International Management Strategies Research Articles

Transboundary migration of Loxostege sticticalis (Lepidoptera: Crambidae) among China, Russia and Mongolia.

The beet webworm, Loxostege sticticalis, a worldwide pest of many crops, performs a seasonal migration, causing periodic outbreaks in Asia, Europe and North America. Although long-distance migration is well documented in China, patterns of transboundary migration among China, Russia and Mongolia are largely unknown. We performed a phase analysis of L. sticticalis periodic outbreaks among three countries based on 30 years of historical population data, analyzed the wind systems during migration over boundary regions, and traced the migratory routes in a case study of outbreaks in 2008 by trajectory simulation. Highly synchronized outbreak years of L. sticticalis were observed between China and Mongolia, China and eastern Siberia, China and western Siberia, Mongolia and eastern Siberia, eastern Siberia and western Siberia from 1978 to 2008, indicating possible transboundary migration between these regions. Winds at 300-600 m altitude, where adult migration usually occurs, also showed a high probability of northwestern winds in Haila'er (China), Chita (Russia) and Choybalsan (Mongolia), favoring successful adult migration from these areas to northern and northeastern China. Back trajectory analysis further showed that the first-generation adults that caused the severe outbreak of second-generation larvae in 2008 originated from eastern Siberia, eastern Mongolia, and the boundary regions of China-Russia and China-Mongolia. Our findings demonstrated that the source of L. sticticalis outbreaks in northern China was closely related to the outbreaks in Siberia and Mongolia via long-distance transboundary windborne migration. This information will help guide international monitoring and management strategies against this notorious pest. © 2024 Society of Chemical Industry.

Evidence‐based management strategies for endocrine complications after pituitary adenoma surgery

AbstractThis study aims to provide a clinical reference for the management of endocrine complications in pituitary tumor patients by synthesizing recent evidence for domestic and international management strategies. Based on the PIPOST (Population, Intervention, Professional, Outcome, Setting, and Type of Evidence) framework, evidence‐based medicine targets were determined. Electronic decision support systems, guideline websites, and databases were searched to identify the best evidence on postoperative endocrine complications in pituitary tumors. The PICO (Patient, Intervention, Comparison, Outcome) principle was used to construct the search strategy, and the studies from the past 10 years (July 2013 to July 2023) were included. A total of 11 articles were included, including four guidelines, two expert consensus statements, one systematic review, one best practice article, and three randomized controlled trials. We obtained evidence on five aspects (endocrine assessment, secondary adrenal insufficiency management, water metabolism disorder management, special population management, and follow‐up management) with a total of 30 pieces of evidence. Clinical healthcare professionals should focus on the care and follow‐up of patients with postoperative complications, such as adrenal insufficiency, temporary or permanent diabetes insipidus, and hyponatremia. Future research should involve large sample sizes, long‐term follow‐ups, and multicenter studies to further clarify the protocols for fluid restriction, diet, and hormone use.

Global Review of International Nuclear Waste Management

In the current situation of global energy transition, nuclear energy maintains its reputation as a stable power generation technology, without dependence on other resources and without CO2 emissions. However, one of the main problems with its use is the management of the radioactive waste it generates, which has given rise to different international strategies: (i) reprocessing; (ii) storage; and (iii) disposal. Given the interest generated by nuclear energy in recent times and the need to manage the waste generated, this paper presents a global review of the different international nuclear waste management strategies, using a scientific method based on (i) a bibliometric review of the scientific publications related to nuclear waste management and (ii) an analysis of the technical aspects of the different international management strategies. The effective and safe management of nuclear waste will contribute to the advancement of international nuclear energy development strategies that encourage the construction of new nuclear power plants and the lifetime extension of existing ones.

Spanning the boundaries: International business theories in a complex global environment

The field of international business is constantly evolving, and there is much debate about what exactly constitutes international business and how its definition influences theorizing. Traditionally international business has focused on cross-border activities of multinational enterprises, including foreign direct investment, multinational enterprises’ strategies, and organization, along with the understanding of the process of internationalization. Changes in the global environment have necessitated a broader, multidisciplinary approach to international business theorizing. This paper explores how international business emerged as a field of inquiry and how the interrelated fields such as international management, international entrepreneurship, and international strategy can inform international business theorizing. A more complementary approach would be beneficial rather than treating these fields as distinct ones. Moreover, this paper recognizes the complex nature of the global environment and highlights the myriad of challenges and opportunities it presents for businesses operating internationally. It proposes a future research agenda that considers this intricate global context, and challenges international business scholars to adopt a holistic and multidisciplinary approach to develop comprehensive theories that capture the dynamic and interconnected nature of the complex global business environment.

