Institutional Conflict Research Articles

The vicious circle of patient-physician mistrust in China: health professionals' perspectives, institutional conflict of interest, and building trust through medical professionalism.

To investigate the phenomenon of patient-physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust (particularly physicians' distrust of patients and their relatives) leads to increased levels of fear and self-protection by doctors which exacerbate difficulties in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism-the primacy of patient welfare-as well as the traditional Chinese ideal of "medicine as the art of humanity". Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures.

How Do Internet Enterprises Obtain Sustainable Development of Organizational Ecology? A Case Study of LeEco Using Institutional Logic Theory

This study explores how Internet enterprises integrate different industries to sustainably develop organizational ecology, using institutional logic theory and an exploratory case study of LeEco, a famous Chinese Internet enterprise. The findings are as follows: (1) There are two main barriers to sustainable development of internal organizational ecology: resource barriers and information barriers. To overcome these obstacles, managers should carry out a series of institutional practices so that the organizational ecology obtains both product and institutional legitimacy; (2) A new institutional practice, the rigid/flexible method, is proposed, which includes implementation, communication, incentive, and cultural mechanisms. This method can help reconcile institutional logic conflicts caused by multiple logic coexistences in the organizational ecology; (3) A sustainable development model of organizational ecologies for Internet enterprises is presented, based on institutional logic, for closed-loop analysis of the ecological growth path. Based on a case study of China’s Internet environment, this paper opens up the “black box” of the internal growth of Internet enterprises at the micro level, complementing the macro studies in the literature. This study enriches organizational ecology theory and institutional logic theory. In addition, the case study of LeEco provides sufficient information on sustainable development to serve as a model for other Internet enterprises.

The Inspector General: Political Culture and Constraints on Effective Oversight

Their enabling legislation and mission statements ostensibly charge federal inspectors general in the United States with capacity-building and performance-enhancement as well as compliance-monitoring powers and responsibilities. This article reviews the constraints on those powers. It proposes that American distrust of government both historic and current—the former reflected in the institutional conflict built into the constitutional structure, the latter reflected in survey research data on trust in American government—encourages the compliance-monitoring role of the inspector general (IG) and discourages the capacity-building and performance-enhancement roles. It then reviews studies of China’s recent anticorruption efforts as well as survey research data on popular trust in the government of the People’s Republic of China. It suggests that Chinese trust in government would support capacity-building and performance enhancement but discourage compliance monitoring were China to institute an IG system. It concludes that an IG system could prove beneficial even in a nation with an authoritarian government, albeit in a different way than in a constitutional democracy, and that, in general, political culture helps to determine which aspects of the role an IG will be able to pursue most effectively.

Implementing cost transparency in oncology: A qualitative study of barriers, facilitators, and patient preferences.

6597 Background: As cancer drug prices rise and insurance plans shift toward greater cost sharing, studies link patients’ high out-of-pocket (OOP) costs to non-adherence and early discontinuation of treatment. Meanwhile, few oncologists routinely discuss OOP costs with their patients. Using qualitative methods, we explored barriers and facilitators of cost transparency (i.e., disclosure of financial risks of cancer treatment). Methods: We performed semi-structured interviews with cancer patients (n = 22) and providers (n = 19) at an academic medical center and three affiliated community practices between August, 2015 and May, 2016. Two analysts coded the transcribed interview data using textual thematic methods, and hypotheses were generated employing grounded theory method. Results: We grouped themes that emerged into three major domains: 1) barriers, 2) facilitators, and 3) patient preferences. Patients and providers both expressed a strong aversion to making tradeoffs between financial and physical health outcomes. While patients feared being “profiled” based on their ability to pay, providers feared that cost transparency might threaten the doctor-patient relationship by exposing personal or institutional financial conflicts of interest. Pragmatic barriers included time constraints and difficulty in providing accurate cost estimates. Important facilitators were strong doctor-patient relationships and availability of support staff with financial expertise. We detected substantial heterogeneity in patient preferences. While some patients wanted to discuss costs with their provider, others feared “distracting” providers from their primary roles as health advocates. Conclusions: With implementation of OOP cost transparency, oncology practices will need to consider patient/provider aversion to financial/health tradeoffs, patients’ sensitivity to socioeconomic “profiling,” provider- and practice-level financial incentives, time constraints, accuracy of cost estimates, and variability in patient preferences. Meanwhile, strong provider-patient relationships and availability of support staff will facilitate OOP cost transparency.

