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Exploring evidence based management in the National Health Service : if doctors in the NHS use evidence based medicine, why don't managers in the NHS use evidence based healthcare management? : can this paradox be explained and is the paradox true?Sharp, D. January 2010 (has links)
Purpose and aims of the study: To contribute to the on-going debate over whether the use of evidence could and should improve organisational effectiveness. This is especially important in the context of the health service that has, since (May 1997) enthusiastically adopted evidence based medicine as its method of health delivery. To develop a practical explanation for policy makers and managers on how and where evidence based management is used appropriately. Justification: Kovner and Rundall (2006 p3) said “the sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence based approach would improve the competence of the decision makers and their motivation to use more scientific methods when making a decision”. The paper reviews the conclusion of Kovner and Rundall (2006) (an American study) within the context of the UK National Health Service. There is a need to develop a theoretical framework of how and why evidence is (or is not) used by managers in the NHS. Motivation: The author holds a senior management position in the National Health Service. The author has performed the role of Director and Chief Executive in NHS organisations since 2000. These organisations have been surplus making, target hitting, award winning, credited by the auditors and successful in the eyes of the regulators. Unfortunately over the last few years the author has been in a quandary about something. Are NHS managers as a group of professionals, using policies that solved the wrong problem or solving the right problem, but still in the wrong way? Following this line of thought, the author wanted to ask "why don’t executives in the NHS make evidence based decisions? Methodology: A survey was conducted of the most senior NHS managers in the East Midlands. A set of interviews and participant observations of senior managers when making key decisions around current policy initiatives was recorded. This explored how the concept of evidence based management is perceived by the managers. The studied group were taken to have had career success and to be taken to be leaders in their field. The researcher was a senior manager within the same region of the NHS. The method additionally studied the effect of a discrete, but accepted piece of data upon the NHS as it struggled to adopt an evidence based response to the operational issue the data highlighted. The researcher was a planner within the same region that this data was being used and was responsible for responding to the data. The ontology used Bryman (2004) and Morgan (2007) to attach meaning to the views that members of that part of the NHS had of their world. Methods: Through taped recordings of meetings and verbatim transcripts of 1 to 1 interviews with senior managers the study recorded the awareness of a need for evidence (or not) and also analysed the collection and evaluation of evidence where such awareness did exist. Using a model developed by Rousseau (2006) the study classified the responses. Interpretation of the responses was shared with the participant and conclusions drawn against the Rousseau based model. Findings: Senior managers approve of evidence as it gives them a systematic view of what their staff are qualified to do and a requirement for evidence based decision making is part of the scheme of delegation. Adoption of innovation and research is a complex and often drawn out process. The adoption of research evidence is not a single discrete event. Managers will only use research if it improves the organisations standing. Finally, it is shown that there are credible and complex reasons for the failure in NHS managers to use evidence very often, despite the prevailing orthodoxy of evidence based medicine. The researcher agrees with McDaniel (2009) that evidence should be used to start new creative methods of working. Although Arndt and Bigelow (2009) raise objections against evidence based decision making as “decisions do not necessarily lead to expected outcomes” The researcher finds their work cautionary rather than impeding to what Banaszak-Holl says are “compelling arguments for moving forward with developing EBM".
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The lived experiences and discourses of African Americans working in multinational organisations in the United States of America and abroadRoss, D. January 2012 (has links)
Diversity is a word that holds many different meanings for different people. In addition, organisations continue to grow and are becoming more diverse in terms of gender, race, ethnicity and inclusion of other diverse groups. However, there exist a growing proportion of African Americans’ in the workplace that hold significantly fewer top management positions than their white counterparts. Using a phenomenological approach, this study investigated if African Americans’ views on diversity in the work environment were in tune with one another, and if they believed (white) top management’s views on diversity were the same as their own views. The main aim of document five is to determine what are the different attributes used, if any, by African Americans’ when discussing the topic of diversity as it relates to the work environment in multinational organisations (MNOs) and if they believed (white) top management used the same attributes to describe diversity. Key findings that emerged from this study include how African American participants viewed diversity in terms of advancement towards top management positions and representation in their organisations. However, African American participants believed (white) top management viewed diversity as reaching a certain percentage of minorities’ in an organisation as a whole. This conceptual difference in diversity, according to participants, also appeared to cause tension and misunderstanding when the two groups communicated with one another regarding matters that took place in work office. Other key findings that emerged included how the non-implementation of a diversity policy/strategy constrained the development of a supportive organisation culture for African Americans’ as well as, contributed to the perceived discrimination of African American participants of this research study from gaining senior roles within their organisations. The absence of an effect implementation of a diversity policy/strategy and the apparent limitations to achieve top management position within their respective organisations reinforced the idea by participants of this research study of their organisations having a lack of diversity within the organisational environment. The conclusion of this document proposes possible solutions for (white) top management to better understand its African American employees and address their issues with advancing in the organisation, such as: providing mentoring programs and initiating diversity workshops for all employees to attend. In addition, the conclusion proposes ideas to coincide with today’s diversity training initiatives, as well as, offering possible ideas and methods for (white) top management and African Americans’ to better coexist in the workforce.