Evaluating International Diagnostic, Screening, and Monitoring Practices for Craniofacial Microsomia and Microtia: A Survey Study.

To (1) appraise current international classification and clinical management strategies for craniofacial microsomia (CFM) and microtia, and (2) to assess agreement with the European Reference Network “European Guideline Craniofacial Microsomia” recommendations on screening and monitoring. This was a cross-sectional online survey study. The survey consisted of 44 questions on demographics, diagnostics and classification, obstructive sleep apnea, feeding difficulties, speech and language development, hearing, ocular abnormalities, visual development, orthodontic screening, genetic counselling, psychological wellbeing, and extracraniofacial anomalies. Respondents were participants of 3 international cleft and craniofacial conferences, members of the American Cleft Palate and Craniofacial Association and members of the International Society for Auricular Reconstruction. Respondents were requested to complete 1 questionnaire per multidisciplinary team. Fifty-seven responses were received from 30 countries (response rate ∼3%).The International Consortium for Health Outcomes Measurement diagnostic criteria were used by 86% of respondents, though 65% considered isolated microtia a mild form of CFM. The Orbit, Mandible, Ear, Facial Nerve and Soft Tissue classification system was used by 74% of respondents. Agreement with standardized screening and monitoring recommendations was between 61% and 97%. A majority of respondents agreed with screening for extracraniofacial anomalies (63%-68%) and with genetic counselling (81%). This survey did not reveal consistent agreement on the diagnostic criteria for CFM. Respondents mostly supported management recommendations, but frequently disagreed with the standardization of care. Future studies could focus on working towards international consensus on diagnostic criteria, and exploring internationally feasible management strategies.

Containment of COVID-19: International experience and management strategies

The aim of the article is to study the international experience in the field of containment of COVID-19 and strategies for overcoming its negative effects. Descriptive, analytical, synthetic and modelling methods are used in the study. The authors analyze the international and national legal framework for the containment of COVID-19, as well as the results of particular studies in this field. The epidemiological, social, economic, legal and other effects of COVID-19 on modern society are comprehensive and possibly long lasting. The pandemic has affected all regions of the world. However, different countries and groups of countries are developing and implementing different COVID-19 management strategies and models to reduce negative impacts of it.

A constructive critique of the World Trade Organization draft agreement on harmful fisheries subsidies

November 2021 could see members of the World Trade Organization (WTO) reach an agreement to prohibit harmful fisheries subsidies, culminating over 20 years of negotiation and discussion. This commentary highlights strengths and places where the current draft text can be improved to ensure the agreement truly contributes to sustainable and equitable fisheries. Overall, conditionalities and exemptions are better streamlined and defined, time periods to enter into compliance are allowed yet reasonably short, types of subsidies to be particularly avoided are clearly noted, and appropriate emphasis is placed on reducing impacts from distant-water and transboundary fishing fleets. Key places for improvement relate to unspecific language on supporting fisher incomes, the uniform handling of illegal, unreported, and unregulated fisheries (IUU), and transparency in distant water fisheries, issues partly stemming from historical definitions that are useful for some fisheries but may not capture the complexity of others. Capacity-enhancing subsidies should be avoided, and it is important to avoid further negative impacts on marginalized fisher populations. Given the importance of reaching an agreement without further delay, we urge members to proactively and inclusively formalize their fishing definitions and practices to prevent inequitable outcomes for vulnerable fishers during the implementation stage of a new agreement. A WTO agreement to prohibit harmful fisheries subsidies is an opportunity to catalyze the design and funding of improved and cooperative national and international fisheries policy and management strategies, to the benefit of fishers, global seafood production, and indeed all who hold relationships with our oceans.

