No / This paper presents findings from a study of 55 cases of decision implementation. The research identifies a number of features that characterize the way implementation is managed which appear to enhance the chance of success. Analysis reveals patterns in the data indicating that these features fall into two groupings, giving rise to two distinct approaches to implementation management. These are termed the Experience-based approach and the Readiness-based approach from the initial conditions which give rise to each. Although following either approach may enhance decision performance, the greatest success is associated with a dual approach. Implementations that follow neither are generally less successful. A theory of implementation management is postulated, comprising a Planned Option and a Prioritized Option.

Australia�s policy on Quality Use of Medicines (QUM) aims to achieve appropriate use of medicines and improved health outcomes. Drug and Therapeutics Committees (DTCs) are educators, policy makers as well as financial gatekeepers in matters relating to medicine use. Increasingly, DTCs are also involved in risk management and clinical governance. As such, DTCs could be considered to be QUM advocates in the institutions in which they function. In a health care arena where there are escalating demands on high standards of clinical practice, quality assessment and improvement is essential in ensuring safe and effective patient care. Given the role DTCs play in safeguarding the interests of the stakeholders of the health care system, research into ways in which DTC performance could be enhanced is required. Although indicators specific to DTCs exist, the literature does not seem to provide straightforward answers to the question of what is currently being done in terms of quality assessment and quality improvement of DTCs. In the absence of such data, an opportunity for research is clearly identified. The first aim of this research project was to gain insight into the current activities undertaken by, and challenges facing Australian DTCs. Following this, the second aim was to explore ways in which DTC performance could be augmented. In addressing the first aim of this project, a national survey of Australian DTCs was conducted. These findings reinforce the evidence in the literature about the roles, structure and stakeholder expectations of DTCs. Our research also documents DTCs� quality improvement initiatives and barriers to DTC activities. It appears that there is little support available to Australian DTCs. Further, a case study was undertaken in order to gain an understanding of the depth and detail of DTC operations. An audit of a DTC in an Australian hospital was conducted. This study revealed that DTC decisions are being implemented in an ad hoc manner. In fact, there were no strategies (or action) planned to implement the majority of their decisions. This could have an impact on DTC performance. In view of this finding, qualitative methods were used to explore stakeholder opinions regarding the implementation of DTC decisions and policies. Stakeholders believed that strategies used to implement DTC policies should be targeted (to the audience as well as the type of decision/policy being implemented), timely, and delivered at the point of care. Face-to-face strategies were perceived to be more effective than printed materials, particularly when an influence on clinical practice was desired. Stakeholders also felt that the lack of resources was a significant barrier to DTC performance augmentation. This probably contributed to a lack of follow-up (or review) of implemented policies. According to stakeholders, other barriers to policy implementation include a lack of ownership of policies, low DTC profile, and an over-reliance on pharmacy to implement DTC decisions. Stakeholders felt one of the ways in which DTC performance could be improved was to prioritise DTC decisions for implementation. In pursuit of a method to prioritise DTC decisions, a survey was conducted. Stakeholders identified patient safety, cost, and the practice of evidence-based medicine as domains of important DTC decisions. The results also suggest that stakeholders recognise the need for the prioritisation of DTC decisions for implementation. Stakeholders implied that higher priority would be assigned to DTC decisions considered to be important. In a follow-up survey, stakeholders (including doctors, nurses, pharmacists, and DTC members) seemed to have agreement of the primary domains of DTC decisions. Higher levels of importance and higher priority were assigned to decisions involving the primary domains of patient safety and cost. However, level of importance and priority assignment were not consistently correlated. The work presented in this thesis suggests that there are ways to improve DTC performance. Although conducted primarily on hospital-based DTCs, it is anticipated that the lessons learnt could be applied to state-based, or even, Area Health-based DTCs. In conclusion, this research found that there was a range of views regarding �importance� and prioritisation for implementation. Social, organisational, as well as environmental factors may contribute to this. Future research should examine other possible factors contributing to the importance and priority of DTC decisions, so that DTC policy could be appropriately implemented into practice.

