delayed effects on bilateral investigation of incidents at the Romanian Bulgarian border

In 1923, the Dobrogean Revolutionary Internal Organization – V.D.R.O. was created by reorganizing the revolutionary section of „Dobrogea” Society. Amid intervention by the Bulgarian authorities informed that the leaders of this group, influenced by the Bulgarian communists, were planning to start a revolt in the autumn of 1925, the Dobrogean Internal Revolutionary Organization – V.D.R.O split, creating a new organization called the Dobrogean Revolutionary Organization – D.R.O. – under communist coordination. From this moment, internally, a strong rivalry began between these terrorist organizations, V.D.R.O and D.R.O. Therefore, between 1925 and 1932, the irredentist activity of Bulgarian counties was reflected in numerous border incidents, investigated by joint military commissions, exchanges of fire between Romanian and Bulgarian border guards, mainly caused by fraudulent crossings of Bulgarian counties, who robbed the Romanian peasants of the villages near the Romanian-Bulgarian border and killed the Romanian border guards who surprised them as they tried to cross the border. In order to stop these events and their investigation in a good collaboration by both parties, in 1932, a protocol agreed by the Government of Romania and Bulgaria was concluded and signed, known as Protocol no. 5, which sought to implement a simple procedure and methodology adapted to a concrete situation in the joint investigation of border incidents.

Government policies for tourism in Romania during the COVID-19 pandemic: a stakeholders’ perspective

This paper explores the tourism-related official actions undertaken by the government in Romania during the COVID-19 pandemic from a stakeholders’ perspective. The approach is based on answering three research questions: (1) Which are the policies that tourism stakeholders benefitted from during the pandemic? (2) How do tourism stakeholders appreciate the utility and efficiency of the measures implemented by the government? and (3) To what extent do the stakeholders perceive these measures as providing long-term benefits? Methodologically, the study relies on the statistical analysis of data collected through a questionnaire applied to tourism stakeholders from Romania. The results indicate mixed perceptions regarding the implemented policies, with most stakeholders considering the received support as less than optimal. A positive perspective is given by the fact that although most stakeholders regarded the positive impact of the policies only in relation to the pandemic period, there are also stakeholders indicating long-term benefits of these policies. These results are useful for providing lessons from the recent pandemic and for suggesting ways for improving governments’ response to future crises.

Implementation of the ROSE Educational Project. Case study: RED ROSE (2019-2022)

"On April 17, 2015, the Government of Romania and the International Bank for Reconstruction and Development (IBRD) signed the Loan Agreement No 8481-RO on the implementation of the Romania Secondary Education Project (ROSE), in Washington. ROSE is a project financed from a loan of 200 million euros by (BIRD), which contributes to reducing the dropout in secondary and tertiary education and to increasing the rate of passing the baccalaureate exam. We intend, through this article, to evaluate the results of the project from the perspective of one of the sub-projects implemented by the Faculty of European Studies, within the Babeș-Bolyai University, Cluj-Napoca, between 2019 and 2022. Keywords: tertiary education, educational project, ROSE, Babeș-Bolyai University, Faculty of European Studies."

Conflicting Rules in Matters Relating to Maintenance Obligations where the Connecting Factor is the Will of the Parties under Articles 7 and 8 of the Hague Protocol of 23 November 2007 on the Law Applicable to Maintenance Obligations

Article 2.612 of the Civil Code provides: "The law applicable to the maintenance obligation shall be determined in accordance with the rules of European Union law."
 The law governing the maintenance obligation is found in the European regulations (European Commission, 2008). 
 Romania has concluded Conventions (e.g. the Convention between Romania and the Kingdom of Belgium on the recognition and enforcement of judgments in matters relating to maintenance obligations) and Legal Assistance Treaties (Government of Romania, 1999; International Act, 1995; Parliament of Romania, 1995; 1997).
 The legal framework for the application in Romania of European Union regulations and various instruments of private international law in the field of maintenance obligations is Law No 36/2012 on certain measures necessary for the implementation of certain regulations and decisions of the Council of the European Union (2009) and instruments of private international law in the field of maintenance obligations (Parliament of Romania, 2012).
 Among the European regulations in this field, we have proposed to dedicate our study to the Hague Protocol of 23 November 2007 on the law applicable to maintenance obligations.
 The Protocol comprises two categories of rules which differ in the nature of the point of connection:
 - The first category is made up of rules which provide an objective location of the obligatory relationship (Art. 3 - Art. 6);
 - The second category consists of rules whose point of connection is the will of the parties (Art. 7 to Art. 8).
 This article is devoted to the presentation of the law applicable to maintenance obligations in the case of conflicting rules whose point of connection is the will of the parties as provided for in Articles 7 and 8 of the Hague Protocol of 23 November 2007 on the law applicable to maintenance obligations.