An Assessment of Environmental Policy Implications under the China-Pakistan Economic Corridor: A Perspective of Environmental Laws and Sustainable Development

Environmental issues know no boundaries and are recognised as a matter of regional and/or global concern, and neighbouring countries have to face shared environmental effects. Environmental laws internationally, particularly in the last thirty years, have grown significantly and have contributed to environmental protection in a variety of national, regional and international management strategies. In recent years, environmental legislation has entered into a responsible and mature phase in several non-Western countries, particularly in Asia. The present study examines the shared environmental obligations of regional or neighbouring countries using China and Pakistan as a case study and provides references from international (environmental) laws as well as states’ best practices. This study adopts a well-defined analytical methodology to not only investigate the implications of environmental laws but also to define the gaps in the existing framework of environmental laws in the region and recommend appropriate grounds to systematically fill these gaps through much-needed legal cooperation before it is too late. The study provides a detailed analysis and pertinent knowledge horizons, and concludes that there is an abrupt need for China and Pakistan to revise their trade agreements and include the environment as an integral part of each mega-infrastructural activity, including the China-Pakistan Economic Corridor. Most of the potential outcomes are already known but there is little academic discussion available concerning the perspective of cross-boundary environmental laws, and the present study intends to fill this gap.

Assessing environmental pollution levels in marinas

Despite the growing interest in recreational boating and the increasing number of marinas along the world's coastlines, environmental knowledge of these ecosystems is still very scarce. Detailed data of pollutants in marinas are necessary to provide a global approach of environmental risks in the context of international management strategies. In the present study, a set of 64 variables (30 in seawater and 34 in sediments) were measured to compare marinas from the Southern Iberian Peninsula (SIP). Uni and multivariate analyses showed significant differences among marinas, evidencing the importance of management on a local scale. The most relevant variables determining these differences were turbidity and the biocide Irgarol 1051 in seawater, and granulometry, hydrocarbons and faecal coliforms in sediment. The use of normalization techniques with Al or Fe, and the suitability of different methodologies to measure Total Organic Matter in marinas were also discussed. Additionally, we perform a comprehensive literature review of worldwide marina stressors and develop a simple and straightforward method for assessing environmental quality. The method was tested using SIP marinas and was based on the comparison of 15 selected sediment stressors with background values, concentrations of worldwide sediment quality guidelines (SQGs), and reference conditions/security thresholds established by the programme of coastal waters in port areas (ROM 5.1). A global score was assigned using a new proposed index, Marinas Environmental Pollution Index (MEPI), ranging from 0 to 150 points according to the environmental quality (<90: bad, 90–120: moderate, >120: good). MEPI of marinas from SIP ranged from 60 to 110 points indicating bad or moderate levels of pollution. Environmental quality is one of the decisive factors for awarding eco-labels or eco-certifications, such as Blue Flags in marinas. Therefore, pollution baseline information and environmental tools are mandatory for correct assignation of these awards and necessary for assessing the efficiency of management actions.

Parking Management Strategies for the Development of Assiut Downtown, Egypt: Opportunities and Challenges

Local authorities are developing urban management plans for the sake of enabling the urban opportunities offered and rationally react to the challenges imposed. Parking Management Plan, especially in downtowns, is of central importance, due to the challenges of meeting the parking demand, and the economic, environmental and urban consequences. In response, cities have formulated innovative parking management strategies. These strategies go beyond filling the gap between supply and demand to the minimization of demand. At the local level, the city of Assiut -the Capital of Assiut Governorate- is the largest city in Upper Egypt, and the most attractive and important in the region, especially in the economic and service domains. However, Assiut downtown encounters various urban challenges, among which parking is considered the most severe. Despite successive traffic and planning solutions, the gap between supply and demand remains. In this paper, Parking Management Strategies that would contribute to the local context are investigated. International management strategies are reviewed, the local context is surveyed and analyzed, the appropriateness of these strategies for application is investigated, and requirements of application are identified.

International management strategies and expatriate practices of Taiwanese multinational corporations: a contingency perspective

In this paper, we examine how the international management strategy (centralized, local, and global) of an MNC affects its expatriate practices, and whether there is a contingent framework between international management strategy and expatriate practices. Drawing on a sample of 126 large Taiwanese multinational corporations, we examine the effects of international management strategies on six expatriate practices—staffing policies, selection criteria, selection methods, training, performance evaluations, and spouse/family support. We find some support for our expectation that, at the headquarters level, the specific international management strategy that an MNC employs affects the choice of expatriate practices. Implications for theory and practice are discussed.

