Internal Management Processes Research Articles

Schockraummanagement

Optimal outcome in the treatment of multiple trauma patients requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times with respect to personnel, technical equipment, and emergency room design. The aim is-based on standardized and prioritized clinical pathways and algorithms-to identify and treat not only life-threatening and debilitating but all other injuries in a timely fashion. Diagnostic and therapeutic measures to manage airway, breathing, and circulatory problems (including transfusion and surgery for bleeding control) have priority, even over the operative treatment of severe head injuries. With respect to severe intra-abdominal and retroperitoneal injuries, the concept of damage control surgery has reached world wide acceptance. However, many parenchymal lesions of intra-abdominal organs can be managed nonoperatively. Similarly, damage control orthopedics for the initial management of major fractures with initial temporary and minimally invasive fracture stabilization followed by definitive osteosynthesis as soon as the patient has stable organ functions is gaining more acceptance. Maintainance of and improvement in the quality of care requires standardized documentation, regular analysis, and feedback in an internal quality management process as well as participation in an external quality program such as the Trauma Registry of the German Society for Accident Surgery.

Administrator of global biodiversity: The secretariat of the convention on biological diversity

The paper presents a case study analysing the effects of the Secretariat of the Convention on Biological Diversity as an intergovernmental organisation. Within the study, the effects of organisations are measured by their outcome, i.e. the influence on the behaviour of other actors such as national governments. Three forms of outcomes are being distinguished, namely knowledge brokerage and diffusion, capacity building, and negotiation facilitation. In addition, the paper tries to explain the observed effects on the basis of internal and external variables. The CBD Secretariat has been established in 1992 and is now located in Montreal with about 70 employees. As most other secretariats of international conventions, it is the main organiser and facilitator of the convention process. The empirical material shows that the Secretariat has a measurable influence on the intergovernmental cooperative process which can be attributed to the effective internal management processes and the qualities of its leaders. Lacking capacity building functions and highly selective effects with regard to the provision of knowledge are explained by the limited formal autonomy and the structure of the global biodiversity problem.

Achieving Growth and Responsiveness: Process Management and Market Orientation in Small Firms

Achieving a consistent market orientation is a challenge for entrepreneurial manufacturers. This research seeks improved understanding of how internal process management assists and hinders small growing manufacturers in achieving the responsiveness component of a market orientation. Under process management, firms implement internal systems, procedures, and performance measures to improve performance and responsiveness to changing markets. Benefits include improved market sensing, two‐way communication, and coordinated responses to market demands. Despite the potential benefits, researchers question whether the internal structure and control of process management will improve responsiveness in entrepreneurial firms. Process management may conflict with the organizational cultures, agility, and responsiveness of entrepreneurial companies. Research results identify how process management assists and hinders the responsiveness component of market orientation in small manufacturers. Management implications and strategies for coping with growth challenges are presented.

Going Green: Motivations for Environmental Commitment in the Airline Industry. A Case Study of Scandinavian Airlines

Many commentators have examined the airline industry’s impacts on the environment but not the internal management processes used to develop company environmental policies. This paper argues that environmental management tools need to take into consideration the complex, value-laden setting in which corporate environmental policy-making occurs if such tools are to be socially and politically legitimated. A case study of Scandinavian Airlines (SAS) examines an airline’s decision-motivations for environmental commitment. An in-depth analysis of the drivers identified by both Scandinavian Airlines and related industry officials shows that attitudes, values and beliefs generated both internally and externally have a critical impact on the airline’s environmental policy-making. Although there are numerous influences that drive SAS’s level of environmental commitment, three ‘motivators’ are found particularly noteworthy. Firstly, this research demonstrates that eco-efficiencies, in various forms, are a strong motive at SAS. Secondly, Scandinavian culture also plays an influential role in the value SAS puts on the environment at a strategic level. Thirdly, it was found that internal leadership, in the form of environmental champions in senior management positions, played a key role in the positive outcomes of the airline’s environmental performance. Given the current growth in benchmarking and eco-labelling activity across tourism, this research enhances understandings about what motivates airlines to develop environmental policy in this increasingly competitive and volatile sector.