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Coastal tourism : the response of Indian Ocean island tourism destinations to climate changeWelton, R. January 2012 (has links)
This research examines tourism within developing island states in the Indian Ocean that will be at extreme risk from the impacts of climate change. Many have a high economic reliance upon tourism and yet will be adversely affected by both higher sea levels and raised water temperatures. However, many developing islands utilise tourism as a vector for economic growth and ironically they too tend to be some of the first destinations to observe possible impacts of climate change like the disappearance of beaches and the greater intensity of storms. Destinations in the developing world are extremely concerned that tourists from developed countries will reduce the number of long haul flights they take to ameliorate their carbon footprint. Three tourism island destinations in the Indian Ocean are used as case studies, namely Sri Lanka, the Maldives and the Seychelles. The research seeks to establish the knowledge levels and actions of public and private sector stakeholders within the tourism industry in response to the impacts of climate change within these island destinations. A multi-method approach is used to gather data: semi-structured interviews, participant observations and documentary evidence. This is useful for the purpose of triangulation and to increase the construct validity of the research. The findings build a detailed picture of the cases and enable an understanding into the respondents’ knowledge of climate change; climate change adaptation and mitigation measures taken or planned within the destination; current and future impacts of climate change and how the tourism industry has responded. This provides an insight as to whether sustainable tourism policies are being encouraged, adaptation and mitigation measures taken or planned and also an assessment of the effectiveness of transfer from policy to practice. The results illustrate that all the destinations are currently experiencing changes which they associate with climate change; these impacts vary within each of the destinations. Contextual factors identified as being significant in understanding the responsiveness of tourism island destinations to climate change within the Indian Ocean were the unique political, economic, social, geographic and technological aspects of each island. These contextual factors influenced the stakeholders’ knowledge, attitude and behaviour regarding climate change. This provides an indication of the tourism islands’ preparedness for the consequences of climate change and an indication of the future of tourism on the islands. Based on the analysis of the findings a model is proposed that seeks to explain the relationship between these factors that will provide an indication of the future shape of tourism on these Indian Ocean island tourism destinations.
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An investigation into the existence of white leadership prototypicality in the Department for Work and Pensions : an ethnic minority perspectiveMuskwe, N. January 2012 (has links)
This document sets out to examine the experiences of twenty ethnic minority managers in SEO to SCS grades in the Department for Work and Pensions in order to enhance the understanding of why there is a relative scarcity of senior and executive ethnic minority managers in the largest government department in the United Kingdom. In particular, the research examines how homosocial reproduction and the effect of social closure can limit the promotion opportunities for ethnic minorities in this organisation. This study did not seek to test a hypothesis but instead attempted to understand ethnic minorities’ own experiences in their propositions to senior management positions and how race as a variable is perceived to impede their career advancement. An interpretive paradigm and qualitative methodology were used which enabled the participants to describe their experiences in detail as a natural inquiry. In-depth semi-structured interviews are conducted with twenty ethnic minorities in SEO to SCS grades. The interviews were recorded and transcribed verbatim, and using a thematic analysis, eight themes were identified from the data analysis. The findings revealed that ethnic minorities when seeking promotion are faced with a set of insurmountable obstacles. These barriers are created by their race, which is atypical to the white leadership prototype. The findings show that there are different paths to promotion for ethnic minority and white employees. Ethnic minorities are excluded through social closure and white managers are reproduced at the top, through homosocial reproduction, as they fit with the white leadership prototype. Ethnic minorities due to their nonprototypicality, have to work hard to gain promotion through contest mobility whilst whites are promoted through sponsorship through homosocial mentoring. The research concludes with a discussion of the research limitations, and future research possibilities including a call for more research into the effects of race on ethnic minorities’ propensity to be promoted. Recommendations are made in relation to how DWP can ensure that the senior and executive teams are reflective of their workforce and also to individual ethnic minorities in terms of how they can improve their promotion prospects.
