Healthcare Management Practices Research Articles

How prepared are Myanmar's health care professionals in their response to gender-based violence?

PurposeGender-based violence (GBV) has negative impact on the health and well-being of the survivors. The initial response can lessen the magnitude of the effect, and thus the health care sector's readiness to respond to GBV cases is important. This study aimed to explore the knowledge, attitude and its association to practice regarding GBV response among health care personnel.Design/methodology/approachA cross-sectional study was conducted in 48 public hospitals in Yangon, Myanmar, involving 398 participants including doctors and nurses, by a self-administered structured questionnaire.FindingsAmong 398 participants, most of the participants had moderate level of knowledge, attitude and supportive environmental factors. Only 12.8% had experienced GBV management. The respondents with a bachelor's degree were more likely to practice on health care management towards GBV cases than those who finished with a diploma degree. The medical officers and senior medical officers were more likely to practice than the junior nurses. The participants who had already attended the trainings had more practice than those who had not. Those who work in the regional hospitals were less likely to practice than those who work in the station-level hospital.Originality/valueThis paper explored the associated factors to health care personnel's practice of health care management towards GBV survivors in Myanmar which contains information about knowledge, attitude and supportive environmental factors. The study results can be used for a supportive data for health system strengthening the response of GBV cases in Myanmar.

Prevailing Housing and Healthcare Management Practices in Urban and Peri-Urban Dairy Farms of Navsari District, Gujarat State

Personal interviews collected the required information from a total of 40 dairy farms from urban and peri-urban areas in and around Navsari. Frequency distribution was made from collected data, and significance between two categories was tested by the Chi-square test. Data revealed that all farms provided housing round the year. The majority of the sheds had cement type of pillars and pucca floor. Gabled roof was more popular in peri-urban areas. The majority of the farms had animal shed away from human dwelling, east-west directional, a double row with head to head. The majority of the sheds had adequate light and good ventilation with drainage facility and manure pit located at an adjacent distance. The majority of farms (90%) practiced regular vaccination to their animals against foot and mouth disease and hemorrhagic Septicaemia disease. The majority (82.5%) of the respondents practiced deworming of their dairy animals regularly and also followed practices to control ectoparasites. However, only 37.5% of the farmers got their sick animals treated by veterinary officers, and 40% of farmers segregate disease affected animals. The study concluded that the majority of the farmers followed housing and health care management practices for improving the production potential and health of the dairy animals.

Extent of knowledge and adoption of livestock rearing practices by the farmers from South Konkan

Majority (75.00 per cent) of the farmers had low knowledge regarding livestock rearing practices. Among the eight practices under housing management practices, all respondents (100.00 per cent) had knowledge about standing space, drainage channel/ gutter, single row housing system and water supply. Data related to health care management practices revealed that 100 per cent of the respondents had knowledge about care of sick animals and vaccination programme. In case of breeding management practices, it is observed that, heat detection in animals, method of breeding, time of artificial insemination, superior stock identification for extensive breeding practices were known to 100.00 per cent of dairy farmers. The result noticed from feed and fodder management practices revealed that, all of the respondents (100.00 per cent) had knowledge about concentrates and dry matter for pregnant animal and hay/ straw shed (Dutch barn). Cent per cent dairy farmers had knowledge about utensils used and their cleaning as well as sanitization, before milking, use of disinfectants for udder and teat cleaning and sign of calving. It was seen from care and management practices immediately after calving that 100.00 per cent dairy farmers had knowledge about watching of cow for placenta expulsion, allowing the calf to suck the colostrum, mucus removal from face and nostrils of calf, well ventilated environment and dry bedding. In case of extent of adoption of livestock rearing practices it was found that majority (49.16 per cent) of the farmers had low extent of adoption, followed by (39.17 per cent) of them show high adoption level, while 7.50 per cent and 4.17 per cent of the livestock owners were having medium and very high adoption level, respectively. In case of livestock rearing practices, full adoption was observed in practices like before milking, use of disinfectants for udder and teat cleaning, watching of cow for placenta expulsion, allowing the calf to suck the colostrum, mucus removal from face and nostrils of calf.