Global Health Initiatives Scale-Up and its Effect on Private Health Institutional Systems Capacity: Selected Cases from Nigeria

Rationale: New Global Health Initiatives (GHI) in a number of countries in the developing world has often followed a vertical approach in a bid to increase significantly the number of treatment beneficiaries in a relatively short time. Increased funding from global initiatives such as the Global Fund for AIDS TB and Malaria (GFATM) and the US President's Emergency Plan for AIDS Relief (PEPFAR) has mostly gone to purchase of diagnostics and treatment health inputs and little focus has been put on strengthening internal systems and management processes that are essential for long term sustainability of these programs. In some cases these programs are threatening to weaken further institutional systems capacities. Objectives: The objective of this paper is to demonstrate the unequal investment in rapid scale up of Anti Retroviral Treatment programs at some hospitals in Nigeria at the expense of systems capacity in these institutions. Methodology: Systems capacities of 3 hospitals in Nigeria were mapped following a generic in-put-process-output-intermediate model. Additionally service configuration of ART programs within the general hospital operations was also assessed to establish any systems linkages and support during the programming phase to establish whether these programs are considered as part of the strategic focus of these institutions since these programs are exclusively donor funded. While not the focus of the study, the effect these new programs are having on general service delivery was also investigated during the mapping and assessment exercise. A statistical analysis was also carried out to show the proportion of financing devoted to new programs versus the service load they represent within the broader context of hospital services delivery. Results: The results show that in all the 4 hospitals ART programs run as vertical stand alone programs. Further analysis of the strategic loci of these institutions showed that ART programming which requires a chronic disease management approach is not considered a core organizational business yet in all institutions these programs are taking up more physical space, staff time and other support services of the hospitals. HIV care and treatment programs funded by donors make up about 83% of total operating budget at one of the hospitals, 54% at another and 40% at the third. While in all the three hospitals HIV care and treatment funding represents a substantial proportion of total annual operating budgets; the proportion of inpatient cases attributed to HIV care make up only 25%, 33% and 18% at each of the three hospitals respectively. In all the three hospitals all HIV related funding is exclusively for HIV programming related activities with none devoted to general support indirect services. Relative to outpatient services, the proportion of HIV related outpatient visits was 65%, 25% and 40% respectively. At the hospital with high HIV patient visits, it was also established that other patients have selectively referred themselves out of the hospital due to longer waiting times and the general perception that the hospital was offering only HIV related services. About 50%of the staff complement at this hospital was paid for and working for the HIV program and the hospital has no plans for sustaining such staff costs post donor funding. At the other two hospital the proportion was 32% and 18% respectively. Even with the high contribution of HIV related funding there is no clear understanding of actual financial and cost implications of these programs. At all the 3 hospitals there were no operational plans and no linkage between funding and any form of planning. They also reported difficulties in prioritising activities versus available funding and decide to pay salaries as a way of absorbing such funds, lest they risk losing it. All expressed a need for support to develop management and institutional capacities to enable them integrate new programs and increase their institutional internal efficiencies. Conclusion: Assessing the full impact on systems capacity for provider individual health institutions will require a longitudinal approach over a number of years. Nevertheless, cross sectional analyses like the one under this study still go a long way to demonstrate current implications and can be a good pointer to what the long term impact will be. Funding vertical programs at small hospitals without equal focus on their internal systems and management processes will eventually have an adverse effect not only on those programs but the institutions as a whole.

State-of-Art and Development Prospects of E-Procurement in the Italian Engineering & Contracting Sector

This paper examines the state-of-the-art and development prospects of using e-procurement for projects related to the engineering and contracting (E&C) sector in Italy, through the results of a study carried out during 2001–2002 in collaboration with ANIMP (Italian Association of Industrial Plant Engineering). The companies included in the sample account for 75% of the revenue generated in the sector, (valued at more than $17 billion). Given the globalized reference market and the internationalization of the E&C companies, the results of the study also provide a sound description of the sector's behavior worldwide. Although there are substantial differences between large and medium/small companies, it is evident that a strong information technology (IT) culture has developed at all corporate levels and integrated into working processes, albeit mainly with simpler applications (i.e., e-mail, Web sites, etc). Furthermore, little attention is paid to codesign and coengineering systems, meaning that present e-procurement solutions are limited to the purchase of project materials and systems with low engineering content. The potential savings in adopting e-procurement solutions are estimated to be worth a 7–10% reduction in overall project purchasing costs. This represents at least the 60% of the company annual revenue. Nevertheless, the study highlights ongoing and planned investments that are underfocused, pointing to unconsolidated e-business strategies. The advent of e-procurement is, therefore, likely to lead to profound restructuring of operational practice and the management of internal processes, generating challenges in company culture and personnel training.