Australia�s policy on Quality Use of Medicines (QUM) aims to achieve appropriate use of medicines and improved health outcomes. Drug and Therapeutics Committees (DTCs) are educators, policy makers as well as financial gatekeepers in matters relating to medicine use. Increasingly, DTCs are also involved in risk management and clinical governance. As such, DTCs could be considered to be QUM advocates in the institutions in which they function. In a health care arena where there are escalating demands on high standards of clinical practice, quality assessment and improvement is essential in ensuring safe and effective patient care. Given the role DTCs play in safeguarding the interests of the stakeholders of the health care system, research into ways in which DTC performance could be enhanced is required. Although indicators specific to DTCs exist, the literature does not seem to provide straightforward answers to the question of what is currently being done in terms of quality assessment and quality improvement of DTCs. In the absence of such data, an opportunity for research is clearly identified. The first aim of this research project was to gain insight into the current activities undertaken by, and challenges facing Australian DTCs. Following this, the second aim was to explore ways in which DTC performance could be augmented. In addressing the first aim of this project, a national survey of Australian DTCs was conducted. These findings reinforce the evidence in the literature about the roles, structure and stakeholder expectations of DTCs. Our research also documents DTCs� quality improvement initiatives and barriers to DTC activities. It appears that there is little support available to Australian DTCs. Further, a case study was undertaken in order to gain an understanding of the depth and detail of DTC operations. An audit of a DTC in an Australian hospital was conducted. This study revealed that DTC decisions are being implemented in an ad hoc manner. In fact, there were no strategies (or action) planned to implement the majority of their decisions. This could have an impact on DTC performance. In view of this finding, qualitative methods were used to explore stakeholder opinions regarding the implementation of DTC decisions and policies. Stakeholders believed that strategies used to implement DTC policies should be targeted (to the audience as well as the type of decision/policy being implemented), timely, and delivered at the point of care. Face-to-face strategies were perceived to be more effective than printed materials, particularly when an influence on clinical practice was desired. Stakeholders also felt that the lack of resources was a significant barrier to DTC performance augmentation. This probably contributed to a lack of follow-up (or review) of implemented policies. According to stakeholders, other barriers to policy implementation include a lack of ownership of policies, low DTC profile, and an over-reliance on pharmacy to implement DTC decisions. Stakeholders felt one of the ways in which DTC performance could be improved was to prioritise DTC decisions for implementation. In pursuit of a method to prioritise DTC decisions, a survey was conducted. Stakeholders identified patient safety, cost, and the practice of evidence-based medicine as domains of important DTC decisions. The results also suggest that stakeholders recognise the need for the prioritisation of DTC decisions for implementation. Stakeholders implied that higher priority would be assigned to DTC decisions considered to be important. In a follow-up survey, stakeholders (including doctors, nurses, pharmacists, and DTC members) seemed to have agreement of the primary domains of DTC decisions. Higher levels of importance and higher priority were assigned to decisions involving the primary domains of patient safety and cost. However, level of importance and priority assignment were not consistently correlated. The work presented in this thesis suggests that there are ways to improve DTC performance. Although conducted primarily on hospital-based DTCs, it is anticipated that the lessons learnt could be applied to state-based, or even, Area Health-based DTCs. In conclusion, this research found that there was a range of views regarding �importance� and prioritisation for implementation. Social, organisational, as well as environmental factors may contribute to this. Future research should examine other possible factors contributing to the importance and priority of DTC decisions, so that DTC policy could be appropriately implemented into practice.