Funding, Institutional Conflicts of Interest, and Schools of Public Health

Individual researchers are accustomed to declaring conflict of interest (COI), if it exists, when submitting manuscripts for publication or in public presentations. In this Viewpoint we focus on an equally important issue—whole-institution COIs, specifically financial COIs in schools of public health, and address 2 interlinked questions: When does this funding represent an important conflict and what can schools of public health do about it? This topic is particularly important because academic schools of public health today have little choice but to accept extramural funding. Schools of public health derive income from 2, or sometimes 3, sources. State schools derive some income from the state, although this source of funding is rapidly diminishing. Other schools rely on income from tuition and extramural sources in the form of grants, contracts, or philanthropy. The majority of the budget of leading schools of public health is often derived from extramural sources. Divesting from such sources would mean a much narrower scope of work, and consequently less potential effect on the health of the public.

Role of Leaders in Fostering Meaningful Collaborations Between Academic Medical Centers and Industry While Also Managing Individual and Institutional Conflicts of Interest

Over at least the past 20 years, putative and real conflicts of interest (COI) at academic medical centers have been featured prominently in the lay press, often with reputational damage to individuals and institutions.1 The heightened focus of concern about alleged financial payments to physicians and academic institutions by pharmaceutical and device companies, coupled with increasing concern by medical students (most notably in the American Medical Student Association scorecard, which gave grades to medical schools ranging from A to F based on how well they performed in avoiding conflicts of interest with the pharmaceutical industry) shone a bright light on individual and institutional integrity.

Analyzing conflict and its management within ICT4D partnerships: an institutional logics perspective

ABSTRACTPromotion and presence of partnerships have been growing within information and communication technology for development (ICT4D). Yet – despite limited analytical literature on this topic – it is clear that the reality of ICT4D partnerships often undershoots the potential, with frequent reports of failure, particularly arising from conflict between partners. This paper addresses calls for more and better-conceptualized research into ICT4D partnerships, with a specific focus on understanding the roots and management of conflict in such partnerships. We use qualitative field data from a Malaysian IT “impact sourcing” public–private partnership case study, viewed through the lens of institutional logics and conflict management strategies. Analysis of three vignettes from the negotiation of the initiative shows one partner always used a competitive approach to conflict management. This led issues to remain unresolved and led the partnership arrangement to steadily loosen. The outcome was always domination of private logic over public logic. As a result, and lacking an overt advocate, welfare goals of the partnership were somewhat sidelined. Our paper contributes by showing (a) how institutional logics helps explain the outcome of ICT4D partnerships, and (b) how the conflict management strategies framework helps explain the practice of conflicting institutional logics in such partnerships.

The System of Motivation As a Way of Solving Institutional Conflicts

The System of Motivation As a Way of Solving Institutional Conflicts

Prison Chaplains: Inmate/Correctional Officer Role Perceptions and Conflict Management in Modern Corrections

ABSTRACTUtilizing data from 19 interviews with prison chaplains employed by a Midwestern state department of corrections, this study examines how chaplains perceive both staff and inmates to view their role within the institution. Moreover, this study examines techniques used by prison chaplains to manage institutional conflict. Chaplains perceived inmates to view them as a gatekeeper of goods and services within the institution, ultimately viewing inmates with an inherent suspicion. Chaplains perceived custodial staff to view them as a “Hug-a-Thug,” casting them as pro-offender and anti-custody while chaplains largely believed custodial staff do not respect an inmate’s religious rights. For conflict-management, chaplains largely utilized the techniques of using conversation as a ‘safety valve,’ demonstrating respect to staff/inmates, and maintaining personal/professional boundaries.