Financial management of patients infected with SARS-CoV-2 virus in Romania

In this article, we highlight comprehensive and up-to-date information on the analysis of the central public administration that addresses how the authorities, institutions and central public entities with responsibilities in preventing and combating the spread of the COVID-19 pandemic in Romania have used public funds allocated in this purpose.
 Romania has accepted the decrease of budget revenues, through a series of fiscal measures and by diminishing the income-generating economic activities. The budgets of some main authorizing officers with special attributions during the state of emergency were supplemented, namely: the Ministry of Labor and Social Protection; Ministry of Health; Ministry of Public Finance; Ministry of Public Works, Development and Administration; Ministry of Interior; Ministry of Transport, Infrastructure and Communications; Ministry of Agriculture and Rural Development; Public ministry; National Sanitary Veterinary and Food Safety Authority; Special Telecommunications Service; Romanian Information Service; Ministry of Foreign Affairs; Romanian Academy. In order to implement measures to prevent and combat the pandemic, as well as to manage the state of emergency, a series of resources were mobilized, in addition to donations and sponsorships, received by public institutions from the central public administration during the state of emergency. At the same time, for the local government component, the data are structured in such a way as to reflect the tasks and tasks of local authorities in preventing and combating the pandemic, but also the findings on resource management used for this purpose, segmented into the following areas: medical assistance (medical equipment, medicines, sanitary materials, salary rights, etc.); expenses incurred in establishing the quarantine; disinfection costs imposed by measures to prevent and combat the epidemic; Other expenditure due to the need to take measures to prevent and combat the epidemic. The Government of Romania has adopted an emergency ordinance for the organization and conduct of public information campaigns in the context of the epidemiological situation caused by the spread of COVID-19, in order to raise awareness of the risks of disease and increase voluntary compliance with health and social regulations imposed by competent authorities, in order to limit the spread of the virus after the end of the state of emergency. Audiovisual and printed materials that will be broadcast in public information campaigns, such as audio and video spots, online banners, print mock-ups, mock-ups for billboards, will be created and produced centrally by a creative structure in which specific professional associations can delegate members. from several volunteer and / or paid agencies.

Trăgători și Mistificatori: Contrarevoluția Securității în decembrie 1989

Trăgători și Mistificatori: Contrarevoluția Securității în decembrie 1989

Corporate Governance in Romania: The Board Structure an Overview of Betplus Companies

AbstractCorporate governance is a relatively new concept that emerged after the middle of the last century in response to financial scandals and bankruptcies of large companies in the 1990s and has become increasingly important, mainly in the present-day context of globalization and the growth of international competition, of the continuous changes of the market, of the economic and political environment, of the rapidity of the technological changes, which make that the maintenance of the balance and success of companies cannot be achieved without paying increasing attention to the way management and control is performed. The concept of corporate governance is based on internal and external mechanisms, designed to align the interests of all those involved in the company’s activity, so as to increase the value of the company and to achieve the highest possible performance, and to increase investors’ confidence through transparency, accountability and honesty. The Board of Directors is one of the most important corporate governance mechanisms, its main role is to elect and monitor the activity of managers, to ensure that they run the company in accordance with the interests of those who elected them (the shareholders), while pursuing the company’s strategy and objectives. This study presents an analysis of the Board of Directors of the companies that are part of BETPlus index of BSE, in terms of compliance with the provisions of Bucharest Stock Exchange Corporate Governance Code, but also a brief review of the main corporate regulations in Romania, highlighting the requirements related to the size and composition of the boards, requirements that the listed companies must comply with.

