Islands Of Excellence Research Articles

IDF21-0405 International knowledge exchange of quality measures in primary diabetes care: a realist synthesis

Background: International knowledge exchange (iKE) offers opportunities for improvement in diabetes quality of care, through setting comparable and evidence-informed standards as well as learning from best practices. While many high-income countries (HIC) have developed diabetes quality measures, little is known on how these were exchanged and how stakeholders in low- and middle-income countries (LMIC) can benefit from and contribute to this knowledge. Aim: To analyze the current exchange of quality measures in diabetes care between countries and provide a roadmap for future improvement of quality, with emphasis on LMIC. Method: Realist synthesis, combining literature review with in-depth interviews. First, we conducted searches of electronic data-bases for peer-reviewed articles (i.e., PubMed), organizational databases (i.e., OECD iLibrary) and country-level reports. We then contacted the corresponding authors of articles and documents relevant to exchanging diabetes quality measurements between countries, and invited them to a 30–60 minutes semi-structured on-line interview on the subject. These steps were repeated iteratively by asking interviewees to recommend other key-informants or relevant studies. 383 documents were retrieved during the process. Subsequently, 80 articles and reports from 32 countries and regions contributed to the final synthesis, and 14 informants were interviewed. Results: Knowledge exchange of quality measures is conducted in two main pathways, namely country-to-country and through international organizations. On the country level, selection of measures is often based on literature reviews, Delphi consensus techniques and international workshops. The International Diabetes Federation (IDF) and the World Health Organization (WHO) have played a major role in assisting stakeholders in LMIC to estimate national diabetes prevalence and risk factors. However, according to the latest IDF Atlas, about one third of all countries still do not have satisfactory data, even for diabetes prevalence. Use of national hospital data for measuring diabetes outcomes is practiced in about one fifth of all countries and has gained momentum due to the OECD ‘Health at a Glance’ project. Nevertheless, this measurement framework is insufficient for improving primary diabetes care nor for strengthening LMIC capacity. Projects for measurement of primary diabetes care on the local/district level or within specific health plans often demonstrate efficacy, such as glycemic control, but fragmented implementation excludes patients who are not in the measured health plans. Population-wide implementation of quality measures for primary diabetes care is currently practiced in only a few high-income countries with universal health coverage. Discussion: On the country level, we suggest a roadmap for policymakers and researchers to identify which international diabetes initiatives are most appropriate in their context and what possible pathways could improve their diabetes quality measurement. Data collection and management capacities serve as barriers, and should be strengthened particularly in LMIC to achieve a global picture of diabetes care. Paradigms of ‘hospital centrality’ limit both HIC and LMIC ability to advance measurement in primary diabetes care. Population-wide and national measurement systems should be prioritized over outstanding but unsustainable projects (‘Islands of Excellence’), to achieve the desired improvement in both quality and equity of diabetes primary care.

Building knowledge beyond our experience: integrating sustainable development goals into IJPR’s research future

The United Nations’ sustainable development goals (SDGs) are now entering their decade of action. We are supporting this decade by further encouraging the International Journal of Production Research (IJPR) and its scholarly community to lead on contributing to global SDGs through research, knowledge development, and dissemination. There are islands of excellence that are evident from the past 60 years of IJPR research – especially in ecologically sustainable production-related SDG. There are also serious SDG gaps – for example, general environmental, gender, and inclusiveness research – that can provide additional insights that can greatly advance the IJPR disciplines. This thematic analysis ends with a number of recommendations that seek to expand our experiences and knowledge.

The Variation of Bureaucratic Capacities in the Brazilian Federal Public Administration: an Analysis with Survey Data

Abstract This paper aims to demonstrate the variation in bureaucratic capacities within the Brazilian Federal Public Administration concerning organizations belonging to different policy sectors and verify theoretical propositions in the literature about the relationship between the characteristics of public bureaucracy and state action. For such purposes, data from a questionnaire applied to Brazilian federal civil servants were analyzed using a set of multivariate analysis techniques. The findings indicate that organizations with a greater perception of bureaucratic "weberianess" are correlated with innovative organizations and organizational cultures that restrict corruption. Likewise, organizations with greater bureaucratic autonomy are associated with more effective organizations. However, the observed variation between perceived capabilities and performance did not characterize a clearly identifiable pattern of organization type with public policy sectors. In this sense, the article contributes to the literature by adding nuances to the "islands of excellence" approach by verifying that the asymmetry of capabilities within the Brazilian executive branch is more complex than indicated by previous research.