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Professionalising counter fraud specialists (fraud investigators) in the UK public sector : a focus upon Department for Work and Pensions, National Health Service and the Local AuthorityFrimpong, K. O. January 2013 (has links)
This thesis seeks to examine and explore the professionalisation initiatives of the UK public sector counter fraud specialists (fraud investigators), with a focus upon the Department for Work and Pensions (DWP), National Health Service (NHS) and Local Authority (LA). The conceptual framework used to underpin the study was functionalist / “traits” theory of a profession and professionalisation. The main research question for the thesis concerns the issue of whether counter fraud specialism is a profession or not. Thus the question here is: “Is counter fraud specialism a profession or not?”. Additionally, the thesis seeks to answer the question on how to develop a profession of counter fraud specialists. Thus, the question here is “If we want to develop a profession of counter fraud specialists (CFS), how do we do it?”. Fraud is a growing problem in UK which affects the government, businesses, individuals and society as a whole, and much more than would be assumed by anyone suggesting it to be a victimless crime. Despite this, the reputation of UK public sector fraud investigators had in the past gained negative images resulting from the use of questionable investigative practices, together with the lack of appropriate mechanism for evaluating the training of fraud investigators, and the ease of defrauding the welfare system. This became a great concern for UK politicians/parliamentarians since the 1970’s, resulting in the introduction of government initiatives, which emphasised the need to professionalise and introduce professionalism into anti-fraud work. The professionalisation initiatives led to the creation of a new breed of fraud investigators, otherwise known as “Counter Fraud Specialists” charged with the responsibilities of protecting the public purse and safeguarding it against fraud. In spite of the introduction of those initiatives and the positive contribution by Counter Fraud Specialists in protecting the public purse coupled with the ongoing austerity measures in the UK public sector, there has not been any major academic study assessing those initiatives. The study is important to the researcher because findings from the study will help inform the debate on professionalisation agenda for the UK public sector counter fraud specialists. Additionally, it will contribute to the academic research on the subject, given that, the literature on fraud and professionalisation on Counter Fraud Specialists has failed to address this. The study was undertaken by applying mixed-methods approaches involving the use of survey questionnaires and semi-structured interviews with a selected number of counter fraud practitioners in the UK public sector. In addition, documentary analysis was also undertaken. Generally, the study revealed developments enhancing the status of UK public sector counter fraud specialists as a result of the professionalisation initiatives/agenda. Nonetheless, the strength of the quality of developments remained arguable given identified weaknesses in the “pillars of institution” such as normative, regulative and cultural-cognitive symbols that, together with associated activities and resources provide the bedrock for institutional transformation and professionalising occupations. The study provides recommendations on areas of improvement and future research. Therefore, my contribution to knowledge in this study is that, I have attempted to show how to develop a profession for counter fraud specialists in the UK public sector, mainly, the DWP, NHS and LA. In addition, the study has failed to find evidence that counter fraud meets what the literature says is a hallmark of a profession. The literatures on fraud and professionalisation of counter fraud specialists have failed to address this and this is my contribution to knowledge.
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Exploring strategic turnaround in English Local AuthoritiesJones, M. January 2013 (has links)
This thesis explores the nature of strategic turnaround in English local authorities during the period of Comprehensive Performance Assessment (CPA) between 2002 and 2008. This period was unique in that it allowed the comparative performance of local authorities and their management practices using the holistic performance management framework of the CPA. Specifically, this study focuses on a group of local authorities that were poorly performing at the start of CPA era, but had sustained improved performance by the end. It aims to establish the turnaround approaches adopted by this group of local authorities, the impact of leadership and the extent to which the approaches adopted promoted sustained turnaround. Publicly available CPA information and interviews with senior officers of turnaround councils and government lead officials are used to classify and analyse the changes in strategic processes. The thesis adopts a case study approach within a managerialist perspective and identifies ten approaches to turnaround that can be related to a longitudinal "7Rs" framework adapting the work of Boyne (2004) and others. This has been developed to include Realisation and Reinforcement at either end of the turnaround period. Realisation is required to kick-start the turnaround process and Reinforcement to embed the organisational changes necessary to sustain improvement over the longer term. Leadership is a key aspect throughout the process, both in terms of introducing new leaders and the adoption of new leadership approaches to support and underpin sustainable organisational improvement. Sustained improvement was found to be achievable by poorly performing councils. The study also concludes that there was a continuing influence of managerialism, originally associated with new public management, throughout the CPA era.
