Process-based Change Research Articles

Variability in composition of parrotfish bite scars across space and over time on a central Pacific atoll

Parrotfishes are conspicuous herbivores, microvores, and detritivores in coral reef ecosystems, and the impacts of their feeding, particularly their capacity to expose reef carbonate, have received much attention. In many cases, parrotfish assemblages have been shown to control algal proliferation and promote the settlement of corals and crustose coralline algae (CCA). In extreme cases, high densities of parrotfishes may negatively affect net reef accretion through bioerosion and targeted coral predation. Most evidence describing the impacts of parrotfish foraging on benthic community structure is based upon correlations between benthic composition and parrotfish behavior or abundance, with much less known about process-based change of individual parrotfish bite scars through time. Here, we estimated parrotfish bite selectivity and determined the change in benthic composition within parrotfish bite scars relative to change in the overall reefscape using data collected over a 12-month duration from the fore reef habitat at Palmyra Atoll. We identified 2150 parrotfish bite scars which appeared most frequently on turf algae covered substrata but also on coral, CCA, and encrusting macroalgae. Of those bites taken on live coral, 96% of scars returned to live coral within 12 months. Notably, adult coral survivorship in bite scars was higher than at randomly sampled coral-covered locations not affected by parrotfish bites. The exposed substrate within bite scars was most commonly colonized by the dominant benthic functional group in the area immediately surrounding the scar. We found little evidence of coral recruitment to bite scars (1/2150); however, CCA growth on bites initially on turf algae increased from 18.4 to 32.9% across the two time intervals. Our results suggest that benthic areas affected by parrotfish bites were more likely to undergo a successional shift to a more calcified state relative to unaffected benthic areas, indicating that parrotfish grazing helps maintain highly calcified coral reef ecosystems.

Integration processes within the Croatian palliative care model in 2014 – 2020

In Croatia, palliative care has been developing as an integral part of the health care system since 2014. This development is in line with the integrated care concept emerging in many countries. However, there are a number of implementation problems. The aim of this article was to identify positive and negative determinants for the integration of palliative care in Croatia. We identified policy processes or organizational changes within three key domains: the development of new organizational structures, stakeholders’ empowerment, and removing barriers to the provision of integrated palliative care. The progress visible in these domains shows the sustainability of the palliative care model used in Croatia. However, there are also barriers hindering the integration of palliative care. We conclude that patient-centred and process-based change in health care can have a positive effect on the integration of care. Staff education and regulation of business processes are key for the sustainability of reforms. Lastly, it seems easier to achieve the integration of care when it develops as a bottom-up model and reflects the need for new processes, than when it is imposed from above as a single regional or national model.

Canadian Continental-Scale Hydrology under a Changing Climate: A Review

Canada, like other high latitude cold regions on Earth, is experiencing some of the most accelerated and intense warming resulting from global climate change. In the northern regions, Arctic amplification has resulted in warming two to three times greater than global mean temperature trends. Unprecedented warming is matched by intensification of wet and dry regions and hydroclimatic cycles, which is altering the spatial and seasonal distribution of surface waters in Canada. Diagnosing and tracking hydrologic change across Canada requires the implementation of continental-scale prediction models owing the size of Canada’s drainage basins, their distribution across multiple eco- and climatic zones, and the scarcity and paucity of observational networks. This review examines the current state of continental-scale climate change across Canada and the anticipated impacts to freshwater availability, including the role of anthropogenic regulation. The review focuses on continental and regional-scale prediction that underpins operational design and long-term resource planning and management in Canada. While there are significant process-based changes being experienced within Canadian catchments that are equally—if not more so—critical for community water availability, the focus of this review is on the cumulative effects of climate change and anthropogenic regulation for the Canadian freshwater supply.

Poor Involvement of General Practitioners in Decisions of Withholding or Withdrawing Life-Sustaining Treatment in Emergency Departments.