Leaving Behind the Commonwealth Model of Rights Review: Ireland as an Example of Collaborative Constitutionalism

This paper develops a model of collaborative constitutionalism as an alternative to conventional models of constitutional review. It argues that the Irish system of rights-based review differs in important ways from the new Commonwealth model of constitutionalism advanced by Stephen Gardbaum. While the Irish courts possess 'strong form' powers of judicial review, the paper provides a detailed examination of the interpretative and substantive principles of Irish law that function, in practice, as structural barriers to judicial supremacy.The paper moves on to argue that these factors are not unique to the Irish situation. Similar principles can be found in other constitutional systems. The paper argues therefore that, between the American model of so-called ‘strong form’ of judicial review and the new Commonwealth model of parliamentary-judicial dialogue, the Irish experience reflects a possible third way, which ‘eschew the exaggerated images of institutional conflict that the language of judicial or parliamentary supremacy tends to evoke’.

Whose Equity Matters? National to Local Equity Perceptions in Vietnam's Payments for Forest Ecosystem Services Scheme

This paper focuses on the assessment of legislative considerations and local perceptions of equity in Vietnam's Payments for Forest Ecosystem Services scheme (PFES). Equity perceptions are powerful determinants of human behaviour and, consequently, many environmental conflicts arise from contested visions of what constitutes as ‘equitable’ environmental management. Therefore, equity can play an instrumental role in shaping outcomes of PFES schemes. This paper analyzes how contextual, procedural and distributive equity considerations are reflected in national PFES legislation and implementation, how equity outcomes are perceived locally, and whether local perceptions match legislative considerations. We reviewed national legislation and government reports, conducted expert interviews on the national and provincial level, as well as surveys, focus group discussions, and in-depth interviews on the local level. Our findings reveal that equity outcomes are very much affected by contextual factors, such as how the Forest Land Allocation regulation determines the distribution of use rights. In the implementation of PFES national aspirations and rationales of equity as outlined in legislation were not met due to technical constraints, financial costs, and social and institutional conflicts. The implementation on the ground contrasts with local interests. Our results show that on the local level the preference for a distributive equity principle is very much influenced by the degree of transparency of the payment distribution process. The prevailing perceptions of equitable benefit distribution by local PFES participants correspond to a merit-based principle of compensation for the effort of forest protection.

Vietnam. Politics in contemporary Vietnam: Party, state, and authority relations Edited by Jonathan D. London Houndmills: Palgrave Macmillan, 2014. Pp. 230. Notes, Bibliography, Index.

Politics in contemporary Vietnam: Party, state, and authority relations Edited by JONATHAN D. LONDON Houndmills: Palgrave Macmillan, 2014. Pp. 230. Notes, Bibliography, Index. doi: 10.1017/S0022463416000667 As the Vietnamese economy further grows and the country pursues broader international integration, it becomes better known to the outside world, and academic research on the country's economy has expanded enormously. In contrast, its contemporary politics remains largely under-explored territory. The number of international scholars working on Vietnamese politics also tends to dwindle as the older generation of Vietnam watchers have become less active or diverted their research interests to other areas, while the younger generation have yet to catch up. Inside the country, national politics is deemed a 'sensitive' subject, further discouraging the study of the issue by Vietnamese researchers. Politics in contemporary Vietnam, edited by Jonathan D. London, is perhaps the only notable recent book-length examination of Vietnamese politics. That fact alone ensures that the book deserves some serious attention from those interested in the country. Apart from the introduction and conclusion by the editor, the volume is composed of seven chapters dealing with three major themes, namely the politics of the Communist Party of Vietnam (CPV), the state administrative apparatus, and the representative institutions and mass organisation. In Chapter 2, Tuong Vu provides a background for the book by examining the evolution of the CPV from its early days into the present. Vu argues that the CPV is currently in decline and describes the Party since 1986 to be in a state of a 'continuing decay'. Vu bases his argument on the perceived large-scale corruption and cronyism within the Party system, as well as the erosion of the Party's rural support base due to the country's shift to an industrial economy. However, Vu posits that the Party still has many tools and measures at its disposal to prolong its survival, including rising nationalism. In two related chapters, Benedict J. Tria Kerkvliet (Chapter 6) and Carlyle A. Thayer (Chapter 7) discuss the nature of the CPV's authoritarian regime. Thayer dissects the country's repressive apparatus, focusing on the role of four state organs: the Ministry of Public Security, People's Armed Security Force, General Directorate II (military intelligence), and the Ministry of Culture and Information (now Ministry of Information and Communication). Thayer's account highlights the repressive nature of the regime and details their various measures to crack down on political dissidents. Meanwhile, Kerkvliet takes issue with some authors' claims that the Vietnamese government 'does not tolerate any challenge to its one-party rule', or that the CPV 'tolerates no dissent or opposition'. While sharing the view that the CPV regime is generally authoritarian and repressive, Kerkvliet also argues that the Party actually tolerates a certain level of dissent as long as the dissidents do not act in an organised manner and directly threaten its rule. Specifically, through an analysis of how the regime treated 62 dissidents, the author concludes that having a history of service to the government or the party, or not being a prominent member of a dissident organisation, may reduce the likelihood of a dissident being arrested and imprisoned. In their chapters on Vietnam's state apparatus, while Thaveeporn Vasavakul (Chapter 3) analyses the evolving accountability relations within the one-party system, Thomas Jandl (Chapter 4) examines the relationship between the central and local governments as well as between local leaders and the central authorities during the process of decentralisation. Specifically, Vasavakul analyses Vietnam's efforts to introduce accountability mechanisms into the operation of the state system. Accordingly, she finds that intra-state institutional competition and conflict play an important role in promoting accountability and thus shaping the evolution of Vietnam's one-party system. …