Global distribution of carbonate rocks and karst water resources

Karst regions offer a variety of natural resources such as freshwater and biodiversity, and many cultural resources. The World Karst Aquifer Map (WOKAM) is the first detailed and complete global geodatabase concerning the distribution of karstifiable rocks (carbonates and evaporites) representing potential karst aquifers. This study presents a statistical evaluation of WOKAM, focusing entirely on karst in carbonate rocks and addressing four main aspects: (1) global occurrence and geographic distribution of karst; (2) karst in various topographic settings and coastal areas; (3) karst in different climatic zones; and (4) populations living on karst. According to the analysis, 15.2% of the global ice-free continental surface is characterized by the presence of karstifiable carbonate rock. The largest percentage is in Europe (21.8%); the largest absolute area occurs in Asia (8.35 million km2). Globally, 31.1% of all surface exposures of carbonate rocks occur in plains, 28.1% in hills and 40.8% in mountains, and 151,400 km or 15.7% of marine coastlines are characterized by carbonate rocks. About 34.2% of all carbonate rocks occur in arid climates, followed by 28.2% in cold and 15.9% in temperate climates, whereas only 13.1 and 8.6% occur in tropical and polar climates, respectively. Globally, 1.18 billion people (16.5% of the global population) live on karst. The highest absolute number occurs in Asia (661.7 million), whereas the highest percentages are in Europe (25.3%) and North America (23.5%). These results demonstrate the global importance of karst and serve as a basis for further research and international water management strategies.

Informing the management of acute malnutrition in infants aged under 6 months (MAMI): risk factor analysis using nationally-representative demographic & health survey secondary data.

BackgroundTackling malnutrition is a global health priority, helping children both survive and thrive. Acute malnutrition (wasting) in infants aged under 6 months (u6m) is often neglected. Worldwide, some 8.5 million infants u6m are affected yet recent World Health Organization malnutrition guidelines highlight numerous evidence gaps on how to best manage them. To inform future research, policy and programming, we aimed to identify risk factors associated with infant u6m wasting.MethodsWe did secondary data analysis of nationally representative, cross sectional Demographic and Health Surveys conducted in the last 10 years. We compared wasted infants u6m (weight-for-length <−2 z-scores) vs. non-wasted (weight-for-length ≥−2 z-score). We used simple and adjusted (for infant age, sex, socio-economic status) logistic regression to calculate odds of wasting associated with risk factors spanning three broad categories: household-related; maternal-related; infant-related.ResultsWe analysed 16,123 infants u6m from 20 countries. Multiple risk factors were statistically associated with wasting. These included: poverty (Odds ratio, OR 1.22 (95% CI [1.01–1.48], p = 0.04)); low maternal body mass index (adjusted OR 1.53(1.29–1.80, p < 0.001); small infant size at birth (aOR 1.32(1.10–1.58, p < 0.01)); delayed start of breastfeeding (aOR 1.31(1.13–1.51, p < 0.001)); prelacteal feed (aOR 1.34(1.18–1.53, p < 0.001)); recent history of diarrhoea (aOR 1.37(1.12–1.67, p < 0.01)); mother disempowered (experiences violence; does not make decisions about health issues; does not engage with health services such as antenatal care, does not give birth in a health facility). ‘Protective’ factors associated with significantly decreased odds of infant u6m wasting included: educated mother (OR 0.64(0.54–0.76, p < 0.001)); mother in work (OR 0.82(0.72–0.94, p < 0.01)); currently breastfed (aOR 0.62(0.42–0.91, p = 0.02)), exclusively breastfed (aOR 0.84(0.73–0.97, p = 0.02).DiscussionInfant u6m wasting is a complex, multifactorial problem associated with many risk factors; knowing them will help shape international and national management strategies. Whilst our observational study cannot prove causation, many factors identified are biologically plausible and/or socially important. They should be considered when assessing and managing infants u6m. Although supporting breastfeeding is core to future interventions, this alone is unlikely to be sufficient; strategies should involve multiple sectors, beyond just health and nutrition. By noting our results, future intervention studies could focus resources and maximise chances of achieving impact.