Governance in Romania: Exploring the determinants of corporate insider trading

AbstractRomania ranks at the extreme low end in Eastern Europe in terms of Hofstede cultural insights, rule of law, government effectiveness, and corruption—potentially limiting governance quality for restricting resource channeling. In this paper, we examine whether these shortcomings flow over into the degree of corporate insider trading profitability at the firm level. Consistent with high power distance, low individualism, and voice and accountability, executives and their family members extract higher returns. The conjectured monitoring constraint of equity ownership had little impact on reducing profitable trading. Second, media reporting of firm‐related scandals only restrained insider profitability in firms with government ownership—consistent with general forbearance of corruption and sanction from the use of politically controlled assets. Third, the global financial crisis revealed both a crisis of inept trading consistent with high uncertainty avoidance and also highly profitable trades for a limited set of executives who undertook short‐term reversal strategies. Our exploratory microanalysis suggests a prototype to highlight areas requiring governance and investor attention in Eastern European countries.

Sustainable Development of the Rural Areas from Romania: Development of a Digital Tool to Generate Adapted Solutions at Local Level

Rural Romania faces many problems, the main one being depopulation. In general, young adults frequently choose to migrate to urban centers or leave the country entirely to satisfy economic and/or social aspirations. The aim of this study is to identify intractable issues that inhibit rural development and to identify actionable solutions. In this regard, a questionnaire was developed and administered at the local level. The results obtained were analyzed with the SPSS Statistical Program, with the Pearson Chi-square, and Cramer and Pearson coefficients were determined. The answers obtained from applying the questionnaire made it possible to identify the causes that inhibit the sustainable development of rural areas. It can be considered that a solution that could lead to the sustainable development of the rural areas from Romania would be represented by the development of a digital tool that would create a synergy between local authorities, researchers and the private sector. In order to be able to solve these problems, the Government of Romania should provide the necessary funds to local authorities, depending on the needs identified through the digital instrument, acting directly on the aspects that restrain the development of those areas.

Comparative study on the analysis of digital governance in Romania and Bulgaria

Digital government boosts countries' economic growth and brings important benefits. This way, it involves the use of communication and information technologies by the public sector to improve the delivery of services and information by encouraging citizens to participate in the decision-making process and the holding government accountable in an effectively transparent way. Digital government offers new opportunities for more convenient and direct citizen access to government and the delivery of government services directly to citizens. This paper aims to provide an analysis of Romania and Bulgaria's digital governance compared to the European Union, highlighting the evolution of digitisation in recent years. Although they joined the European Union at the same time, the applicability and timeliness of digital technologies differ from country to country, with Romania and Bulgaria always compared to each other in their evolution over the years.

CHANGES IN MANAGEMENT AND GOVERNANCE IN PUBLIC ADMINISTRATION. CASE STUDY IN ROMANIA

"The paper addresses to the Public Administration (PA) from the management perspective. The first part of the study defines the conceptual framework of the two management doctrines, generically called the New Public Management and New Public Government. The second part of the paper reviews the transformation movement in PA management and governance in Romania in the last two decades. The methodology of the study consists in the analysis of the recent theoretic studies on PA modern approach, and official documents, national and European reports, and other publications related to the PA reform in Romania. "

Socio-demographic analysis of the phenomenon of population aging with implications on the Romanian pension system

The first part of the study has as it’s main objective to expose a brief socio-demographic analysis on the problem of aging population, both in Romania and in other European Union countries. The second part of the study follows the implications that the aging population phenomenon has on the Romanian state pension system. Also, the paper proposes an investigation of the risks to which the population aged 65 years and over is exposed in the context of the COVID-19 pandemic, based on specific comorbidities. To form an overview of these aspects, it will be used secondary data research, with information from public institutions such as: the National Institute of Statistics; Ministry of Internal Affairs; National House of Public Pensions; The Government of Romania; Financial Supervisory Authority; Eurostat; World Health Organization; United Nations Organization; Organization for Economic Co-operationand Development; as well as specific legislation and updated specialized literature. The last part of the study offers a series of conclusions which will result in several general solutions to the aging population problem.