Cattle production system in doab area of Uttar Pradesh

The present study was undertaken for collecting base line information on cattle rearing pattern and identify, establishment of germplasm distribution network of Frieswal crossbred and zebu cattle under field conditions of Doab area.The study on socio-economic parameters revealed that the average age of dairy farmers was 51.31 years with range between 23–85 years.Occupation wise maximum (89%) households belonged to agriculture (farming) group followed by dairy (8%), service (2.5%) and business (0.5%).The average educational qualifications of animal owners were high school (24.5%). The average herd size was 2.89 dairy animals per household followed by 1.15 cattle and 1.75 buffalo per households in study area. A total of 95.58% crossbred cows were covered by artificial insemination and 4.42% were covered through both AI/natural services. The average number of services per cow was 1.75 per animal. Parity wise production of cattle was found highest (14.28±2.7 kg) in 4th lactation and lowest (9.61±3.4 kg) in 1st lactation followed by 5th (11.71±4.4 kg), 2nd (10.21±3.0 kg) and 3rd (9.70±2.9 kg) lactation. The average milk production was 14.33 kg out of which, 7.36 kg per day was used for household’s consumption. The rest of milk (12.24 kg) was sold to local milkman/purchaser for income. This study will be very helpful in improvement of breeding, feeding and healthcare management practices and to understand the production and consumption pattern of milk in the Doab area of Uttar Pradesh.

Psychoanalysis: neglected ally in an emerging “critical healthcare management studies” (CHMS)?

PurposeThe purpose of this paper is to demonstrate the relevance of psychoanalysis to an emerging sub-field known as “critical healthcare management studies” (CHMS).Design/methodology/approachBuilding upon a wave of critical scholarship in the broader field of management, scholars and practitioners of healthcare management have begun to forge a critical scholarly movement of their own. CHMS, short for “critical healthcare management studies,” formally denotes a new subfield of inquiry dedicated to challenging entrenched assumptions, exposing power relations, and cultivating critical praxis, all the while serving as a vital counterpoint to mainstream scholarship. This paper seeks to augment the CHMS movement with psychoanalysis, and particularly the critical vein of organizational psychoanalysis already well-established in critical management studies.FindingsThe argument is made that a greater engagement with psychoanalysis offers novel avenues for critical theorizing and practice in healthcare management. Specifically three areas are considered: 1) the exploitative role of guilt in the caring professions, 2) the resurgence of authoritarianism and its implications for unconscious organizational dynamics, and 3) the potential for a psychoanalytically informed critical healthcare praxis.Originality/valueWhile there remain wide differences of opinion about the utility of psychoanalysis outside of the clinical arena, this paper reveals just how psychoanalysis can inform today's healthcare organizations, and more broadly the social and political organization of health in society.

Application of the basics of strategic management in healthcare practice (review)

The study confirms the decisive role of strategic management in healthcare management practice. The authors pay attention to historical aspects and modern approaches to the characterization of strategic management. The study justifies the importance of ensuring the continuity of strategic goals. The analysis made it possible to identify general and unique characteristics of the strategic management of health care. The authors emphasize the need to take into account the specifics of the healthcare industry when using traditional methods of strategic management. An analysis of existing tools and approaches to strategic management in healthcare proved their relevance and confirmed the mandatory regulatory and organizational support of strategic management in this industry. Therefore, strategic management ensures unity and coherence of strategic objectives. The results of the study expanded the understanding of the possibilities of applying strategic management technologies in the healthcare system, paving the way for further research on this issue.

Healthcare management and the 2020 Nightingale bicentenary celebrations

Nursing and midwifery will be in the spotlight throughout 2020, which has been declared the international year of the nurse and midwife by the World Health Organization. In conjunction with this, the Nightingale bicentenary celebrations are also taking place globally this year. Healthcare managers worldwide are encouraged to look back on the contribution that Florence Nightingale made to contemporary healthcare management and healthcare practice, as well as reflecting on the crucial role of nurses and midwives today.

Accessibility and frequency of Information and Communication Technologies (ICTs) usages by Haryana Farmers

The study was carried out in four district of Haryana state namely Yamunanagar, Karnal, Hisar and Fatehabad, selected randomly. In total 240 respondents from 16 village were selected for analysis of Accessibility and frequency of ICT. Availability of mobile among the farmers was high followed by television, FM/Radio, internet accessed WhatsApp; face book; YouTube; E-mail, camera enabled mobile phone, Computer, , E-book and CD/VCD were found available and accessed by the farmers. Frequent use of mobile phone by farmers was found followed by TV, FM/Radio, internet, WhatsApp; Mobile phone, face book, YouTube, Computer, E-mail, E-book and CD/VCD. Farmers use of ICTs for the Variety of purpose included marketing, schedule of water supply, supportive facts, plant protection measures, marketing of dairy product, health care practices, management practices, breeding and reproduction practices. Variables education, socio-economic status, extension contact, mass media exposure, scientific orientation, economic motivation and risk orientation exhibited positive and significant whereas age exhibited negative significant with number of ICTs usage by farmers.