The Variation of Bureaucratic Capacities in the Brazilian Federal Public Administration: an Analysis with Survey Data

Abstract This paper aims to demonstrate the variation in bureaucratic capacities within the Brazilian Federal Public Administration concerning organizations belonging to different policy sectors and verify theoretical propositions in the literature about the relationship between the characteristics of public bureaucracy and state action. For such purposes, data from a questionnaire applied to Brazilian federal civil servants were analyzed using a set of multivariate analysis techniques. The findings indicate that organizations with a greater perception of bureaucratic "weberianess" are correlated with innovative organizations and organizational cultures that restrict corruption. Likewise, organizations with greater bureaucratic autonomy are associated with more effective organizations. However, the observed variation between perceived capabilities and performance did not characterize a clearly identifiable pattern of organization type with public policy sectors. In this sense, the article contributes to the literature by adding nuances to the "islands of excellence" approach by verifying that the asymmetry of capabilities within the Brazilian executive branch is more complex than indicated by previous research.

India @ 75: Science, Technology and Innovation Policies for Development

India was perhaps the only country among the developing world with a colonial past to have organised and established national science community much before it attained its independence. Nehruvian science and technology (S&T) policy in India’s formative years left a distinct imprint in the post-colonial and post-independent India. With a huge population of nearly 1.35 billion people, India is not dependent on food on outside countries since the 1960s. Green and White Revolutions have made immense contribution to develop scientific and technical capacities in agriculture. India’s innovation system, including higher education, has given her some comparative advantage through ‘human capital’ in information technology, biotechnology, pharmaceuticals, space research and so on. In export promotion and economic competitiveness in technology-based industries, we lag compared with East Asian ‘Dragons’. India’s informal sector poses a formidable challenge with more than 95% of the total labour force, about 550 million, 90% of which is 8th class dropouts. When we begin to assess our national innovation system, one feature that stands out to research observers is few islands of excellence and vast ‘hinterlands’ of underdeveloped research potential. There is clearly a gap between theory and practice of science policy in India. Our gross expenditure on research and development as a proportion of gross domestic product remained relatively stagnant and, in fact, receded from 0.8% in the 1990s to 0.7% in 2020. In this period, our neighbour, China, left us far behind in S&T for development.

“Islands of excellence”: On the emergence of corporate socials in India

In 2014, the government of India mandated that India's largest companies devote 2% of their net profits to corporate social responsibility (CSR). Drawing on fieldwork on the CSR activities of Bangalore‐based Titan, a Tata Group company and India's largest watch producer, and Wipro, one of India's largest IT companies, this article contends that government‐mandated biopolitical engagements by Indian corporations forge new iterations of “the social” and are generative of spatially delimited and heterogeneous “corporate socials.” Corporate socials can be situated within broader global shifts away from universal forms of social welfare. While these developments may represent the “death of the social,” I contend that they are an emergent modality of government‐mandated service provision by private actors in India, one that is giving rise to a patchwork of plural socials, which proponents argue can also serve as engines of corporate‐led resource redistribution.

The importance of the online storage of patient data in Indian COVID-19 scenario: A narrative review.