A reality check on the landscape approach to REDD+: Lessons from Latin America

Developing and institutionalizing cross-sectoral approaches to sustainable land use remains a crucial, yet politically contested, objective in global sustainability governance. There is a widely acknowledged need for more integrated approaches to sustainable land use that reconcile multiple landscape functions, sectors and stakeholders. However, this faces a number of challenges in practice, including the lack of policy coherence and institutional conflicts across agricultural and forest sectors. In this context, the global climate change mitigation mechanism of “reducing emissions from deforestation and forest degradation” (REDD+) has been flagged as a unique opportunity to stimulate the development and institutionalization of more integrated, “landscape” approaches to sustainable land use. In this article, we provide a reality check for the prospects of REDD+ to deliver on this promise, through analyzing three pioneer cases of REDD+ development and implementation in Brazil, Ecuador, and Mexico. We analyze how REDD+ has operated in each of these three contexts, based on field work, key-informant interviews, and analysis of primary and secondary documents. Our findings suggest that REDD+ has stimulated development of “niche” sustainable land-use investments in each case, which aim to integrate forest conservation and agricultural development goals, but has done so while competing with business-as-usual incentives. We conclude that national and international political commitment to more integrated and sustainable land-use approaches is a precondition for, rather than a result of, transformative REDD+ interventions.

理性博弈、制度变迁与经济效率—基于完备理性人假设的理性度—制度模型

新疆南北疆经济发展存在着很大的不均衡性，区域之间经济发展的差异较大，本文试应用理性度——制度模型，将文明与制度的冲突在模型中应用来分析南疆和北疆所处的效率区域，并分析制度的供应造成的社会交易费用差异和社会分工的差异，从而提出新疆经济社会发展政策建议，以更好地促进新疆区域间经济发展。 There are great disparities in the southern and Northern Xinjiang, the economic development, this article tries to explain the difference of economic development between the areas from the perspective of cultural and institutional conflict, using reasonable degree, system model, system culture and conflict in the model should be used to analysis of efficiency of South Xinjiang and North Xinjiang region, and to analyze the system of mandatory supply caused by the difference in the social transaction cost differences and the division of labor in society how to influence economic and social development in Xinjiang, and puts forward the Xinjiang's economic and social development needs of system intervention, so as to promote the Xinjiang regional economic harmonious development.

How sociopolitical factors affected the implementation of Cape Town's vacuum sewer

This paper discusses various institutional and social conflicts that detrimentally affected the implementation of a vacuum sewer in South Africa.

G20 and the Reform of Global Energy Governance

Due to institutional fragmentation and conflicts among various actors, a systematic reform to improve the effectiveness of the global energy governance system has become increasingly urgent. Currently, the Group of Twenty (G20), which consists of the world’s major economies and constitutes 60 percent of global energy trade, is in a good position to remold the global framework for energy governance. The past G20 summit meetings have witnessed more attention and efforts from member-state leaders to address problems associated with global energy. However, most of the discussion has been focused on technical issues rather than a comprehensive review of the whole governance system. In the future, the G20 should take proactive measures to enhance its leadership role and policy innovation in the reform of global energy governance, in order to spur green development of the world. As the largest developing nation, China should tap into the G20 platform to advance the transformation of its domestic and international energy systems.