Corporate Governance at European Level: Romania – Study Case, Romanian Public Enterprises

The background: This paper present how the implementation of Corporate Governance in Romania’s Public Enterprises is applied. The paper examines how the Key Performance Indicators are used to monitories the performance of the Public Enterprises, of the Board’s performance and overall the Corporate Governance efficiency. Objective: Although the primary target of this paper is the improving of the Key Performance Indicators by introducing the sustainability indicator. The establishment of the sustainability indicator reflecting the competencies and clarifications of Board members from each public enterprises under the auspices of the Public Authority. Preliminary Studies: The Corporate Governance Codes, along with the Principles and Recommendations in this area, bring a reform in Europe. The research is based on the definition of Corporate Governance from the perspective of established scholars of the field, in which it is understood a concept of “corporate governance”. Method: The methodology used in data collection, in consultation with the Annual Reports prepared by the Board of a public company, has led me to obtain key quantitative information that bases on the indicators used in the annual reporting and allows me to study new indicators for the future recruitment process. In order to obtain the necessary data for the formulation of the hypotheses, I approached the non-participatory observation in the conduct of investigations at the Romanian state companies. This matrix must also include a sustainability indicator, in addition to those that reflect the candidate's experience and training. Results: Depending on the current decisions, the recruitment process is lacking in adaptation of future trends in a developing society. This implies the adjustment of the present recruitment matrix, bringing to a form closer to the market demands and taking into account the transformations that takes place in the society. Implications: I am one of the specialist in the field of the implementation process of Corporate Government in Romania, so through self-questioning I will disseminate the information necessary for the study. Conclusion: A sustainable Corporate Governance is about efficiency, and must have a complex approach in the process of selecting candidates for the vacancies spots in the Board. By adopting a new selection criterion in addition to the existing ones, Corporate Governance conforms to the new trends of the society, such as sustainability trend. Sustainability in decision-making process becomes a strong point of “good Corporate Governance”.

Micula and Others v. Government of Romania

678Arbitration — Arbitration award — International Centre for Settlement of Investment Disputes (“ICSID”) — ICSID Convention, 1965 — Article 54 — Enforcement proceedings — Convention on the Settlement of Investment Disputes Act 1966 giving ICSID Convention domestic effect in United StatesJurisdiction — Subject matter jurisdiction over enforcement of an ICSID Award — Foreign Sovereign Immunities Act 1976 — Act of State doctrine — Foreign sovereign compulsion doctrine — Whether act of State doctrine or foreign sovereign compulsion doctrine barring enforcement of an ICSID AwardState immunity — Jurisdiction — Petition to enforce arbitration award — Foreign Sovereign Immunities Act 1976 — Exceptions to sovereign immunity — Arbitration exception — Romania’s agreement to arbitrate — Whether Romania’s agreement to arbitrate nullified by Romania’s accession to European Union — Whether United States court having jurisdiction to enforce arbitration awardTreaties — ICSID Convention, 1965 — Sweden–Romania Bilateral Investment Treaty, 2002 — Romania’s agreement to arbitrate — Romania acceding to European Union in 2007 — Whether Romania’s agreement to arbitrate nullified by Romania’s accession to European Union — Whether United States court having jurisdiction to enforce arbitration awardRelationship of international law and municipal law — Treaties — ICSID Convention, 1965 — Obligations of the State under ICSID Convention — United States law — Convention on the Settlement of Investment Disputes Act 1966 — Section 3 — Jurisdiction of federal courts to enforce an ICSID award whilst award subject of review by a foreign sovereign — The law of the United States