Generation Z has seen drastic changes in the medical sector with the health-care industry constantly updating itself with newer tools to provide quality treatment. The COVID-19 pandemic has greatly tested the services in every aspect of life and has led to an unprecedented increase in the online storage of patient data. Electronic health records (EHRs) are real-time records that make health information of any patient available securely to authorized users. EHRs in the Indian scenario are still in their budding stages, described as "islands of excellence in an ocean of inadequacy." The central institutes and corporate hospitals have implemented it, but the state medical colleges and peripheral health centers have miles to go. These patient data records become an essential tool in physician's decision-making, expertise, and management. One can review the data which is just a click away even after the patients have been discharged, especially in the follow-up period. The current scenario is such that health-care workers and nonhealth-care workers alike share the data of the patients in respect to their records, radiographs, and laboratory data using social media such as WhatsApp, Facebook, and Telegram. In the absence of adequate regulations, the reliability of the EHRs is questionable and doubt creates a preference for the traditional medical services among the health-care workers. To conclude, a clear and precise guideline that can enlighten the patient and health-care workers is the need of the hour. The concerns of online storage of data need to be alleviated and privacy regulations need to be addressed.

Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation

ObjectivesThis study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco.DesignWe adopted the realist evaluation...

Designing learning-skills towards industry 4.0

The world is shrinking now more than ever due to new scientific and technological breakthroughs that expand the boundaries of human knowledge, resulting in improvements in transportation, communication, space exploration and educational technologies. Today’s students will compete in a technological, diverse, multi-cultural world and must be prepared to thrive in this futuristic environment. Therefore, it is vital that today’s pedagogy produce lifelong learners, who can succeed in a global pulpit. To ensure our educational technology progresses at the rate demanded by today’s ubiquitous digital learners, we review emerging technologies and traditional teaching methods and propose desirable changes. Future companies will need employees with specific Internet of Things connected additive manufacturing skills across the value stream, including computer-aided design, machine operation, raw material development, robotics and supply chain management; but these are only island of excellence in industry 4.0 and not the consummate requirement of the manufacturing process.Keywords: Industry 4.0, IoT, smart teaching, future skills.

Management of Collegiate Education in the 21st Century:Some Insights

An accepted reality of the Indian higher education, especially college education is the decline in its qualitative relevance with respect to the curriculum, method of delivery, value system and skills. Another area which requires immediate attention is the ever-widening gap between some of the ‘islands of excellence’ and other higher education institutions. Therefore, it is imperative that we as a nation address this issue and reform the higher education system thoroughly in order to arrest the declining trend. In order to undertake such a redesigning of the system, it is essential to understand the complexities that exist and have a comprehensive overview of changes that need to be made to address individual issues. In this context, this book is extremely relevant to the present higher education landscape of the country, with specific reference to collegiate education.

Contracting Out, Legitimacy, and State Building

ABSTRACTContracting out what are traditionally regarded as core sovereign functions is an iconic example of governance in areas of limited statehood. When national political authorities share sovereign authority with external actors, at least two key questions arise. First, when will such arrangements be accepted as legitimate? Second, how can they boost the capacity and legitimacy of state institutions? We argue that the dominant source of external actors’ legitimacy will be their performance. External actors that perform well can help create ‘islands of excellence’ in the domestic system that can raise the effectiveness and legitimacy of other local institutions. However, this type of virtuous cycle is rare and depends on external, domestic elite, and public support – a formula not easily achieved. We illustrate these arguments with several brief case studies.

Low prevalence of anaemia among the wives of serving personnel in a military station: A community-based study

BackgroundVarious studies in India have reported the prevalence of anaemia to be more than 50% among women of the reproductive age group. A community-based study was done to find out the prevalence of anaemia in non-pregnant, non-lactating wives of serving soldiers in a military station. MethodsIt was a cross-sectional study. The sample size was 600. Venous blood was collected for haemoglobin and ferritin levels. Analysis was done by SPSS 20. ResultsThe mean age at marriage was 19.8 years (SD+2.76). The average age at first childbirth was 20.88 years. Major symptoms reported were weakness (24.34%), giddiness (23.47%), fatigue (20.17%) and heavy bleeding (3.13%). Prevalence of anaemia in our study was 13.9%, which is much below the national prevalence. Prevalence of iron-deficient status was reported in 153 (26%) individuals. Out of these, 81 subjects were non-anaemic (Hb>12d/dL) but were iron deficient (ferritin <15μg/L). Sixty out of these 81 subjects reported presence of fatigue and 36 had weakness. Statistically significant associated observations of anaemia were low Body Mass Index, irregular menstrual pattern, shortened menstrual cycle and increased duration of bleeding (p<0.05). Low ferritin levels were significantly associated with low BMI, not using Oral Contraceptive Pills and bleeding for more than 3 days during menstrual cycle (p<0.05). ConclusionThe scenario of low prevalence of anaemia in women under the cover of the Armed Forces Medical Services represents an ‘island of excellence’.