Epidemiology of Hypertension in a Typical State-Level Poverty-Stricken County in China and Evaluation of a Whole Population Health Prevention Project Intervention.

Background In China, there were 584 state-level, poverty-stricken counties until January 2019. The central government has invested a large amount of funds and preferential policies to alleviate poverty in these areas. The Whole Population Preventive Healthcare Pilot Project (WPPHCPP) aims to explore the use of limited funds to achieve healthy poverty alleviation through free regular physical examinations and comprehensive health management for the entire population in impoverished regions. Objective By demonstrating the prevalence of hypertension in populations of poverty-stricken counties in Western China and evaluating health management outcomes after implementing the WPPHCPP, we can provide a foundation for the future development and promotion of improved public health. Subjects and Methods Through the WPPHCPP, the entire population in the pilot area was required to undergo free physical examinations. The examinations screened for hypertension revealed the epidemiology of adult hypertension. Based on blood pressure levels and risk factor exposures, risk classifications for hypertensive patients were performed. Corresponding intervention and management strategies for different risk levels were provided by a joint management team consisting of family physicians from three different levels of local medical institutions (village, town, and county). Healthcare management outcomes including awareness, treatment, and hypertension disease rates were compared between the period before and after the intervention and management. Results By the end of 2017, among the 452,200 permanent residents in the region, 285,458 adults had completed the physical examination. The prevalence of hypertension was 18.5%, which was lower than the national average of rural areas (28.8%). The prevalence of hypertension in men (18.7%) was slightly higher than that of women (18.3%). The prevalence of hypertension increases with age; for people aged >65 years, it was 39.2%. There were 15,074 newly discovered hypertensive patients in the WPPHCPP, accounting for 29.6% of the total hypertensive population in the region. Regarding the management outcomes, the rates of management and standardized management of hypertension increased each year between 2015 and 2017. Although the rate of disease control management decreased slightly, the overall level of management remained significant. The awareness and treatment rates of hypertension also increased over the years and peaked at 95.0% and 94.9%, respectively, in 2017. The disease control rate was 45.6% in 2016, which was the highest among the years assessed. All the above parameters were better than the national average of rural areas. From 2015 to 2017, the number of people with high-risk factors for hypertension and percentage of high-risk patients decreased from 33,064 to 26,982 and 27.4% to 24.6%, respectively. The percentage of the population exposed to cigarettes and alcohol decreased from 30.6% to 27.2% and 25.1% to 22.0%, respectively. The number of deaths due to hypertensive cardiovascular or cerebrovascular diseases decreased each year and was 275 (39.55/100,000 people) in 2017, which was the lowest rate measured. The annual growth of cardiovascular or cerebrovascular diseases remained negative. Conclusions The overall prevalence of hypertension in the studied area was lower than the national average of rural areas. The health management model of “government-led joint efforts of three levels of medical institutions (village, town, and county) with active participation of local village communities” improved the management outcomes of hypertensive patients and fulfilled the latest advocacy of the prevention and control of chronic diseases by the United Nations. This model can be considered an effective model for healthcare management practice in similar situations.

Hacking teamwork in health care: Addressing adverse effects of ad hoc team composition in critical care medicine.

The continued need for improved teamwork in all areas of health care is widely recognized. The present article reports on the application of a hackathon to the teamwork problems specifically associated with ad hoc team formation in rapid response teams. Hackathons-problem-solving events pioneered in computer science-are on the rise in health care management. The focus of these events tends to be on medical technologies, however, with calls for improvements in management practices as general recommendations. The hackathon reported here contributes to health care management practice by addressing improvements in teamwork as the focal problem. The hackathon event took place over 2.5 days in conjunction with an academic conference focused on group research. Three teams comprised of practicing healthcare professionals, academic researchers and students developed solutions to problems of ad hoc team formation in rapid response teams. The event fulfilled several goals. The teams produced three distinct, yet complementary solutions that were backed by both field-based experience and solid research evidence. The event provided the opportunity for two-way translation of research and practice through direct collaboration among key stakeholders. The hackathon produced long term effects through establishing or strengthening collaborations, dissemination of the ideas through presentations, workshops, and publications, and changes in participantsâ work practices. The event demonstrated that hackathons, classically focused on technology, can also offer a spur to innovation around organizational processes. The article provides advice for organizing other hackathons focused on similar topics. The solutions offered by the participants in the event yields the clear insight that multipronged solutions for emergency-oriented teamwork are needed. The hackathon highlighted the scaled of collaboration and effort needed to tackle the many complexities in health care that impact outcomes for providers, patients, and health organizations.