Decisions of withholding or withdrawing life-sustaining treatment are frequent in emergency departments (ED) and patients are often unable to communicate their wishes concerning end of life desires. To evaluate the participation of general practitioners (GPs) during the decision-making process of withholding or withdrawing life-sustaining treatments in ED. Prospective observational multicenter study. We included patients for whom a decision of withdrawing or withholding life-sustaining treatments was made in ED. For each patient, we enrolled one general practitioner. GPs were interviewed about their perception of end of life patient's management and the communication with ED and families. There were 109 potential patient participants. We obtained answers from 54 (49.5%) of the patient's associated GPs. Only 4 (7.4%) GPs were involved during the decision-making process of withholding or withdrawing life-sustaining treatments. Among GPs, 29 (53.7%) were contacted by family after the decision, most often to talk about their difficult experience with the decision. A majority (94%) believed their involvements in these decisions were important and 68% wished to "always" participate in end of life decisions despite the fact that they usually don't participate in these decisions. Finally, 66% of GPs believed that management of end of life in the emergency department was a failure and should be anticipated. GPs would like to be more involved and barriers to GP involvement need to be overcome. We do not have any outcome data to suggest that routine involvement of GPs in all end of life patients improves their outcomes. Moreover, it requires major system and process-based changes to involve all primary care physicians in ED decision-making. NCT02844972.

Easier and Faster Is Not Always Better: Grounded Theory of the Impact of Large-Scale System Transformation on the Clinical Work of Emergency Medicine Nurses and Physicians.

BackgroundThe effectiveness of Lean Thinking as a quality improvement method for health care has been contested due, in part, to our limited contextual understanding of how it affects the working conditions and clinical workflow of nurses and physicians. Although there are some initial indications, arising from prevalence surveys and interviews, that Lean may intensify work performed within medical environments, the evidence base still requires detailed descriptions of the changes that were actually introduced to individuals’ clinical workflow and how these changes impacted health care professionals.ObjectiveThe aim of this study was to explore ways in which a Lean intervention may impact the clinical work of emergency medicine nurses and physicians.MethodsWe used a realist grounded theory approach to explore the clinical work of nurses and physicians practicing in 2 emergency medicine departments from a single teaching hospital in Canada. The hospital has 1000 beds with 128,000 emergency department (ED) visits annually. In 2013, both sites began a large-scale, Lean-driven system transformation of their practice environments. In-person interviews were iteratively conducted with health care professionals from July to December 2017. Information from transcripts was coded into categories and compared with existing codes. With repeated review of transcripts and evolving coding, we organized categories into themes. Data collection continued to theoretical sufficiency.ResultsA total of 15 emergency medicine nurses and 5 physicians were interviewed. Of these, 18 individuals had practiced for at least 10 years. Our grounded theory involved 3 themes: (1) organization of our clinical work, (2) pushed pace in the front cell, and (3) the toll this all takes on us. Although the intervention was supposed to make the EDs work easier, faster, and better, the participants in our study indicated that the changes made had the opposite impact. Nurses and physicians described ways in which the reconfigured EDs disrupted their established practice routines and resulted in the intensification of their work. Participants also identified indications of deskilling of nurses’ work and how the new push-forward model of patient care had detrimental impacts on their physical, cognitive, and emotional well-being.ConclusionsTo our knowledge, this is the first study to describe the impact of Lean health care on the working conditions and actual work of emergency medicine nurses and physicians. We theorize that rather than support health care professionals in their management of the complexities that characterize emergency medicine, the physical and process-based changes introduced by the Lean intervention acted to further complicate their working environment. We have illuminated some unintended consequences associated with accelerating patient flow on the clinical workflow and perceived well-being of health care professionals. We identify some areas for reconsideration by the departments and put forward ideas for future research.