An international comparison of diagnostic and management strategies for vestibular schwannoma

ObjectiveTo compare international diagnostic and management strategies for vestibular schwannoma (VS).MethodsA web-based questionnaire was sent to 130 otolaryngologists, mainly identified through the European Skull Base Society. It contained questions on general information including guideline usage as well as questions on diagnosis (focussing on selection of patients for MRI) and management of VS, including case scenarios. Descriptive statistics were reported.ResultsThirty-six otolaryngologists working in 11 different countries completed the questionnaire (response rate: 28%). Guidelines for diagnosis and management of VS are used by 44% and 42% of respondents, respectively. In the diagnostic strategy for VS, different types and combinations of audiovestibular function tests are used when deciding whether a patient should undergo an MRI. Respondents apply 18 different definitions of asymmetrical hearing loss. Variation was also apparent from reported considerations on management of VS. Most respondents (84%) prefer a wait-and-scan strategy in case of a small intrameatal VS (Koos 1). Variety in management strategies increases for patients with a medium to large sized VS (Koos 2, 3 and 4). The details of each management strategy (wait-and-scan, microsurgery, stereotactic radiosurgery and fractionated radiotherapy) also differ among respondents.ConclusionsA large variation in diagnostic and management strategies for VS was identified between respondents. More evidence and/or consensus seem warranted to reduce uncertainties for patients, and differences in outcome and costs that might result from the variety of strategies currently being applied.

Trace organic contaminant (TOrC) mixtures in Minnesota littoral zones: Effects of on-site wastewater treatment system (OWTS) proximity and biological impact

On-site wastewater treatment systems (OWTSs) are an international wastewater management strategy for rural and semi-rural communities without access to centralized sewage treatment. These systems are a suspected source of trace organic contaminants (TOrCs) that may be responsible for endocrine disrupting effects to resident fish species in Minnesota Lakes. This study assessed localized porewater concentrations of TOrCs in near-shore environments across five Minnesota Lakes. Sampling sites were designated as either likely (HOME) or unlikely (REF) to receive OWTS discharges based on their proximity to shoreline households. Sampling sites also served as sunfish spawning habitats concurrently studied for biological impacts to resident adult males. Two-group hypothesis tests demonstrated significantly (p = .02) higher total TOrC concentrations in HOME (Mean = 841 ng/L) versus REF (Mean = 222 ng/L) sites. HOME sites also contained a wider suite of TOrC detections relative to REF sites. The distance to the nearest household (most proximal distance; MPD) negatively correlated (r = −0.62) with total TOrC concentrations. However, 2,4-D and DEET were major contributors to these total concentrations, suggesting that anthropogenic influence from households may not be exclusively attributed to OWTS discharges. Further, TOrC presence and elevated nitrogen concentrations in REF site porewater suggest additional, non-household TOrC discharges to these lakes. Significantly higher blood concentrations of vitellogenin (p = .03) and 11-ketotestosterone (p = .01) were observed in adult male sunfish captured from HOME versus REF sites. Comparisons between chemical and biological data indicate enhanced bioactive effects of co-contaminants. The findings from this study demonstrate multiple diffuse transport pathways contribute to the presence of biologically active TOrC mixtures in Minnesota Lakes, and mitigation efforts should consider minimizing residential inputs of chemicals associated with both outdoor and OWTS activity.

The October 2011 Kenyan invasion of Somalia: fighting al-Shabaab or defending institutional interests?

ABSTRACTThis paper asks why Kenya invaded Somalia in October 2011. It scrutinises five possible explanations as to why Kenyan decision-makers decided to invade neighbouring Somalia. The explanations are inspired by different theoretical frameworks. Some are inspired by theories developed to analyse Western societies, whereas others are inspired by theoretical reflections aimed at understanding politics in Africa. It is concluded that the decision to invade Somalia was made because of the institutional and ‘bureaucratic’ interests of the Kenyan Defense Forces (KDF) advanced by a limited number of men of Somali-Kenyan origin who pursued their own interests. Security and economic concerns did play a role, while the paper dismisses that the invasion can be understood as a consequence of the Kenyan government pursuing an ‘international image management strategy’. Theoretically, the paper concludes that ‘Western’ theories may contribute to explaining the launch of ‘Linda Nchi,’ whereas Africa-focused theories like neo-patrimonialism seem less helpful in this particular context.