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A re-evaluation of the relevance to key account management to the UK higher education sectorHarden, G. R. January 2010 (has links)
This research set out to explore the nature of business-to-business (B2B) relationships in the UK higher education postgraduate sector. More specifically, it sought to address the strategic issue of how relationships between a UK business school (in this case, Nottingham Business School) and its corporate clients could be organised and managed effectively over the longer-term in order to provide, maintain or, where appropriate, enhance the mutual satisfaction of all parties concerned. It is argued that such research is relevant and timely given that revenue generated from commercial activity (third stream income) is considered increasingly vital to UK business schools as they attempt to remain financially solvent in a toughening market that is faced with the additional threat of longer-term reductions in Higher Education Funding Council grants (Watling et al., 2003; Prince, 2004; Prince, 2007). It is not only commercial activity that would appear to be a relatively underdeveloped activity in most new universities (Prince, 2004). B2B literature shows little or no research into business relationships within the UK corporate education sector (Murray and Underhill, 2002). Additionally, Ellis and Mayer (2001) and Wright (2004) are typical of those calling for more research across different B2B sectors. Having scoped the research problem (Document 1) and undertaken a critical review of the B2B relationship marketing literature (Document 2), exploratory qualitative research in Document 3 focused on NBS lecturers with responsibility for managing both open and client-specific postgraduate programmes. Whilst previous commercial experience and academic expertise were thought to lend weight and respectability to the client manager’s position, social and inter-personal aspects were felt to exert a greater influence on the relationship. However, a number of barriers are likely to hinder the successful development of commercial relationships. Some of these are external (e.g. sudden and unexpected adverse trading conditions or a more general economic downturn), others are more or less self-inflicted (e.g. lack of senior management support or a tendency to overload the client manager job role). Client managers were also more likely to adopt a positive attitude to business development if they were rewarded appropriately. Document 4 enabled some of these issues to be explored further through quantitative survey-based research that benefited from the inclusion of a number of corporate clients as well as client managers from other higher education institutions. An initial review of the B2B relationship marketing literature had identified a number of dimensions that were thought vital to relationship formation and development: attraction, atmosphere, social bonds, trust and commitment. Of these, social bonds were thought to have the greatest impact. However, the research suggested that it was actually the attraction dimension that figured most prominently, with all parties appearing to value intuition (or ‘gut feel’), personal chemistry, a sense of humour and a charismatic personality as core ingredients in relationship formation. Interestingly, closer economic ties were considered more relevant than social bonds. The research also tackled a number of issues ranging from the strategic development of the relationship portfolio through to operational matters such as whether appropriate incentives (financial or otherwise) should be offered to client managers. Whilst it was reassuring to note that half of the respondents believed senior managers provided reasonable support and investment for commercial relationships, this support did not necessarily extend to financial and other incentives for client managers themselves. From the outset, this study was designed to conclude with an exploration and reappraisal of the strategic relevance to a UK business school of the Key Account Management concept. Thus, Document 5 focused on the relevance of the concept for Nottingham Business School, as seen through the eyes of the academics adjudged to be occupying key account management roles. On the face of it, many of the elements of KAM appear to have the potential to be adapted to fit a business school environment. Nevertheless, this study suggests that the KAM journey is likely to be a long, arduous and challenging one. Indeed, KAM represents a bold strategic move for an organisation like Nottingham Business School and would require significant investment in both people and support systems in order to flourish. Unfortunately, there is no guarantee of a short-term return on that investment. Equally, when the potential barriers to KAM implementation are considered - particularly the longer term problem of encouraging commercial flair and developing business acumen in an entrenched academic culture - the task confronting senior managers would appear to be a challenging one. Consequently, it would be no surprise to see a KAM strategy overlooked in favour of a simpler, more cost-effective alternative.
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A strategic decision making model on global capacity management for the manufacturing industry under market uncertaintySabet, E. January 2012 (has links)
Multi-national, large-scale and complex manufacturing systems, such as those for automotive manufacturers, often require a significant investment in production capacity, as well as great management efforts in strategic planning. Capacity-related investment decisions are often irreversible or prohibitively expensive and time-consuming to change once they are in place. Furthermore, such companies operate in uncertain business environments, which can significantly influence the optimal decisions and the systems’ performance. Therefore, a strategic question is how to globally and interactively set production resources for such systems so their optimal performance can be achieved under business uncertainty. Conventional optimisation models in this field often suffer from one or more drawbacks, such as deterministic styles, non-inclusive and non-comprehensive decision terms, non-integrated frameworks, non-empirical approaches, small size practices, local/non-global approaches or difficult-to-use methods/presentations. This research develops a new scenario-based multi-stage stochastic optimisation model, which is capable of designing and planning the production capacity for a multi-national complex manufacturing system over a long-term horizon, under demand and sales price uncertainty. Unlike many other stochastic models, this model can simultaneously optimise many strategic capacity-related decisions in an integrated framework, which helps to avoid sub-optimality. These decisions comprise capacity volume, location, relocation, merge, decomposition, product management, product-to-market decisions, product-to-plant planning, flexibility choices, etc. Furthermore, an enumerated scenario approach, which rightly fits real strategic decision making practices, has been employed in the model development. This model is also empirically designed for non-OR specialist users (managers), exploiting a programming technique and a more user-friendly input & output interface, which potentially makes the model more practical in real-scaled industrial applications. The model’s ability and its contribution to practice in real systems are demonstrated in two case studies from the automotive reference system, after a set of validations and verifications with fourteen hypothetical cases. Finally, in a systematic analysis the models’ features and abilities are compared with other newly developed analytical models and state-of-the-art researches in this field and the contribution to knowledge of this research is established.