A process-based land use/land cover change assessment on a mountainous area of Greece during 1945–2009: Signs of socio-economic drivers

In the Mediterranean region, natural vegetation has been strongly affected by human activities for thousands of years. During the last decades, there has been a notable tendency for abandonment of marginal agricultural land that is further associated with a number of ecological consequences. In this study we recorded and mapped the temporal changes of land use/land cover (LULC) classes that were further aggregated into major process-based changes for the period 1945–2009 in Aetoloakarnania prefecture, Greece. LULC mapping was based on aerial photographs acquired in 1945, 1960, 1985–1986 and 2007–2009. Object-based image analysis allowed the classification of the region's LULC classes and, consecutively, the assessment of process-based LULC changes for each time period. The results indicated that agricultural land increased during the first post-war years while abandonment of agricultural land took place during more recent decades, especially after the period 1960–1985. The observed land abandonment is combined with a simultaneous densification of shrublands and forests. Radical socio-economic changes that took place in the 1960's include the migration of rural populations towards big cities and the beginning of the development of the tourist industry. We argue that these socio-economic changes play an important role in shaping the observed LULC changes.

Applicability of Lewin’s Change Management Theory in Australian Local Government

Public sector organisations are now expected to shift policy towards greater competition and to apply private-sector style management practice to the public domain. Around 70 per cent of all change programs initiated report a failure of the change effort. A lack of a valid framework to guide the implementation and management of organisational change is a major reason for the poor success rate of change initiatives. Public sector organisations are increasingly adopting private sector management principles and practices. Many private sector management techniques, applied without appropriate change management techniques have been criticised for creating problems, such as the language of consumerism, the contracting-out culture, and the monitoring and management of performance. Local government (City councils) are typically considered to be resistant to innovation and are relatively inert compared to other forms of organisation. This article examines the ‘process’ of organisational change. Among other theories, process-based change theories consider change as an on-going process. Thus, change typically occurs in multiple steps that take a considerable amount of time to unfold and efforts to bypass steps seldom yield a satisfactory result. Planned change advocates that organisations move from one fixed stage to another, through a series of pre-determined stages. This article concludes that Lewin’s (1951) planned approach to change can still be used to investigate change management in the city councils. Lewin’s (1951) models are highly generic. It argues that the focus of the change must be on the behaviour of the group, concentrating on factors such as group norms, roles, interactions, and socialisation processes. Lewin’s (1951) models are more relevant to incremental and isolated change projects which are often the case for the Australian local government. The model tends to be more appropriate for organisations, such as city councils, that are based on traditional top-down, command-and-control style of management, with segmented, small units and slow change timelines.

Stakeholders’ involvements in the implementation of proactive environmental practices

Purpose– The purpose of this paper is to investigate key causal linkages of proactive environmental practices of small and medium enterprises (SMEs). Specifically, this paper studies the ways that the interactions between different stakeholders such as suppliers and customers could intensify the widespread diffusion and implementation of green technologies. Understanding these linkages provide an opportunity to develop a framework that integrates stakeholders’ involvement, environmental practices and environmental/operational performances.Design/methodology/approach– This paper adopts the quantitative methodology. It uses the survey data collected from 232 Malaysian SMEs. The structural equation modelling (SEM) via AMOS 19 was employed to test the hypotheses.Findings– The empirical results suggest that decisions on environmental practices are influenced significantly by interactions between stakeholders but notably in different ways. While customers and employees involvements are targeted at process based changes, senior managers are interested in internal management improvements. Suppliers’ interactions, on the other hand, influence SMEs to improve on operations for product and process based changes at the same time. Interestingly, we did not observe any significant achievement on government partnership programmes aimed at improving SMEs’ environmental practices.Originality/value– The finding in this paper adds to the literature on corporate environmental practices (CEPs), by applying two stages SEM analysis to a survey data for a single industry (electronic and electric industry). The gap of the mainstream CEP literature is bridged by focusing on different types of CEP, namely, internal management systems, process-based changes and product-based changes.

Environmental Protection through Small Businesses: An Analysis of the Role of Stakeholders in Green Operations

In this paper we investigate key causal linkages in proactive environmental practices based on an empirical study of 232 Malaysian Small and Medium Enterprises (SMEs). We propose a conceptual framework and test this framework using Structural Equation Modelling (SEM). The key focus of this study is to explore SMEs’ environmental initiatives and the impact of stakeholders’ involvement in determining SMEs’ environmental strategies. The study examines the relationship between stakeholders’ involvement (customers, suppliers, government, top managers and employees) and proactive environmental practices (internal management systems, process-based changes, product-based changes). The results support the notion that SMEs have moved to develop an increasingly proactive environmental orientation. Although our survey strongly suggests that each stakeholder has a different role and impacts differently on SMEs’ sustainability practices, vertical partners play the most critical roles in supporting environmental practices based on product and process-based changes.