Modelling the factors affecting Nigerian medical tourism sector using an interpretive structural modelling approach

ABSTRACT Healthcare system of Nigeria is still considered to be in its developing stage when compared to other countries like USA and UK. Nigeria can perform exceptionally well in its healthcare delivery system if some factors are put into place. The aim of this paper is to identify the factors affecting Nigerian medical tourism sector. With respect to this, 15 variables were identified from literature reviews and brainstorming sections among experts in healthcare executives which, in turn, gave rise to the development of a structural model. More appropriate understanding of these factors/variables and their various contextual relationship will help to improve Nigerian medical tourism sector. The contextual relationship between these variables was identified and Interpretation Structure Modelling (interpretive modelling technique) was used. Furthermore, the MICMAC analysis was also employed in the classification of the 15 variables based on their individual driving power and dependence power in order to classify the factor affecting Nigerian medical tourism sector. The model factors affecting medical tourism in this study will contribute to improving healthcare management practice in other countries, which are currently having issues concerning high migration of patients for medical tourism. When these factors are properly implemented, they will give rise to best practices and ensure excellent healthcare delivery.

\u2018You can give them wings to fly\u2019: a qualitative study on values-based leadership in health care

BackgroundWithin contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health care managers experience their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way?MethodWe carried out a qualitative study (Grounded Theory Approach) to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium.ResultsSix predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: (1) values-based health care management as managing a large garden, (2) as learning and using a foreign language, (3) going on a trekking with an ethical compass, (4) embodying integrity and authenticity in a credible encounter with everyone, (5) being a present and trustworthy leader during sun and storm, and (6) contributing to human flourishing by giving people wings to fly.ConclusionsNotwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization.

The effect of healthcare management and physicians’ loyalty

ABSTRACT This paper examines the effect of Healthcare Management (HCM) on the satisfaction and loyalty of physicians from hospitals in Bangladesh. Five hundred physicians from both private and public hospitals were sampled, and 175 questionnaires were returned, giving a response rate of 35 per cent. Data collected was analyzed using descriptive statistics and structural equation modelling (SEM). Findings revealed that there are significant positive relationships between healthcare controlling, healthcare leading, healthcare organizing, healthcare staffing, and physicians’ satisfaction in Bangladesh while healthcare planning is not supported. Results also show that 30.5 per cent variations in physicians’ loyalty are explained by physicians’ satisfaction. Practically, the findings of this study serve as inputs for policymakers in formulating policies to improve healthcare management practices as well as the entire health sector in Bangladesh.

Understanding the Current State and Future Directions of Hotel Sector Knowledge Management: A Literature Review

This review highlights the huge opportunity provided by leveraging knowledge management principles across the hotel industry. By way of context, the author has over 20 years of international experience in the hotel industry (at executive level, including managing privately-owned and single hotels, some as part of a medium-sized brand, with others as part of a very large [global] hotel brand). When he transitioned from a hotel company of medium size to one of the largest (about 10 years ago), he observed significant differences in business processes, structure, resources, and culture. Wondering about these differences, he examined them more closely and started to read broadly about strategy, competitive advantages, and capabilities. Gaining a deeper understanding, he realized that the observed differences were related to knowledge management. In his research, many organizations were found to have used knowledge management to extract, recycle, harness, share, and leverage knowledge for improved performance and competitive advantage. In some cases, millions of US dollars were saved. Furthermore, from knowledge management practices in consultancy, healthcare, and manufacturing, the expectation was that rich, in-depth research would be found on hotel-(specific) knowledge management. Logically, it was expected that top executives (and other stakeholders holding hotel portfolios, such as real estate/investment funds/investment bankers and hotel operators) would be extremely keen to learn about and use knowledge management to leverage their companies’ performance. Surprisingly, the opposite seems to be the case. This thorough review demonstrates that little research has been conducted on hotel knowledge management, and that even in hotel-(specific) knowledge management, “secrecy” (operating in a vacuum) can be experienced. The premise is that top executives (C-level executives) constantly search for the latest insights (knowledge) and best practices to find implementable concepts so their organizations can remain ahead of the competition. This paper reviews and establishes the current state of the existing body of hotel-(specific) knowledge management literature and highlights gaps and possible opportunities for the future. Through adding to the depth of hotel-(specific) knowledge management research, refreshed interest can be generated in this field, possibly stimulating a better understanding of how hotel-(specific) knowledge management can be used to maximize its benefits.