КРИЗИС В ВЕНЕСУЭЛЕ И РЕГИОНАЛЬНАЯ ИНТЕГРАЦИЯ

Modern Venezuela has nothing to do with stability and development. Caracas, run into debt, is suffering diplomatic defeats one after another. Political and economic crisis captured the country, and the government seems to be incapable of retrieving the situation. The opposition between the government and the National Assembly creates the threat of unconstitutional or even military actions. Yet the international community, including the major multilateral blocks like UNASUR involved in peaceful settlement, lacks adequate means as well as political will either to help the country in crisis resolution, or to prevent the internal institutional conflict from influencing regional processes. However, the question is whether the Venezuelan crisis affects the regional integration, or it has become just an indicator of the deadlock of innumerable Latin American integration models happened to be politically and ideologically determined to a certain extent, and thereby inefficient in the context of geopolitical shift within the continent, after new leaders appeared in Argentina and Brazil? Anyway, Caracas almost for sure has got its regional leadership bogged down in an attempt to relieve itself from any responsibility for the crisis. In that context, an unexpected activity of the new Secretary General of the OAS, Luis Almagro, attracts attention. Backed by the Venezuelan government during the elections to the office, L. Almagro now has chosen firm and consistent position against N. Maduro, introducing new approaches designed to reestablish the role of the OAS in the Americas.

Гендерный конфликт глазами молодежи: биосоциологический аспект

<p>Целью данной статьи является изучение гендерного конфликта как биосоциального явления, причин и последствий его становления и развития в современном обществе. Методологическим основанием исследования служит концепция биосоциологии, предложенная Вал. А. Луковым. Концепция призвана выявить возможные трансформации общества через накопление в новых поколениях критической массы биологических и интеллектуальных, а также социокультурных изменений. Основанием своих рассуждений авторы полагают биосоциальный принцип конструирования взаимоотношений между полами в рамках пирамиды власти. В задачи входит изучение трансформации взаимоотношений полов в молодежной среде, поскольку именно молодежь и процессы, в которых она принимает участие, детерминируют будущее.</p><p>В статье представлены результаты и выводы эмпирического исследования (2013–2014 гг.), посвященного изучению содержания гендерного конфликта современности таким, каким видит его молодежь, через анализ взаимных претензий юношей и девушек, актуальных в конкретных социально-исторических условиях. Интерпретация результатов эмпирической части проводилась с опорой на идею о регуляции непосредственных реакций и поведения людей биосоциальным гендерным кодом, имеющим биологическую и социальную составляющие, и тезис о том, что в основе поведения людей лежит биологическая и социальная целесообразность.</p><p>Анализ эмпирических данных, полученных в ходе изучения повседневных практик межполового взаимодействия студенческой молодежи показывает, что гендерный конфликт сегодня базируется на биосоциальной дисфункции полов, на когнитивном диссонансе, отражающем перемешивание имманентных иерархий полов. Обоснованы реальность гендерного конфликта и тенденции его обострения. Выделяются институциональный, межличностный и внутриличностный конфликты и причины, их вызывающие. Особую опасность представляет связанный с развитием гендерного конфликта рост неконтролируемой агрессии в обществе.</p>

A Phase I/II Clinical Trial of the First-in-Class GPCR Antagonist ONC201 in Relapsed/Refractory Acute Leukemias