Mellanchefer har en komplex roll, där de befinner sig i en gränsposition mellan anställda och ledning. Deras unika position gör att de har stor insikt i olika delar av organisationen, inom såväl det strategiska som det operativa arbetet. Många gånger berörs mellanchefer av beslutsimplementeringar, där deras roll kan beskrivas som strategiska förkämpar. De förväntas styra gruppen åt ett gemensamt mål samtidigt som krav kommer både uppifrån och nerifrån i organisationer, vilket leder till orättvisa förväntningar som är svåra att möta. Det finns begränsade studier inom företagsekonomin vad gäller mellanchefers roll i beslutsimplementering, samt hur mellanchefer själva upplever sin roll. Syftet med denna studie är att förstå mellanchefers upplevda roll i beslutsimplementering inom industriella organisationer. Denna kvalitativa studie antar ett hermeneutiskt förhållningssätt och genomförs induktivt med hjälp av kvalitativa och kvantitativa data. Semistrukturerade intervjuer samt enkäter utgör grunden för insamlingen av data. Den insamlade data analyseras med hjälp av IPA-metoden och leder till sju identifierade teman och tre identifierade kluster. Kluster 1) Chefsrollen med teman kommunikation, tillit & förtroende samt ledarskap. Kluster 2) Krav & Utmaningar med teman krav, ansvar och förväntningar samt utmaningar. Kluster 3) Delaktighet med teman operativ samt strategisk delaktighet. Dessa kluster och teman utgör grunden för studiens resultat och skapar förståelse för hur mellanchefer upplever sin roll i beslutsimplementering. / Middle managers have a complex role in their position between employees and management. Their unique position means that they have great insight into different parts of the organization in both the strategic and the operational work. Middle managers are often affected and involved in the implementation of decisions, where their role can be described as strategic advocates. They are expected to lead the group towards a common goal while at the same time, handle the demands from above and below in the organization, leading to unfair expectations that are difficult to meet. There are limited studies within the field of business regarding the role of middle managers in decision making, and how middle managers themselves perceive their role. The purpose of this study is to understand the perceived role of middle managers in decision implementation within industrial organizations. This qualitative study assumes a hermeneutic approach and is conducted inductively with the help of qualitative and quantitative data. Semi-structured interviews and surveys are used to collect data. The collected data is analyzed using the IPA method and leads to three identified clusters and seven identified themes. The collected data is analyzed using the IPA method and leads to seven identified themes and three identified clusters. Cluster 1) The managerial role with the themes of communication, trust, and leadership. Cluster 2) Requirements & Challenges with the themes of requirements, responsibilities, and expectations as well as challenges. Cluster 3) Participation with the themes of operational participation and strategic participation. These clusters and themes form the basis for the study's results and create an understanding of how middle managers perceive their role in decision implementation.

Although several multi-dimensional models of strategic decision-making processes (SDMPs) have been examined in the literature, these studies have paid insufficient attention to the public sector context and Gulf Cooperation Council (GCC) region. SDMP in the public sector and the State of Qatar can vary to SDMP in the private sector due to institutional and socio-cultural differences respectively. Therefore, more research is urgently needed to better understand SDPM within this context. To contribute to filling this void, this study develops and tests a multi-dimensional SDMP model including SDMP dimensions, implementation, and outcome. The study model examines (𝑖) the impact of four SDMP dimensions—procedural rationality, intuition, constructive politics, and participation—on the implementation success of the strategic decision; (𝑖𝑖) the impact of the successful implementation of SD over the SD quality; (𝑖𝑖𝑖) the mediation role of the implementation success of SD; (𝑖𝑣) the moderation effect of stakeholder uncertainty. The model was analysed using Partial Least Square Structural Equation Modelling (PLS-SEM) and tested using data from multiple informants on 170 strategic decisions in 38 Qatari public organisations. The study finds that procedural rationality, constructive politics, participations, and the implementation Success of SD plays a significant and positive role on SDMP and its overall outcome. Finally, the study provides substantial and original contributions to the knowledge of SDMP in the public sector; implications for decision-makers and directions for future research.