Global Advances in Value-Based Payment and Their Implications for Global Health Management Education, Development, and Practice.

Global advances in health policy reform, health system improvement and health management education and practice need to be closely aligned to successfully change national health policies and improve the performance of health care delivery organizations. This paper describes the globally acknowledged need for incentive-based organizational performance and relevant implications for health care management education (HCME) and practice. It also outlines the major rationale underlying Value-Based Payment (VBP) or Pay for Performance (P4P) health policy initiatives and their basic elements. Clearly, the major global health policy shift that is underway will likely ultimately have major impacts on the strategic and operational management and performance of health care delivery organizations. Thus, practical specific suggestions are made regarding changes that need to be introduced and strengthened in contemporary health care management education and development programs to help organizational managers in the future.

Embedding the patient during a service improvement programme in a healthcare system. Making beds in the NHS

An introduction comprising background and problem statement: There is a wide range of research into Patient Participation PP in healthcare 1, 2. However, certain areas of patient co-designed care remain under researched. One such area is organizational service delivery systems and models 2. While PP in organizational change management in healthcare remains almost unexplored. Unique access to an English Foundation Trust’s Lean service improvement programme SIP, enabled research which looks at whether/how the delivery of organizational change management in healthcare can be co-designed with the patient. Adopting the integrated care components of ‘Vision holistic perspective, organization and governance’ 3 the research captures tensions involved in fully involving the patient in their own care. Theory/Methods: Tensions in power, rationality and accountability/responsibility, examine and explain the patient’s role in the SIP. Ethnography empirically captures data relating to these tensions. Critical Action Research situates the research in the Trust’s organizational discourse. Results: To date the research offers dual insights into PP in organizational change management. Firstly, coterminous themes have been identified between PP and Lean theory which suggest existing organizational change management practices in healthcare are concomitant with theories of integrated care. Waste and value in systems efficiency; knowledge and perspective in strategy development; and organizational and healthcare boundaries, the traditional divide between roles and voice in co-designing care. Next, research into the patient’s role as a change agent in Lean organizational change management, suggests possible new Lean practices in healthcare, which work around patient participation. Discussions: PP in healthcare is already well established 1. Moral 4, 5, consequentialist 4, 6, epistemological and ontological 4, 6 and historical 7 perspectives and approaches have all been explored. Greater PP in their own care has a positive effect on patient 8 and organizational 6 outcomes. However, research into PP in healthcare organizational change management identifies further interesting areas of tension. Including the manifestation of coterminous themes and the boundaries organizational change management. Perspectives on the research’s theoretical rigour, place within the integrated care framework, limits and possible future research, will be discussed. Conclusions comprising key findings: For progress on integrated care aims the tensions between PP and organizational change management need to be explored and reconciled. For example, patient perspective, experience, specificity and voice may achieve healthcare improvements through contextual clarity and coherence of care. But the aim of zero-defect operating manifest in the SIP and patient safety goals to which healthcare organizational income is related, place these two positions at odds. This raises ontological and epistemological questions. Such as who or what structures drive patient service delivery outcomes power, who should make decisions on strategy development rationality and who or what is responsible for poor system efficiency responsibility and accountability. Suggestions for future research: Exploring capacities within care organisations to provide double-loop learning process redesign or deutero-learning learning to learn. 2; Overcoming barriers and integrating facilitators in cross-disciplinary groups 9 Orchestrating wider local governance which encompasses people’s integrative needs and perspectives 3

Dairy husbandry information needs of farmers in different agro-climatic zones of Uttar Pradesh