ONC201 is a highly selective G protein-coupled receptor (GPCR) antagonist that is the first-in-class member of the imipridone class of anti-cancer compounds. Preclinical studies have shown that ONC201 is highly effective in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL), regardless of resistance to standard-of-care therapies, TP53 mutations, or complex karyotypes. Furthermore, ONC201 equally induces cell death in both the bulk tumor and cancer stem cells (CSC) in a range of malignancies. The anti-CSC activity has been validated in preclinical hematological malignancy models in vitro and in vivo, as well as in primary relapsed/refractory AML patient samples using CD34+CD38- as leukemia stem cell marker (Ishizawa et al, Science Signaling, 2016).On the basis of robust preclinical activity, a phase I/II clinical trial of single agent ONC201 is ongoing that enrolls adult patients with relapsed/refractory AML, ALL, or high-risk myelodysplastic syndrome. Phase I dose escalates from 125 to 625mg in 3 schedules; once a week, twice a week and once every 3 weeks, using an accelerated titration design. The primary endpoint of Phase I is to determine the recommended Phase II dose and the primary endpoint of phase II is to determine the overall response rate. Secondary endpoints include pharmacokinetics, pharmacodynamics, and other clinical outcomes.Between December 2015 and July 2016, 6 relapsed/refractory AML patients (median of 4 prior therapies) have been enrolled in dose cohorts ranging from 125 to 625mg ONC201 administered every 3 weeks and one additional AML patient received weekly ONC201 at 125mg. All patients have successfully cleared the DLT window, dose escalation has proceeded uninterrupted, and no drug-related adverse events have been reported. Pharmacokinetic results indicate that all patients achieved a Cmax of >1.4 ug/mL (3.6 uM) that exceeds therapeutic thresholds in preclinical models. The second patient with relapsed/refractory AML and prior therapies that included decitabine, fludarabine and cytarabine and two investigational IDH2 inhibitors showed a reduction in circulating blasts from 78% to 3% after one dose of 250mg ONC201. Furthermore, a >2-log reduction in circulating CD34+CD38- cells was observed in parallel in a time-dependent manner after the first dose of ONC201 in this patient. The fifth AML patient remains on study with stable disease after 5 cycles of 500mg ONC201 despite prior treatments that included azacitidine, eltrombopag, bortezomib, ruxolitinib, and decitabine.Patient enrollment in the weekly schedules and pharmacodynamics, are ongoing. In agreement with Phase I results in advanced solid tumors (NCT02250781), these early results suggest that ONC201 is a very well tolerated investigational therapy that achieves therapeutic plasma concentrations and shows encouraging preliminary signs of biological activity.Note: The research being reported in this abstract is research in which The University of Texas MD Anderson Cancer Center has an institutional financial conflict of interest. Because MD Anderson is committed to the protection of human subjects and the effective management of its financial conflicts of interest in relation to its research activities, MD Anderson has implemented an Institutional Conflict of Interest Management and Monitoring Plan (Plan) to manage and monitor the conflict of interest with respect to MD Anderson' s conduct of this research. DisclosuresDiNardo:Daiichi Sankyo: Other: advisory board, Research Funding; Celgene: Research Funding; Novartis: Other: advisory board, Research Funding; Abbvie: Research Funding; Agios: Other: advisory board, Research Funding. Allen:Oncoceutics: Employment, Equity Ownership. Oster:Oncoceutics: Employment, Equity Ownership. Cortes:ARIAD: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding; Teva: Research Funding. Kantarjian:Amgen: Research Funding; Bristol-Myers Squibb: Research Funding; ARIAD: Research Funding; Pfizer Inc: Research Funding; Delta-Fly Pharma: Research Funding; Novartis: Research Funding. Andreeff:Oncoceutics: Equity Ownership, Membership on an entity's Board of Directors or advisory committees.

Payments for ecosystem services in Hoa Binh province, Vietnam: An institutional analysis

This study examines the institutional design and actual performance, of payments for ecosystem services (PES) in Vietnam. Taking Payments for Forest Environmental Services Program (PFES Program) implementation in Da Bac district, Hoa Binh province as a case study, it brings to light how PES program design and implementation contributed to the central government's objectives to: (1) involve stakeholders in forest management; (2) reduce the government's budget burden for forest protection; and (3) maintain political control over forest resources. In Vietnam, the PFES Program is implemented in a top-down manner. Participating households act as government-induced forest guards rather than forest owners. Incomplete design at the central-level results in poorer performance at lower levels and, the lack of strategic management makes it difficult to know whether the program has actually improved ecosystem services and forest management. While the PFES Program complements other institutions at the national- and local-levels, some institutional incompatibilities exist in terms of customary practices. It is unlikely, however, that these will develop into an institutional conflict.