Rural Development in Romania – A Few Considerations

Abstract The ‘Agenda 2000’ introduces the Rural Development Policy, as part of the Common Agricultural Policy (CAP), as a complex policy that can ensure a stable income and a reasonable standard of living for the rural population. Rural development is a major CAP objective since over 50% of the population lives in rural areas and accounts for 80% of E.U. Territories. As a concept, the ‘rural area’ is defined both at a national and European level following specific criteria; however, these criteria differ from one country to another. A complete definition can be found in the European Charter of Rural Areas. Between 2014-2020, the development of rural areas in Romania is supported by the National Rural Development Program. It provides non-reimbursable funds from the European Union and funding from the Government of Romania. Convergence with the Europe 2020 Strategy is ensured through the Partnership Agreement with the European Union, which covers a number of challenges and thematic objectives. In order to achieve them, well-founded investment programs are needed. These programs must have a direct impact on increasing the living standards of the population residing within rural areas. Over 19 billion euros were allocated to Romania for the 2014-2020 period; these funds were used for agricultural policy and rural development. The total budget of the NRDP (2014-2020) is 9.4 billion euros, of which 1.3 billion euros comes from national funding. We believe the achievements recorded in rural areas, up to 2020, are modest and do not reflect the proposed objectives. Thus, projects were drawn up at national and local levels seldom support rural development and do not reflect development needs; sadly, these projects are often drawn up without focusing on efficiency.

The role of European funds in developing and sustaining rural entrepreneurship in Romania

Abstract With the integration into the European Union (EU) in 2007, growth opportunities have arisen for Romania. In terms of rural area and agriculture, National Rural Development Programs (NRDPs) are implemented, through which funds are granted from the European Union and the Government of Romania, for the economic and social development of the rural area. In this context, entrepreneurial initiatives for rural development have been encouraged, and many SMEs were given the opportunity to be eligible for European funding. The NRDP 2014-2020 continues the efforts for rural development, through strategic objectives, allowing entrepreneurs to implement their business ideas and sustain the development of the rural communities. The paper aims to analyze how the European funding influences the development of rural entrepreneurship in Romania. The study will comprise an analysis of the existing results of the NRDP 2014-2020, referring to annual evaluation indicators of the project implementation (number of jobs created in supported projects, percentage of rural population targeted by local development strategies, etc.). The methodology focuses on interpretation of the latest statistical data from trusted sources, as well as analysis of the official documents and reports (e.g. NRDP 2014-2020 annual report). This paper will contribute with accurate results and discussions concerning the role of EU funds for the rural communities. Also, the study will describe some of the challenges that Romanian rural entrepreneurship still faces after implementation of European funding programs and unresolved issues.

Innovations in Health Care Management: the Effect of the Pandemic on the Labour Market Change

The COVID-19 pandemic was identified in 17 days, and the related enormous economic and social impacts have mobilized the global scientific world in almost all areas of science. The leaders of individual countries have to face a challenge that has been unprecedented for many decades. The global pandemic could lead to profound changes in the balance of power, economic operations, and the labor market. In turn, the accompanying measures have brought a lot of changes to everyday life. Although the government of Romania had taken some measures to avoid the collapse of the economy. However, the experts did not regard these as efficient enough. At this time two-thirds of the Hungarian population do not feel that the media exaggerates the severity of the COVID-19 outbreak and the economic consequences of the pandemic are undisputable for the Hungarian people, just like for the Italian and French people who were severely affected by the virus. People have been deprived of the joy of social gatherings, free movement, travel and many of them have even lost their jobs. The primary question at the moment is whether countries could finance the sectors in hardship and whether their inter-dependence regarding the exchange of goods imposes any kind of danger to their citizens. In terms of macro-economy, however, the long-term consequences are much more interesting, and it raises questions like how the countries will be able to handle the situation resulted by the increased unemployment and the different trade relations. This study presents a primary research with the age group of 18-30. The target group is leaders of student unions and academics of four universities. This questionnaire survey aims to examine how the Hungarian and Transylvanian respondents see the prospective economic effects of the current situation on the different sectors of the economy. In addition to the descriptive statistical analysis, the perception of economic impacts was examined with variance analysis concerning different demographic characteristics, and the currently studied subject area. Is the negative attitude prevailing or do the different groups react differently to the state of affairs? The greatest differences in the opinion of respondents could be observed in the area of lifestyle and healthcare. The experts think that the pandemic will result in great changes in the offices, homes, schools, and places of work. Negative aftereffects are not predicted in higher education, sales, and trade. It can be concluded that negative labor market trends are expected, therefore probably the young generation currently studying in higher education will be one of the biggest losers of the virus in the long run. Keywords: COVID 19, pandemic, economic impact, changes in subject areas.