The present study was undertaken to examine the information needs of farmers using mKisan services with respect to different dairy husbandry practices. Results of weighted mean score revealed that farmers have higher information need about feeding and watering practices (2.20) followed by marketing of farm produce (2.19), breeding practices (2.18), health care practices (2.12), management practices (2.11) and fodder production and grass land management (2.10) with their information deficiency level of 73.3, 73.0, 72.7, 70.7, 70.3 and 69.9%, respectively. Major needs were related to recommended feeding practices of dairy cattle (2.38) and area specific mineral mixture (2.30). Information about procurement agencies in area (2.15) and day-to-day price variation of different farm produce (2.11) were also found of great concern in marketing of farm produce. Farmers have higher information need about estrus detection and time of insemination (2.30), selection of dairy cattle (2.21) and heifer management (2.18) in the domain of breeding. In health care practices, information about preventive measure against diseases (2.23) and vaccination schedule (2.17) was much needed. In management practices, information need for calf management (2.20) and clean milk production (2.19) was found to be highest. In fodder production and grass land management domain, information need about locally suitable fodder varieties (2.16) and management for fodder availability round the year (2.14) were at highest priority. Information need over different aspect of dairy husbandrypractices had significant variation across the different agro-climatic zones of Uttar Pradesh. North Eastern Zone and Bundelkhand Zone were found the highest information deficient zones in Uttar Pradesh.

System Stability: The Role of Treatment Program Size and Performance on Closure

Little is known about the stability of the substance use treatment service system to provide consistent care. Guided by organizational theories, we examined whether program size (number of admissions) and performance (treatment access, retention, and completion) is associated with program closure. This study relied on multiyear administrative data of 249,029 treatment admission episodes from 475 treatment programs in the Los Angeles County system between 2006 and 2014. Findings from survival analysis show partial support for most hypotheses - program size and retention rates were negatively associated with risk of closure. Compared to residential treatment services, outpatient services were positively associated with risk of closure. Contrary to what we expected, having a higher proportion of Medicaid-eligible clients was associated with risk of closure. The closure of smaller and strategically located outpatient programs in minority communities has significant implications for population health and reducing health disparities. Implications for theory development and health care management practices to support delivery of quality care are discussed.

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

Doctors' work and the changing, contested meanings of medical professionalism have long been a focus for sociological research. Much recent attention has focused on those doctors working at the interface between healthcare management and medical practice, with such ‘hybrid’ doctor-managers providing valuable analytical material for exploring changes in how medical professionalism is understood. In the United Kingdom, significant structural changes to medical regulation, most notably the introduction of revalidation in 2012, have created a new hybrid group, Responsible Officers (ROs), responsible for making periodic recommendations about the on-going fitness to practise medicine of all other doctors in their organisation.Using qualitative data collected in a 2015 survey with 374 respondents, 63% of ROs in the UK, this paper analyses the RO role. Our findings show ROs to be a distinct emergent group of hybrid professionals and as such demonstrate restructuring within UK medicine. Occupying a position where multiple agendas converge, ROs' work expands professional regulation into the organisational sphere in new ways, as well as creating new lines of continuous accountability between the wider profession and the General Medical Council as medical regulator. Our exploration of ROs' approaches to their work offers new insights into the on-going development of medical professionalism, pointing to the emergence of a distinctly regulatory hybrid professionalism shaped by co-existing professional, managerial and regulatory logics, in an era of strengthened governance and complex policy change.

English

The study was purposively taken up with the objective to find out the patterns of pre-weaning piglet mortality and economic losses in field condition. The study was purposively taken up in Gorkhaland Territorial Administration area where pig farming is a common practice. The study shows that overall pre-weaning piglet mortality was 15.62% where it was slightly higher in exotic than indigenous breed. Highest pre-weaning mortality was recorded among 0 to 15 days age group piglets mainly during winter months and in third parity of dam. The major reasons of pre-weaning piglet mortality found in the study area were chilling, piglet anemia and scouring. Overall economic losses due to pre-weaning piglet mortality were around $18696 during the last 3 years in which it was around $5453 in indigenous breed and around $13243 in exotic breeds. Economic losses due to pre-weaning piglet mortality was recorded highest for scouring, followed by chilling and low birth weight in indigenous breed, whereas it was highest for piglet anemia followed by chilling and scouring in exotic breed. Therefore, proper healthcare programme and management practices must be undertaken to avoid these huge economic losses under field condition. Key words: Piglet mortality, indigenous breed, exotic breed, piglet anemia.