The Elusive Island of Excellence - A Study on Student Demographics, Accessibility and Inclusivity at National Law School 2015-16

National Law School of India University set up by Dr. Madhava Menon in eighties, transformed the legal education in the country. Very soon, five-year integrated law course became the preferred option amongst students and National Law Universities (NLUs) now numbering eighteen, sprouted across the country. These autonomous law institutes are unique in their character and are different from traditional universities. One such characteristic is their low student intake, giving them an air of exclusivity. Former Prime Minister went to the extent of describing them as "Islands of excellence in vast ocean of institutionalised mediocrity". NLS by all popular parameters, is considered to be the premier law institute of the country. This feeling of belonging to an elite institution and an aura of exclusivity, prompted this study to assess student demographics to be undertaken. NLS Diversity Census 2015 covered 97.9% of the student body, tabulating data relating to socio-economic background and performance & participation at NLS. Using this data as the basis, supplemented with several rounds of interviews and specialised surveys - this report has been compiled, which looks at the correlations between background factors and performance at NLS.The Report is divided into two parts. The first part looks at and tries to answer the question of accessibility, ie, who is likely to get admitted into NLS? The second half analyses and tries to assess influence of one's background upon performance and participation within NLS, and impact on one's future plans. Evaluating the existing support systems and structures-how they are currently and also how they once were, the Report concludes by making suggestions on how to make National Law School even more democratic institution where all can excel, equitably.

Upgrading translational engineering in medicine and biology through conscious-technology with humanistic motivation and global vision

The synergy between Engineering and Biology, which evolves as fast as both each of these disciplines do, allows us to offer top-of-the-line foundations to generate strong interactions industrial and welfare entities associated to health and living systems fields. We propose to articulate these fields based on the premise that new professionals must face different situations or crises due to the so-called islands of excellence. Often, the effort of retaining the lectures of teachers conspires against one’s own capability for analysis, logic and reasoning; a university education that does not stimulate the critical mind and does not teach how to think is not higher education, but training to submission. We are revising the programs of biomedical engineering education and the application of new pedagogic paradigms where critical thinking is the key: a holistic challenge which consists in a new way of teaching, learning, innovating, communicating and sharing with a creative attitude that represents quality of perception. We must redesign Engineers to work in a hybrid world where technology, science, humanism and other tendencies fuse and interconnect. In consequence, engineering becomes a profession whose limits are not specified, and where technology is the cause of a splendid amalgamation of science, art and management, widening the scope of its institutional mission. Rene Favaloro stated that individualism had to be replaced by collective interests and realized that teachers could cooperate in his plans through daily preventive education. During his lectures, he did not speak only about Medicine, but also about important social aspects such as poverty, the environment, drugs, education and the arms industry. He promoted changes in society, where education and social justice would be a top priority, and where university graduates got strongly involved with society, because history has taught us that good ideas and technologies can have unintended and negative consequences. On the basis that an increasingly educated and Internet-connected generation is rising up against the abuse of power and threats that hang over our entire planet, we propose a new educational paradigm which takes into account the thoughts of Favaloro as well as those of the Nobel Laureate Bernardo Houssay, and the legacies of Louis Pasteur and the Medici Family, to enhance Engineering Education in Biology and Medicine, and thus while encouraging faculty with this approach and motivating students and stimulating their creativity and their innovative ability throughout a conscious-technology curricula with humanistic motivation and global vision.

A proposal to enhance Engineering education in biology and Medicine by following the legacy of René Favaloro.