Progress toward New Public Governance in Romania

PurposeNew Public Governance is becoming an important framework for managing the public sector in the era of collaborative governance. The purpose of this paper is to explore the extent to which New Public Governance as a framework is limited to the political and administrative context of Romania and to create a connection between good governance and New Public Governance through operationalizing the concepts and clarifying their inter-dependency. New public leadership skills are required from both horizontal and vertical approaches, in order to tackle the country’s wicked problems.Design/methodology/approachThrough the use of qualitative methods, such as document analysis of Cooperation and Verification Mechanism reports of the European Commission on Romania, and expert interviews with a focus on governance aspects, the paper seeks to clarify the challenges that Romania faces in terms of democratization given the current political and administrative context.FindingsFindings in Romania reveal little agreement on progress in government effectiveness, regulatory quality and implementation of the rule of law. However, progress has been noted on voice and accountability and strengthening democracy.Research limitations/implicationsThe authors discuss the uncertainty that the concept of good governance has created from an international organizations’ perspective in developing countries, and define the good governance infrastructure as a means of bringing governance closer to the complex and changing context of each country. The paper aims to clarify the connection between good governance and New Public Governance, by assessing contextual factors in developing countries.Practical implicationsThe practical implications of the study are related to the possibility of this paper to inform other developing countries on the conditions that are necessary in order to adhere to New Public Governance. The paper has implications in proposing the use of the good governance infrastructure as a helpful concept when considering democratic frameworks for research and practice.Social implicationsThe social implications of this paper are connected to the current political, administrative and social context of the Central and Eastern European region and its component countries. Improving democratic practices, through advancing the importance of good governance indicators in switching to a public governance perspective in public administration, is the main outcome of New Public Governance-style reforms.Originality/valueThe paper’s originality stands in designing the premises for the “good governance infrastructure” as a new concept that aims to bridge the gap between good governance and New Public Governance, and bring more conceptual clarity. Being supported by evidence, through the use of primary data generated by expert interview analysis, the new concept can improve and encourage further research on this topic.

Assessment of Public Hospital Governance in Romania: Lessons From 10 Case Studies.

Background: The Government of Romania commissioned international technical assistance to help unpacking the causes of arrears in selected public hospitals. Emphases were placed on the governance-related determinants of the hospital performance in the context of the Romanian health system. Methods: The assessment was structured around a public hospital governance framework examining 4 dimensions: institutional arrangements, financing arrangements, accountability arrangements and correspondence between responsibility and decision-making capacity. The framework was operationalized using a 2-pronged approach: (i) a policy review of broader health system governance arrangements influencing hospital performance; and (ii) a series of 10 casestudies of public hospitals experiencing financial hardship. Data were collected during 2016-2017 through key informant interviews with central authorities and hospital management teams, exhaustive semi-structured questionnaires filled in by hospitals, as well as the review of documentary sources where feasible. Results: Overall, the governance landscape of Romanian public hospitals includes a large number of seemingly modern legislative provisions and management instruments. Over the past 30 years substantial efforts have been made to put in place standardised hospital classification, hospital governance structures, management and service purchasing contracts with key performance indicators, modern reimbursement mechanisms based on diagnosis-related groups (DRGs), and regulatory requirements for accountability, including internal and external audit. Nevertheless, their application appears to have been challenging for a range of reasons, pointing to the misalignment between the responsibility and decisionmaking capacity given to hospitals in a questionably conducive context. Incoherent policy design, outdated and often disjointed regulatory frameworks, and cumbersome administrative procedures limit managerial autonomy and obstruct efficiency gains. In a context of chronic insufficient funding, misaligned incentives, and overly rigid service procurement processes, hospitals seem to struggle to adjust service baskets to the population’s health needs or to overcoming financial hardship. External challenges, combined with the limited strategic, operational, and financial management capacity within hospitals, make it difficult to exhibit good financial and general performance. Conclusion: Existing governance arrangements for Romanian public hospitals appear conducive to poor financial performance. The suggested framework for hospital governance assessment has proved a powerful tool for identifying system and hospital-specific challenges contributing to sub-optimal hospital performance.