Beyond common factors: multilevel-process models of therapeutic change in marriage and family therapy.

A number of scholars have proposed the common factors perspective as the future direction of marriage and family therapy (MFT). Although intuitively appealing, the case for the common factors perspective is not as clear-cut as proponents portray. In its current form, the common factors perspective overlooks the multilevel nature of practice, the diversity of clients and settings, and the complexity of therapeutic change. In contrast, comprehensive process-based change models are an alternative to the limitations of common factors. In this article, we consider the limitations of the common factors perspective and propose the necessary and sufficient components and processes that might comprise comprehensive, multilevel, process-based therapeutic change models in MFT.

Capitalizing on thematic initiatives: a framework for process-based change in SMEs

This paper challenges the critical articles that have classified thematic initiatives as ‘fads’ or ‘fashions’ of their period with little real value. Using business process reengineering (BPR) as an example, the paper suggests that it is important to ‘unpack’ thematic initiatives into their key management principles. The key management principles that form the conceptual basis of BPR are described. Primary data from empirical studies are accumulated to identify the existence of these principles in the change management practices of small and medium sized enterprises (SMEs). The results indicate that the SME companies studied used uncoordinated change management practices which move from one implementation issue to the next without appropriate strategic planning and monitoring practices. A methodology that specifically embodies the conceptual basis of BPR was developed and tested. The results from this phase of the research indicated that the initial bias of SME managers towards some and away from other specific implementation issues was levelled out by the application of the methodology. The paper will argue that methodology development, based on the key management principles, encourages companies to consider systemically the full range of issues. The paper concludes that it is not appropriate for companies to oscillate around an adoption–abandonment cycle with respect to thematic initiatives. Companies need to ‘unpack’ these initiatives and develop their practices based on the key management principles which popularized the ‘theme’ in the first place.

PROCESS-BASED ORGANIZATIONAL CHANGE: FROM CHINA TOWARDS A GLOBAL MODEL.

Process-based organizational change has attracted considerable attention in recent decades, with the rise of total quality management (TQM) being followed by the emergence of business process reengineering (BPR). Since contextual factors can influence both the adoption and results of these process-based change initiatives, their international popularity has created an imperative to move beyond a culture-bounded perspective. The stark philosophical, economic and historical differences between Americans and the Chinese make the comparison of process-based organizational change in these two societal contexts an important step in the development of a global model. This paper begins by outlining the evolution of process-based organizational change and proposing that BPR be seen as TQM with American characteristics. A selective review of Chinese culture and management systems then highlights five factors that are likely to influence Chinese organizational change. Evidence from field studies and insights from key informants reveals that organizations across Greater China have adopted a distinctive approach to re-engineering. The existence of this BPR with Chinese characteristics prompts a more general examination of how the nature of organizational change may be affected by specific cultural dimensions of the implementation context. By elaborating on an existing typology of change, we provide a foundation for the development of cross-cultural theory and a general model of process-based organizational change.

A reference model of 'operate' processes for process-based change

This paper highlights the key issues which restrict the practical integration of business processes in manufacturing enterprises. The interest in integration among both practitioners and academics is evident from the research agendas and improvement programmes which have emerged. It has become apparent, however, that there is fragmentation within the domain. Whilst practitioners have focused on business processes through their re-engineering programmes to improve enterprise efficiency, information system developers have emphasized the use of standard models to accelerate the speed of configuration and implementation of integrated systems for enterprises. For their part, researchers have concentrated their efforts on the development of conceptual frameworks which embody the key characteristics and dimensions relevant for enterprise integration. There is now a need to capitalize on these developments and to bridge the gap between the conceptual and practical requirements of integration. The development of a reference model, constructed using IDEF0 is described. The model is a partial model which can be particularized by practitioners to form a representation of their own enterprise.