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Construction of "self" and "out-there" : the narratives and organisational development of Business Angels in Portugal and the United KingdomTeixeira de Gouveia, R. N. January 2013 (has links)
This is the first research conducted into Portuguese business angels – a term referring to informal investors – who are private wealthy individuals willing to invest a part of their own wealth in new business ventures for a profit. The business angel market is partially opaque in that many informal investors are not part of any organisation, club, or network and, therefore, they are difficult to identify (Mason and Harrison 2010; Mason and Harrison 2011). Many, however, are formally organised in clubs, associations, or networks (Amis and Stevenson 2001; Van Osnabrugge and Robinson 2000). Starting from the visible part of the market—the one linked by networks—and subsequent to the literature review, two relevant topics were identified: business angel profiles and their investment profiles. These two topics were crucial to the design of the questionnaires. Analysis of the questionnaire responses – which included the recipients of two of the most representative informal investor clubs in Portugal – helped to identify the profile of Portuguese business angels and their investments. Although the results of this research (detailed in Document 5: 3.2) could not be extrapolated to the entire Portuguese business angel community, the current research will offer future researchers another source in addition to the limited knowledge base available in this area. These findings, together with the conclusions of the literature review, were fundamental to the preparation of the semi-structured interviews, which took place in Portugal and in the United Kingdom. The research questions were designed to assess if and how the identity-construction of the business angels both in Portugal and in the UK were linked to the way in which informal investors have mapped their own “out-there”. New research areas were identified in both geographic areas during the course of the research. This is detailed in Chapter 10 of Document 5. Two major research gaps were identified in the process: first, using objectivist ontology, there was no evidence that any research had previously been performed to analyse the profile and investment characteristics of the Portuguese business angels, although there was evidence that this had been done in the UK. Second, the semi-structured interviews (framed by the questionnaires), were designed to analyse the ways in which business angels (in both geographic areas) frame their own identities; how they construct their own “out-there”; and the binding mechanisms used to link these two realities. This was another research gap that was identified in the DBA research. There are similarities among business angels in the UK and Portugal in the way that they define themselves towards the reality they have constructed, but that said, there is a significant difference in the way that business angels in the UK offer a broader perspective of their roles. Of particular significance among business angels in the UK is the way in which their “out-there” is constructed; their informal investment activities, in some cases, are not central to the narratives of the interviews. Business angels constructed themselves in a variety of ways, it was found, but in Portugal, the multivoice of the discourse was less evident. Finally, the research suggests that the higher the ranking of the interviewee within the network, the more concrete the interviewees’ perception of his own organising activities.
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Corporate governance in emerging markets : a study of South African and Zimbabwean banksSanangura, C. January 2010 (has links)
Since 1994 (that is from the time SA became an independent state) 12 banks failed in SA and 8 in Zimbabwe. BCCI was operating in both countries (Document 2: Appendix 1). The impact of a failure of a bank to any economy is huge as evidenced by the failure of Lehman Brothers in 2009. From the beginning of the 20th century, studies of business structures and management procedures were carried out and business managers increased their knowledge and understanding of how to achieve results beneficial to both shareholders (owners) and other stakeholders. The modern industrial capitalist system has developed with significant advances from that time, developing organisational structure, management skill and culture systems within enterprises (Daft, 1997). Banks are controlled by boards of directors who represent the interests of all stakeholders. Banks perform differently while operating in the same macro and micro economic environment. The behaviour, association, independency, experience and skills of board members seem to determine the future of any organization. The focus of this study is therefore to understand what makes boards effective or ineffective resulting in bank success or failures. The study will provide an analysis of the factors that contribute to the effectiveness or ineffectiveness of different bank boards and how to measure the two.
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