Inter-institutional Processes Research Articles

Realist evaluation of a pilot intervention implementing interprofessional and interinstitutional processes for transitional care

ABSTRACT In 2016, in Switzerland, we implemented transitional interprofessional and interinstitutional shared decision-making processes (IIPs) between a short-stay inpatient care unit (SSU) and primary care professionals. Between 2018 and 2019, we evaluated this intervention using a realist design to answer the following questions: for whom, with whom, in which context and how have IIPs been implemented? Our initial theory was tested via interviews with patients, primary care professionals and staff from the SSU. Results showed that a patient’s stay at the SSU, with actors committed to facilitating IIPs, reinforced the perceived appropriateness and implementation of those IIPs. However, this appropriateness varied according to different contextual elements, such as the complexity of needs, preexisting collaborative practices and the purpose of the inpatient stay. Since IIPs occurred in a context of fragmented practices, proactive and sustained efforts are required of the actors implementing them and the organizations supporting them.

Managing Fragmentation between International Trade and Investment Law and Global Priorities for Noncommunicable Disease Prevention in Food and Alcohol

This article examines three ways in which instruments developed by international health organizations might be used to manage fragmentation between health and international trade and investment law in the context of regulating food and alcohol as noncommunicable disease risk factors. These are: by modifying or overriding trade and investment obligations, affecting interpretation and fact finding, and establishing cooperative inter-institutional processes. The article assesses the advantages and disadvantages of each of these approaches for managing fragmentation under the rules of treaty interpretation and dispute settlement. It argues that while much of the discussion of fragmentation between trade and health focuses on treaty interactions, many of the actual uses of health instruments are not necessarily dependent on their formal legal status. It then proposes several features of international instruments that might strengthen or support these uses, whether through binding or through non-binding instruments.

The Inter-Institutional Interface of Religion and Business

ABSTRACT:It is frequently asserted that religion enhances the ethical climate of business. This is buttressed by the tacit assumption that religious moral authority is easily combined with and exerted in business, an inter-institutional process I call Engagement. By drawing upon Secularization Theory’s societal-level focus on religious authority and the symbolic boundary work surrounding the interface of competing institutional logics, I theorize a broader range of inter-institutional processes including, Disengagement, Co-optation and Adjudication. To exemplify these inter-institutional processes, I engage in qualitative analysis of historic religious magazines from 1927-1931 and 1985-1989 and focus on the religious moral authority directed at the financial market. I discuss how my findings relate to the scholarship on Religion and Business in particular and Business Ethics more broadly.

The Alpha-Flow Approach to Inter-Institutional Process Support in Healthcare

Inter-institutional collaboration among physicians becomes increasingly important and yet, it’s unrealistic to assume that cooperation can be supported via a homogeneous system which is pre-installed in every organization. Instead physicians will typically have their own autonomous systems that support internal processes. Traditional activity-oriented workflow models or content-oriented process models do not resolve inter-institutional integration challenges. The authors present the a-Flow approach for distributed process management, which enables ad hoc collaboration via active electronic documents without the need to integrate local systems. A distributed case file, the a-Doc, is used to coordinate cooperating parties. Using this case file does not require any preinstalled system components, so true ad-hoc information interchange is enabled. The case file contains both, the inter-organizational process schema as a document, as well as arbitrary content documents that are shared among the cooperating parties. To illustrate the approach an inter-institutional use case is provided by cooperative breast-cancer treatment. The authors explain the rationale behind separating content, decision support, and coordination work and in large-scale inter-institutional scenarios its necessary to decouple collaboration functionality from the existing applications and to resolve the duality between content-oriented and activity-oriented process models.

Democratic Government, Institutional Autonomy and the Dynamics of Change

Against the backdrop of decades of public sector reforms in Europe, this essay aims to make sense of the processes through which institutions, democratic government included, achieve and lose autonomy or primacy and why it is difficult to find a state of equilibrium between democratic government and institutional autonomy. The analytical value of ‘autonomy’ as detachment-from-politics and the apolitical dynamics of change assumed by NPM reformers are challenged. In contrast, the interplay between democratic government and institutional autonomy is interpreted as an artefact of partly de-coupled inter-institutional processes involving struggle for power and status among interdependent and co-evolving institutions that are carriers of competing yet legitimate values, interests and behavioural logics. The problem of finding a stable equilibrium between democratic government, autonomous agencies and non-majoritarian institutions is illustrated by the cases of public administration and the public university.