Succeeding in process standardization

Purpose The purpose of this paper is to explore the fit between process standardization and international management strategy of multinational corporations (MNCs) by assessing the compatibility between process standardization and corporate structural characteristics in terms of asset configuration and headquarters-subsidiary relationships. Design/methodology/approach First, after a literature review on MNCs’ strategy and process standardization, the study suggests two propositions on the fit between corporate international management strategy and process standardization. Second, to empirically examine the propositions, the study investigates the outcome of process standardization in three cases with different strategic and structural contexts. Third, using the propositions and empirical findings, the study proposes a framework for aligning process standardization with MNCs’ structural characteristics. Findings Process standardization has a higher degree of fit in MNCs pursuing global integration where process standardization parallels the need for coordinating interdependencies in the functional structure, and is consistent with the headquarters’ operational control over the subsidiaries. Process standardization has a lower degree of fit in MNCs seeking local responsiveness as process standardization disturbs the financial control relationship between the headquarters and subsidiaries and is less crucial for coordination as the subsidiaries contain the necessary coordination mechanisms. Originality/value The study provides in-depth understanding of how the international management strategy and consequent structural characteristics of MNCs affects process standardization in the course of a global enterprise resource planning implementation. The study proposes conditions of fit for aligning process standardization with asset configuration and headquarters-subsidiary relationships of an MNC.

Molecular systematics of the Cape Parrot (Poicephalus robustus): implications for taxonomy and conservation.

The taxonomic position of the Cape Parrot (Poicephalus robustus robustus) has been the focus of much debate. A number of authors suggest that the Cape Parrot should be viewed as a distinct species separate from the other two P. robustus subspecies (P. r. fuscicollis and P. r. suahelicus). These recommendations were based on morphological, ecological, and behavioural assessments. In this study we investigated the validity of these recommendations using multilocus DNA analyses. We genotyped 138 specimens from five Poicephalus species (P. cryptoxanthus, P. gulielmi, P. meyeri, P. robustus, and P. rueppellii) using 11 microsatellite loci. Additionally, two mitochondrial (cytochrome oxidase I gene and 16S ribosomal RNA) and one nuclear intron (intron 7 of the β-fibrinogen gene) markers were amplified and sequenced. Bayesian clustering analysis and pairwise FST analysis of microsatellite data identified P. r. robustus as genetically distinct from the other P. robustus subspecies. Phylogenetic and molecular clock analyses on sequence data also supported the microsatellite analyses, placing P. r. robustus in a distinct clade separate from the other P. robustus subspecies. Molecular clock analysis places the most recent common ancestor between P. r. robustus and P. r. fuscicollis / P. r. suahelicus at 2.13 to 2.67 million years ago. Our results all support previous recommendations to elevate the Cape Parrot to species level. This will facilitate better planning and implementation of international and local conservation management strategies for the Cape Parrot.

Validating Global Competency Scale for Indian Business and Management Education

When the organizations started to expand their business across the globe, with the opening up of markets, the issues of international management strategies and competencies of international mangers got more and more attention. Researchers along with the business houses started their quest for identifying, defining and framing a set of competencies necessary for a successful international manager. In this process throughout the years a number of models and construct have been developed to address the issue of competencies required for globalized management era. In the context of management educations the issues global competency development is yet in the stage of infancy, developing very sluggishly, un-professionally and irrelevantly. Considering the state of pseudo showcasing the global competency development practices in the Bschools in India, the authors attempted to develop a scale for facilitating assessment among the students of b-schools for Indian educational set-up. The present attempt has identified the variables from various models and constructs and checked the validity and reliability of the scale proposed.

Wissenschaftliche Betrachtung der Mindestmengen – Theorie und Empirie

Das Landessozialgericht Berlin-Brandenburg hält die Assoziation zwischen der Menge und dem Ergebnis einiger Leistungen, für die der Gemeinsame Bundesausschuss Mindestmengen festgelegt hat, für nicht patientenrelevant. Damit wird die Mindestmengenvereinbarung grundsätzlich hinterfragt. Studien zur Mengen- Ergebnis-Beziehung können anhand der Bradford-Hill- Kriterien im Hinblick auf eine kausale Assoziation überprüft werden. Eine wissenschaftliche Betrachtung der Studienlage verdeutlicht jedoch, dass die methodische Qualität vieler Studien weiterhin kaum ausreicht, um evidenzbasiert Leistungsbereiche respektive Mindestmengen festzulegen. Stärker als durch die Leistungsmenge von Ärzten und Krankenhäusern wird die Qualität durch die Anwendung der jeweils besten Behandlungsverfahren beeinflusst. Dieser Faktor sollte eine auf Mengen fokussierte Qualitätssicherung immer ergänzen.