Meso Factors Research Articles

Corporate governance of audit firms: Assessing the usefulness of transparency reports in a Europe‐wide analysis

AbstractManuscript TypeEmpiricalResearch Question/IssueBased on both institutionalized agency theory and meso‐level theory, this study examines corporate governance disclosure in an audit firm's transparency report (TR) and whether more disclosure is associated with (a) the audit function of the country in which it is disclosed; (b) high levels of investor confidence in public interest entities (PIEs) shown in the portfolio of the audit firm; and (c) increased competition within the audit market.Research Findings/InsightsOn the basis of content analysis, different measures of a corporate governance disclosure index (CGDI) are calculated for a sample of 122 auditing firms from 10 European countries over the period 2010–2012. Despite attempts at harmonizing audit practice across the EU, results confirm the role of institutional context in explaining differences among European countries. Moreover, while the CGDI reveals that the TR does improve investor confidence, no evidence was found that the new disclosure requirement unsettled audit market concentration.Theoretical/Academic ImplicationsResults support arguments of the institutionalized agency theory that audit firms’ corporate governance disclosures depend on both firm‐ and country‐level factors. Moreover, the interplay between these macro and meso factors explains the information asymmetry reduction that exists between auditors and shareholders, thus improving micro‐level investor confidence.Practitioner/Policy ImplicationsThe study provides an analysis of audit firm transparency based on the information disclosed in mandatory TRs. Policymakers and practitioners may benefit from the knowledge of items included in the TRs expected to impact on investor confidence. It also proposes the use of the TR for achieving market competition strategies, although it may be inefficient.

Palliative Care Development in European Care Homes and Nursing Homes: Application of a Typology of Implementation

BackgroundThe provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. ObjectivesTo identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe. Design and methodsWe undertook a mapping exercise in 29 European countries, using 2 methods of data collection: (1) a survey of country informants, and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data, we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From these data, a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed. ResultsWe identified 3 levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities, such as education, tools/frameworks, service models, and research), and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development, and means of provision. We found that macro and meso factors at 2 levels shape palliative care implementation and provision in care homes at the micro organizational level. ConclusionsImplementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high-quality palliative care in care homes is supported by implementation activity at these 3 levels. Understanding where each country is in terms of activity at these 3 levels (macro, meso, and micro) will allow strategic focus on future implementation work in each country.

'Gearing Up' to improve interprofessional collaboration in primary care: a systematic review and conceptual framework.

BackgroundInterprofessional Primary Care Teams (IPCTs) have been shown to benefit health systems and patients, particularly those patients with complex care needs. The literature suggests a wide range of factors that may influence collaboration in IPCTs, however the evidence base is unclear for many of these factors. To target improvement efforts, we identify studies that demonstrate an association between suggested factors and collaborative processes in IPCTs.MethodsA systematic review of 25 years of peer-review literature was conducted to identify studies that test associations between policy, organizational, care team and individual factors, and collaboration in IPCTs. We searched Medline, ProQuest subject, ProQuest abstract, CINAHL, HealthSTAR, and Embase electronic databases between January 1990 to June 2015 and hand-searched reference lists of identified articles.ResultsThe electronic searches identified 1421 articles, nine of which met inclusion criteria.Eighteen factors were significantly associated with collaboration in at least one article.We present the findings within a proposed conceptual model of interrelated ‘gears’. The model offers a taxonomy of factors that policy makers (macro gear), organizational managers (meso gear), care teams (micro gear) and health professionals (individual gear) can adjust to improve interprofessional collaboration in IPC teams. Thirteen of the eighteen identified factors were within the micro gear, or team level of decision-making. These pertained to formal processes such as quality audits and group problem-solving; social processes such as open communication and supportive colleagues; team attitudes such as feeling part of the team; and team structure such as team size and having a collaboration champion or facilitator. Fewer policy (eg governance), organizational (eg information systems, organizational culture) or individual (eg belief in interprofessional collaboration care and personal flexibility) level factors were identified.ConclusionsThe findings suggest that individual IPCTs have opportunities to improve collaboration regardless of the organizational or policy context within which they operate. Evidence supports the importance of having a team vision and shared goals, formal quality processes, information systems, and professionals feeling part of the team. Few studies assessed associations between collaboration and macro and meso factors, or between factors across levels, which are priorities for future research.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0492-1) contains supplementary material, which is available to authorized users.

General Practitioners and Chronic Non-Malignant Pain Management in Older Patients: A Qualitative Study.