The synergy amongst Engineering, Medicine and Biology evolves as fast as these disciplines. We propose to articulate these specialties based on the premise that new professionals must face different situations or crisis due to the so-called islands of excellence. René Favaloro focused his work and struggles against poverty, since malnutrition and environmental degradation may increase the propensity to cardiovascular diseases. Doctor Favaloro has dedicated, throughout his career, a considerable amount of time to prepare and qualify a research group, aware of the importance that an adequate working environment has over the final results. He created a team of young students, engineers, medical doctors, physicists, mathematicians and other specialists. He centered his attention on human resources, in order to disseminate his latest advances in Biology, Medicine and Engineering. We are revising the programs of biomedical engineering education and the application of new pedagogic paradigms, where critical thinking is the key: a holistic challenge that consists of a new way of learning, innovating, communicating and shearing, with a creative attitude that represents quality of perception.

From network to hierarchy: the evolution of the Estonian senior civil service development system

The aim of this article is to explore the opportunities for and constraints of the establishment of a central coordination instrument in a highly fragmented central government. The article is based on a case study which examines the creation of a development system for Estonian senior civil servants. It describes and explains shifts in the coordination mechanisms within this initiative over the last decade. The study concludes that networks may offer an alternative to hierarchy for the creation of new coordination practices in fragmented administrative systems. However, networks may prove to be insufficient and require further institutionalization and formalization through the inclusion of hierarchical elements once the coordination instrument matures. The study also shows that the funding arrangements may trigger a shift in basic coordination mechanisms. It is therefore suggested that future research should systematically examine funding practices as an integral part of coordination arrangements.Points for practitionersThis article shows how civil servants can launch a major coordination initiative without the input of the legislator, and build a governmental ‘island of excellence’ with the help of the EU’s structural funds. The establishment of a sound basis for the initiative in the form of a competency model and subsequently an assessment system was crucial in the evolvement of the senior civil service development system in Estonia. Constant learning and the gradual winning of the target group’s trust and support laid the groundwork for institutionalizing a coordination instrument initially designed to operate on a voluntary basis. The article also shows how addressing one coordination problem may raise new issues of accountability, sustainability and coordination.

India’s higher education challenges

India, with the world’s second largest higher education system and a rapidly growing economy as one of the BRIC nations, faces significant challenges in building both capacity and excellence in higher education. India’s higher education system is characterized by “islands of excellence in a sea of mediocrity.” The mainstream universities are recognized as lacking in quality. Only the Indian Institutes of Technology and related institutions garner international recognition. This article analyzes the challenges facing India’s higher education system in the twenty-first century.

Entrepreneurial Community in Kansas City: From Fragmented to Collaborative?

A small set of metropolitan areas in the United States can be considered second-tier life sciences or technology regions. Kansas City is such an emerging second-tier region. The Kansas City metropolitan area was able to grow a small but specialized knowledge economy because of the presence of large firms and subsequent efforts to strengthen entrepreneurship. This paper presents data from twenty interviews conducted in the summer of 2012 with regional experts, venture capitalists, and entrepreneurs who have successfully raised risk capital.The analysis of Kansas City’s entrepreneurial community shows, first, that large firms’ role as incubators of entrepreneurial startup companies seems to have diminished, and that there are weak connections between existing large firms and entrepreneurial ventures. Second, entrepreneurial exits in the form of mergers and acquisitions have increased and a small number of cashed-out entrepreneurs are reinvesting their funds and becoming engaged. Yet this process seems to be still in its beginning stages. Third, the region’s entrepreneurial community does not exhibit strong networking and collaboration. Rather, entrepreneurial ventures and industry connections exist much like “islands of excellence” without strong interconnections. Fourth, although the availability of funding has increased, local entrepreneurs perceive the accessibility and availability of funds - and the capacity local venture investors bring to the table - as limiting factors. At the same time, while the number of investment groups has increased, the investor community is still fragmented and not well connected. Fifth, the energy and collective effort to improve the Kansas City entrepreneurial community has increased and strengthened significantly since 2006 when a similar study was conducted.Various groups and organizations have ensured a thickening of the entrepreneurial support infrastructure in the form of creation of incubators, establishment of financial incentives to invest in entrepreneurial ventures (i.e. angel tax credits), and the addition of effective mentoring and networking events. Yet the analysis of the data shows that Kansas City faces the drawbacks of a region characterized by organizational thinness in the form of weak endowment of firms and organizations that can fuel the entrepreneurial pipeline and a lack of interaction and networks among key members of the entrepreneurial community, which keeps the entrepreneurial economy fragmented. To overcome organizational thinness and fragmentation, this paper suggests focusing policy efforts on connecting key actors in the entrepreneurial economy such as existing large firms, entrepreneurial ventures, universities, and funding and mentoring organizations.