Developments: External Regulation and Best Value in Local Government

Best Value has been presented by central government as a means of promoting local diversity and innovation. However, it contains a large superstructure for regulating the behaviour and performance of local authorities, through performance indicators, audit, and inspection. The characteristics of these regulatory instruments are analysed and their potential strengths and weaknesses are assessed. The instruments overlap not only with local authorities' own internal management processes, but also with each other. Therefore it is concluded that the costs of regulation may outweigh the benefits.

Strategic Management in the Public Sector: Concepts, Models, and Processes

Lffective public administration in the age of results-oriented management requires public agencies to develop a capacity for strategic management, the central management process that integrates all major activities and functions and directs them toward advancing an organization's strategic agenda. Strategic management is concerned with strengthening the long-term viability and effectiveness of public sector organizations in terms of both substantive policy and management capacity. It integrates all other management processes to provide a systematic, coherent, and effective approach to establishing, attaining, monitoring, and updating an agency's strategic objectives. Strategic management is integrative in nature in the sense of (a) focusing attention across functional divisions and throughout various organizational levels on common goals, themes, and issues; (b) tying internal management processes and program initiatives to desired outcomes in the external environment; and (c) linking operational? tactical, day-to-day decisions to longer run strategic objectives. Particularly given the dynamic political and institutional environment within which many public agencies operate, an effective strategic management capability is essential for maintaining or strengthening the fit between the organization and its external stakeholders and managing for results within a clearly defined context of mission, mandates, values, and . . vlslon. Strategic management has been addressed in the public administration literature (Koteen, 1989; Nutt & Backoff, 1992; Rabin, Miller, & Hildreth, 1989; Steiss, 1985) but by no means as extensively as has its most critical component, strategic planning, or other management approaches such as total quality management. However, a more recent article by Mlnzant and Vlnzant (1996a) goes a long way toward refocusing appropriate attention on the role of strategic management in the public sector and discussing implementation issues and strategies in an instructive manner. The purpose of the present article is to raise awareness of the central importance of strategic management in government, define the critical elements in a holistic model of strategic management, discuss the strategic management process, and

Managing Autonomy: Employment Relations in Small Professional Service Firms

D R. MONDER RAM IS PROFESSOR OF Small Business and Director of' the Enterprise Research Centre at the University of Central England Buisiness School, United Kingdom. An inicreasingly noted feature of the small business population is the rise of the small professional service firm, yet comparatively little is known of the niature of employment relations in such enterprises. This paper aims to explore the maniner in which work is regulated in such settings by examining the internal management processes of three firms engaged in the provision of business and 'professional' services. The study, which is based on an ethnographic investigation over a year-long period, examines three particular processes that are deemed to be distinctive in this sector: recruitment, performance and supervision. Much of the rhetoric associated with social relations in such firms, for example collegialitv, person-centredness, trust, was evident in the study. BuLt it was clear that emiployee autonomiv still had to bc imanaged' and this process xwas a contingent and fluid one that often- contained a harsher edge thaIn existing accouints suggest.

Planning and performance in state-owned enterprises: A multidimensional assessment

The present paper investigates the relationship between planning and performance in the context of State-Owned Enterprises (SOEs). It considers dimensions of planning relating to: decentralisation, formalisation, depth of analysis, monitoring/reviewing, and coverage of plan content. Each dimension is operationalised through multiple measures and composite variables, as derived from statistical analysis. Planning variables are then related to performance, which is approached by ‘output’ and ‘process’ effectiveness. Output effectiveness is measured through profitability, growth and innovativeness indicators. Process effectiveness refers to the role of planning in organising and focusing management effort; measures are constructed which refer to planning's contribution to awareness of factors external to the enterprise, cross-functional integration, mobilisation of human potential and exercise of management control. The analysis controls for tightness of the regulatory framework, market competition, and enterprise size. Empirical testing is based on data from the operational planning processes of 55 Greek SOEs. Statistical analysis reveals various significant associations between specific aspects of planning and measures of output and process effectiveness. More significant appears to be the impact of planning on innovative aspects of performance, as well as on the internal management process. The results offer new insights into the impact of planning, and justify the multidimensional treatment of both planning and performance. Directions for future research are pointed out, and conjectures for practitioners are derived.