Chronic non-malignant pain (CNMP) is commonly managed by General Practitioners (GPs) in primary care. Analgesics are the mainstay of CNMP management in this setting. Selection of medications by GPs may be influenced by micro factors which are relevant to the practice setting, meso factors which relate to the local or regional environment or macro factors such as those arising from national or international influences. The aim of this study is to explore influences on GP practises in relation to pain management for older adults with CNMP. Semi-structured interviews were conducted with 12 GPs. Transcripts were organised using the Framework Method of Data Management while an applied thematic analysis was used to identify the themes emerging from the data. Clinical considerations such as the efficacy of analgesics, adverse effects and co-morbidities strongly influence prescribing decisions. The GPs interviewed identified the lack of guidance on this subject in Ireland and described the impact of organisational and structural barriers of the Irish healthcare system on the management of CNMP. Changes in practice behaviours coupled with health system reforms are required to improve the quality and consistency of pharmacotherapeutic management of CNMP in primary care.

Women in Healthcare: Barriers and Enablers from a Developing Country Perspective

As the under-representation of women in management positions continues to persist globally, little is known about the experiences of women in the healthcare sector in the context of the developing Middle Eastern nations. In an attempt to address this knowledge gap, the current study explores some of the barriers that hinder and the enablers that foster women's career advancement in the healthcare sector. To meet its objectives, the current study uses a relational approach that integrates the macro socio-cultural, meso-organisational, and micro-individual levels of analysis. Guided by institutional theory as a theoretical framework and social constructionism as a philosophical stance, the current study adopts a qualitative research methodology. It capitalizes on in-depth, semi-structured, face-to-face interviews with women managers in different occupational fields, across the managerial hierarchy in the healthcare sector in Lebanon. Snowballing and purposeful sampling procedures were used, and the interviews were analysed using thematic analysis, focusing on identifying new, emerging themes. The results of the study confirm the salience of discriminatory cultural values, gendered social roles and expectations in Middle Eastern societies, and illustrate their role as barriers hindering women's career advancement. The results also portray the spillover effect of societal expectations and cultural gender stereotypes into the organisational realm, resulting in widely experienced attitudinal and structural organisational barriers. This study also illustrates how the enablers that facilitate and promote women's career progression unfold amidst the interplay between the macro and meso factors, lending credence to the role of women's agency at the individual micro level. Amongst the toll of barriers, Middle Eastern women navigate the patriarchy of their cultures and the discrimination inherent in their organisations by using their agency and persistence as they construct and negotiate their careers in management. This study provides new knowledge on the status of Middle Eastern women in the healthcare sector, a sub-category of female employees that to date, is under-researched. It primarily highlights the role of agency in building women's careers. It also stresses the notion that the complexity of women's careers in the healthcare sector can be best understood using a relational approach that highlights the intersectionality between gender, agency, socio-cultural realities and organisational boundaries.

Ecological factors associated with sexual risk behaviors among detained adolescents: A systematic review

Adolescents who have a history of being detained report rates of STI that are 8 to 10 times higher than peers without such histories. Over the last decade, an increasing number of studies have identified multiple factors that are associated with STI risk behaviors and acquisition among detained youth. However to date, no reviews of this literature have been conducted, which is the aim of this paper. We conducted a review of the published literature to identify correlates of risky and STIs among detained youth. PsycINFO, PubMed, MEDLINE and Googlescholar were searched for English-language publications from 1999 to present. These dates represent the time period when the majority of research was conducted among this population. This paper utilizes an ecological model to review risk and protective factors related to STIs among this population. Findings indicated that individual factors (i.e., age, gender, substance use, and mental health); micro factors (i.e., parental monitoring, family violence, and peer influences); meso factors (i.e., school enrollment, student-teacher connectedness, and community violence exposure); and macro factors (i.e., race/ethnicity, cultural norms, gender violence and health care policies) were related to risky sex and STIs. We discuss conceptual and theoretical mechanisms that may account for such relationships and conclude with recommendations for advancing future research and service delivery with this population. ► Detained youth report higher rates of STIs than their non-detained peers. ► We reviewed ecological factors associated with these STI risk behaviors. ► Understanding mechanisms linking such factors will help inform prevention initiatives. ► Prevention initiatives need to address the social determinants of sexual risk when possible.

The Influence of National Culture on the Adoption Status of Innovations:: An Empirical Study of Firms Across Europe

Firms, like consumers, differ in their likelihood and speed to adopt innovations, i.e. new products, systems or services. Differences in adoption status are generally explained by scholars based on (i) particular characteristics of the firm and of the new products (micro factors) and (ii) the type of industry the firms are in (meso factors). This study adds to the literature by investigating if national culture (a macro factor) adds to the explanation of differences in adoption status for firms operating in different countries. A large-scale empirical study was carried out in 10 European countries concerning the adoption of Enterprise Resource Planning (ERP) software by medium-sized companies. Key finding is that variables describing national cultural highly significantly explain variance in adoption decisions in addition to the traditional micro and meso variables. These findings support the proposition that cultural differences between countries, even within the EU, are still so large that they impact the likelihood of adoption by companies operating in different countries. The findings have important implications for business-to-business companies expanding in foreign countries with new products and services.