Entrepreneurial community in Kansas City: From fragmented to collaborative?

A small set of metropolitan areas in the United States can be considered second-tier life sciences or technology regions. Kansas City is such an emerging second-tier region. The Kansas City metropolitan area was able to grow a small but specialized knowledge economy because of the presence of large firms and subsequent efforts to strengthen entrepreneurship. This paper presents data from twenty interviews conducted in the summer of 2012 with regional experts, venture capitalists, and entrepreneurs who have successfully raised risk capital.The analysis of Kansas City’s entrepreneurial community shows, first, that large firms’ role as incubators of entrepreneurial startup companies seems to have diminished, and that there are weak connections between existing large firms and entrepreneurial ventures. Second, entrepreneurial exits in the form of mergers and acquisitions have increased and a small number of cashed-out entrepreneurs are reinvesting their funds and becoming engaged. Yet this process seems to be still in its beginning stages. Third, the region’s entrepreneurial community does not exhibit strong networking and collaboration. Rather, entrepreneurial ventures and industry connections exist much like “islands of excellence” without strong interconnections. Fourth, although the availability of funding has increased, local entrepreneurs perceive the accessibility and availability of funds - and the capacity local venture investors bring to the table - as limiting factors. At the same time, while the number of investment groups has increased, the investor community is still fragmented and not well connected. Fifth, the energy and collective effort to improve the Kansas City entrepreneurial community has increased and strengthened significantly since 2006 when a similar study was conducted.Various groups and organizations have ensured a thickening of the entrepreneurial support infrastructure in the form of creation of incubators, establishment of financial incentives to invest in entrepreneurial ventures (i.e. angel tax credits), and the addition of effective mentoring and networking events. Yet the analysis of the data shows that Kansas City faces the drawbacks of a region characterized by organizational thinness in the form of weak endowment of firms and organizations that can fuel the entrepreneurial pipeline and a lack of interaction and networks among key members of the entrepreneurial community, which keeps the entrepreneurial economy fragmented. To overcome organizational thinness and fragmentation, this paper suggests focusing policy efforts on connecting key actors in the entrepreneurial economy such as existing large firms, entrepreneurial ventures, universities, and funding and mentoring organizations.

The institutionalization of meritocracy in Latin American regulatory agencies

Research into 72 regulatory authorities in four policy sectors (pharmacy, telecommunications, finances and pensions) in 18 Latin American countries shows that the institutionalization of meritocratic practices in the recruitment and careers of its staff has not been widespread, even in countries with a professionalized bureaucracy. The implementation of meritocracy could be partially explained through the policy sector and the influence of epistemic communities while alternative explanations like administrative legacies or the autonomy of the regulatory authorities to devise and implement personnel policies play a less important role. The institutionalization of meritocracy in ‘islands of excellence’ has policy implications for sustained merit-based strategies for the civil service.Points for practitionersThis research has shown that the institutionalization of meritocracy is not widespread when considering recruitment and staff careers in 72 regulatory Latin American agencies. Successful meritocratic practices are partially explained by the policy sector in which these agencies operate. Economic regulated sectors (financial services, delivery of pensions and telecommunications) are more meritocratic than social regulated areas (pharmacy). Two explanations have been offered for this. On the one hand, meritocracy seems to be influenced by particular epistemic communities in which competition plays an important role (for instance, economists). On the other hand, agencies need to increase their credibility and attract the confidence of international donors and private regulated enterprises. These findings suggest that the introduction of meritocracy could be more successfully approached through a more individualized process (i.e. by targeting individual agencies) instead of launching overall civil service reforms with uncertain consequences.