A Typology for Evaluating Branch-Level Perceptions of Internal Customer Management Processes within the UK Clearing Banks

Since the late 1980, the UK Clearing Banks have faced growing criticism over the quality of their finanical services. Advantages may exist in using internal marketing to ensure closer integration of multiple functions across all departments. Although adoption of an internal marketing philosophy may improve the quality of services delivered to both internal and external customers, it appears that there are few paradigms available which can be used by bankers seeking to introduce the concept into their organisation. By applying a quasi-ethnographic approach, a qualitative internal customer management model was developed based on the Peters and Waterman 7s framework to describe the factors influencing internal customer relationship which exist between branches and other departments within a bank. To determine if the model could be used to evaluate branch-level perceptions of internal customer management practices, a survey was undertaken using a modifed version of the Parasuraman SERVQUAL model. The response...

Internal customer management and service gaps within the National Health Service

One implication of being required to respond to the Patients' Charter without access to more resources, is that managers in the U.K. health care sector will have to ensure integration of multiple functions across their units in order to achieve the objective of creating a quality conscious workforce. This situation will probably demand adoption of an internal marketing philosophy within the NHS; thereby ensuring implementation of TQM and/or Customer Care schemes in which departments work together to create effective internal customer chains. To determine the degree to which the NHS have effectively adopted an internal customer orientation, a survey was undertaken using a modified version of the Parasuraman SERVQUAL model. The majority of respondents indicated the existence of Type 1, 2, 3 and 4 Gaps in the internal customer management process within their unit. Major influencers of these service gaps include departments placing internal efficiency ahead of internal customer needs elsewhere in the organization, limited effort to gain further understanding of internal customer needs and an inadequate level formal quality standards for managing internal customer relations. Respondents consider their departments are able and willing to enhance the quality of provision if the issue was given higher priority by senior management. Identified obstacles to increased future emphasis behind an internal customer philosophy include insufficient resources to service internal customer needs, lack of trust between departments and limited confidence about abilities to manage the process. Unless senior managers in the NHS can be persuaded to allocate the resources needed to create effective internal customer chains, then concern must exist about the capability of operating units to fulfil the health care standards specified in the Patients Charter.

Are British Universities in a Position to Consider Implementing Total Quality Management?

Abstract Accompanying the removal of the binary divide between polytechnics and universities, the Department of Education and Science (DES) also specified the requirement that the British higher education sector should give more emphasis to the effective management of quality. Some writers have suggested that this can be achieved by institutions introducing the concept of Total Quality Management (TQM). A vital aspect of TQM is the integration of multiple functions across the organization with the objective of establishing a quality conscious workforce. A recommended practice is to use the concept of internal marketing as a mechanism to persuade departments to work together in the creation of internal customer chains. To determine the current status of internal customer management practices in British Universities, a survey of academics was undertaken using a modified version of the Parasuraman SERVQUAL model. The majority of respondents indicated the existence of Type 1, 2, 3, 4 and 5 Gaps in the internal customer management process within their institution. Major influencers of these service gaps include minimal effort to gain further understanding of internal customer requirements and a lack of formal quality standards for managing internal customer relations. Respondents consider their faculties are unable to enhance internal quality if the issue was given higher priority by senior management. Identified obstacles to greater emphasis on an internal customer philosophy include insufficient trust between departments and low confidence levels of ability to manage the process. Under these circumstances, it does not appear that for the foreseeable future, British universities are in a position to adopt TQM philosophy. Hence it seems more advisable that these institutions should restrict their quality management activities to the simpler assessment‐based approach recommended by the Committee of Vice‐Chancellors and Principals (CVCP) Academic Audit Unit.

Effects of landscape fragmentation on ecosystem processes in the Western Australian wheatbelt

The effects of landscape fragmentation are usually considered in terms of biogeographic changes and habitat loss. I argue here that the effects of fragmentation on ecosystem processes are just as important to the long-term conservation of biota in remnant areas. In the Western Australian wheatbelt, widespread rapid clearing for agriculture has removed most of the native perennial vegetation and replaced it with an agricultural system based predominantly on annual crops and pastures. Fragmentation of the natural system has led to large changes in the water and nutrient cycles, radiation balance and wind regimes of the region. Removal of perennial vegetation has reduced evapotranspiration and altered soil water flows, such that peak runoffs have increased and water tables have risen, bringing stored salt to the surface. Salinity and waterlogging problems have resulted. The agricultural system has a very open nutrient cycle compared with the native vegetation. Changed vegetation covers have altered the radiation balance, and temperature and humidity gradients are apparent at the edges between remnants and agricultural land. Similarly, lack of perennial cover increases the wind speed near the ground and leads to increased soil erosion. These changes in the landscape impinge on the remaining fragments of native vegetation, and management of external influences is probably more important than management of internal processes within remnant areas. Remnant vegetation management has to be carried out in the context of the overall landscape.

Rural Development Through Cooperative Automation

The Upper Peninsula Region of Library Cooperation, Inc., a multi-type cooperative serving Michigan's Upper Peninsula, provides an example of rural development through automation for resource sharing and for the improvement of internal management processes. Overcoming the barriers of distance and of scarce staff and resources, the group has organized itself and purchased and implemented the NOTIS system. Through progress in completing this proccss, the participants have come to terms with the many technical and professional issues associated with automation and have found a broader role in addressing the common problems of all libraries across this rural region.

Creating a total quality health care environment

Until recently, health professionals lacked incentives to integrate internal management processes, depending instead on external quality assurance and regulatory standards. Competitive markets and increased regulatory pressures now encourage managers to reorient systems from a cost-driven reimbursement approach to the implementation of Total Quality Care as a management strategy.

Das Primat der Neutralitätspolitik: Building Regimes at Home

Sundelius, B. Das Primat der Neutralitätspolitik: Building Regimes at Home. Coop eration and Conflict, XXIV, 1989, 163-178. In this article the strategies used by the traditional foreign policy chief to control the passageway between the foreign and domestic arenas of public activity will be discussed. The paper focuses on the domestic struggle over the conduct of foreign policy. Drawing on the works of Charles Kegley and Robert Keohane, it is argued that the continued prominence of the Swedish Foreign Ministry in this sector can be understood in the context of the persistence of a well-entrenched decision regime built around the concept of neutrality. The apparent ability of this traditional gatekeeper to dominate this internal management process also in the face of the decentralizing pressures associated with interdependence will be explained in terms of the decision regime concept. The study contributes to an understanding of how international developments affect the internal organizational life of a state. Further study into the domestic roles of the international guardians of the national interest in other states, too, may be warranted. Regime-building may facilitate international cooperation or national policy coordination. It may also help perpetuate the influence of hegemonic actors in the international system and within a domestic setting. The unmasking of the attributes of decision regimes in various states or in various international issue areas would seem to be an important task for a political scientist.

Planning for Esso Greece—The impact of nationalization

This paper investigates the implications for planning processes of the transition to public ownership. In doing so it draws upon the case of the Greek subsidiary of a multinational oil company, Esso Europe. This subsidiary was brought under state ownership in 1984 and is now named Eko. The paper focuses on three distinctive characteristics of the planning process: formalization, participation and decentralization. Changes in these characteristics in the 2 years after the transition to public ownership are investigated. The results show that: 1. (a) the degree of formalization has slightly decreased, 2. (b) the participation of management down the hierarchy has not changed substantially, and 3. (c) the process became more decentralized. Overall, planning has remained ‘a way of life’ in this company. This particular case study offers evidence that casts doubt on the argument that public ownership brings radical changes in the internal management processes. At least for planning, the changes observed were not radical. The analysis suggests that those observed were minor and would constitute a natural response by any company—private or public—to changes in the company's role and objectives and in the control framework. Ownership alone does not appear to have had a decisive influence on the type and the functioning of this management process. Other factors, namely competitive pressures and company tradition and culture with respect to planning seem to be important in explaining the continuing use of effective planning systems. Implications for other state-owned enterprises are discussed.

Recognizing Contexts and Managing Processes in Universities

In their study of West German university departments, Bresser and Dunbar (1986) related measures of context and structure to measures of departmental effectiveness. Ryder (1988) suggests that other measures of effectiveness as well as measures of internal management processes would have greatly improved the study. Ryder may have missed some of the contributions that the Bresser and Dunbar (1986) study makes, particularly with respect to how size is measured and its impact on effectiveness. This note clarifies these contributions, along with implications for the management of contingencies that may influence the effectiveness of university departments.

Choosing a diversification project in a regulated economy

Choosing a diversification project in a regulated economy involves consideration of a large number of micro and macro issues. In order to make an optimal choice of strategy, a formal approach to diversification planning is necessary. This article develops an approach which aims at breaking up the problem of identification and selection of projects into manageable components. The approach involves three steps: identification of broad industry groups: identification of specific projects within each broad industry group; and comprehensive feasibility study. The major benefit of this approach lies in providing a systematic mechanism for reducing the number of alternatives and in recognizing the link between the internal management processes of strategy formulation with the political and administrative processes in government and regulatory bodies. The article is based largely on the Indian experience.