This study explored teamwork in two hospitals implementing Total Quality Management. Its objectives were to: document and describe the social process of constructing teamwork in the two hospitals and the patterns of interaction that emerged; to compare the experiences of teamwork in the hospitals to the conceptualization of teamwork prescribed by TQM and to compare the experiences of the two hospitals to each other; and to understand how teamwork is interpreted by members of TQM hospitals. A multi-site case design was used; data was collected through participant observation, interviews, and document analysis. Results suggested that quality improvement teams represent a means for creating teamwork in hospitals by providing a forum for members to understand each other's needs, work, and problems through which respect and cooperative relationships emerged. Team leaders played a key role in the construction of teamwork by managing the meaning of teamwork, guiding the work of teams, assuring equal participation and facilitating the establishment of meaningful ground rules and mutually shared objectives. Identified obstacles to teamwork included the lack of physician involvement in team efforts; managers and staff who would not cooperate with team recommendations; the time required to improve work processes; managers who attempted to control a team's work; and leaders who failed to provide clear direction and guidance. In exploring the practice of teamwork outside the boundaries of QIT's, the data revealed that barriers between departments still existed. Management efforts to forge teamwork across functional areas were fragmented. Department heads who promoted teamwork tended to be those who had been involved in QIT's. In both hospitals conflict, distrust and a lack of mutually shared objectives among senior managers was identified by middle managers as antithetical to TQM and an obstacle to building a sense of "all one team" hospital-wide. Recognizing that the hierarchical, departmental structure in hospitals prevents the construction of teamwork across departments and recognizing the ability of quality improvement teams to break down departmental barriers, this study recommends that organizational restructuring be explored for hospitals which might include the management of processes or systems vs. departments and incorporates the team structure.

<p> This project presents a theory and an application for using the integrated systems of Total Quality Management (TQM) and Six Sigma (SS) for the American Samoa Lyndon B Johnson (LBJ) Tropical Medical Center to improve results for the random survey and recertification process for Medicare and Medicaid. Identified aspects of the project include roles, responsibilities, and measurement requirements of the TQM framework, using the Juran Quality Trilogy, cost of quality, and investment training in SS. The basis of the research that forms the foundation of the project comes from a review of related literature. Methods are presented in order to clarify where improvement processes are required. This project provides the LBJ center with a proven approach that has found success for implementing TQM and an SS foundation to ensure efficient compliance with The Center of Medicare and Medicaid Services (CMS) and other regulatory government agencies.</p>

<p> Inadequate resources, poor market strategy, competition, contract regulation, and disparate performance outcomes are issues small business owners face while competing for government contracts. The purpose of this correlational study was to examine the market orientation-business performance relationship and the influence of market factors among veteran-owned small businesses competing for government contracts in the United States. A survey with adapted MARKOR and Government Regulation Lassez-Faire scales was administered to 203 veteran-owned small business owners. Resource-advantage theory served as the theoretical foundation for this study. The results of the multiple linear regression were significant, suggesting that market orientation relates to firm performance and total contract revenue. However, the regression models had a poor fit, with R² values ranging from .019 to .094, suggesting that significant results of this study lacked the power to conclude predictive accuracy. Market orientation did not significantly relate to contract bid to win rate and number of years in the government market. The PROCESS moderation analysis provided mixed results for market factors&rsquo; influence on the market orientation relationship with business performance outcomes. Study participants were market-oriented, with few seeing corresponding success. The introduction of new variables is necessary to make future models useful. Implications for positive social change include guidance for better-fitting models, ones that will inform the efforts to improve the survivability of small businesses in the B2G market. Veteran-owned small business owners should not waste resources on market orientation as a sole strategic focus for capturing and winning government contracts.</p>

<p> Water quality has evolved legislatively from protection of navigation routes and quantity of sources to more emphasis on impairments on water quality for surface and groundwater sources. Nonpoint or diffuse sources of impairments represents a major challenge for management due to the complexity of its sources and difficulty in tracking.</p><p> The most cited sections on public policy analysis focuses on the overall process agencies employ to understand the results the program yields. Often overlooked are finer details and mechanisms, such as decision-making and priority setting, which have a great impact on the overall process. To investigate these factors, we need to analyze the decision-making process used by managers.</p><p> This study focuses on using information from those with direct involvement in the establishment and implementation of the Total Maximum Daily Load program for the state of Florida. This study used decision-making analysis models from Rational-Decision-Making and Multi-Criteria Decision Analysis concepts to construct questionnaires that looks to develop priorities as seen by managers&rsquo; preferences for several presented options. This methodology allowed us to structure the viewpoints and processes water quality managers use to breakdown decisions.</p><p> The analyzed results show water quality managers prefer strong management options, involvement from stakeholders with scientific knowledge, and data collected from the source or point of impact. Interestingly, opinions in the group show that urban best management practices are considered more effective than their agriculture counterparts with a disfavor for volunteer derived data.</p><p> Ultimately, the survey highlights the need for more robust enforcement and reliable measurement of non-point source of impairments. Continued public outreach and education, especially through workshops, are denoted as important tasks to completing successful TMDLs and should be expanded and strengthened by both the Florida Department of Environmental Protection and its boundary programs.</p>

Depuis la décentralisation de 1982, suivie de la Loi Organique, relative aux Lois de Finance (L.O.L.F.), les administrations d'Etat et les organisations publiques ont beaucoup évolué. Ce nouveau contexte a un impact sur le contrôle de gestion des organisations publiques, qui se traduit par la mise en œuvre de nouveaux instruments. Notre recherche porte, grâce aux enseignements tirés de nos 3 études de terrain en Management Public, sur la production d'indicateurs (conception d'une démarche pertinente, architecture, construction et articulation des indicateurs, et enfin sur leurs exploitations et leurs actualisations). Le premier apport de cette thèse est donc d'ordre pratique, car grâce à ces préconisations portant sur les moments clefs de la démarche de construction et de mise en place des indicateurs cela va permettre d'apporter un "savoir actionnable" aux professionnels. Le second apport est d'ordre méthodologique, car la combinaison des différentes approches (2 recherches-actions, 1 observation participante, une analyse quantitative), a renforcé la validité de notre recherche. De plus, notre démarche a eu une dimension exploratoire, car elle a permis de faire un état de lieux en matière de contrôle de gestion tant au niveau d'organisations spécifiques, qu'au niveau des pratiques et jeux d'acteurs. Enfin, sur un plan conceptuel, nous montrons comment l'on peut articuler, au sein d'un même processus de modélisation des activités, des mesures relevant d'une vision partagée et des mesures plus objectives, car c'est l'articulation de ces deux types de mesure qui va renforcer la pertinence du système mis en place et gagner l'adhésion des acteurs du terrain / The State administrations and the public organisations in France have deeply evolved since the decentralisation of 1982 followed by the "Loi Organique" relative to the “Lois de Finance LOLF”. One impact of this emergent context on the management control takes the form of new management tools applied in the public organisations. This dissertation draws lessons on the production of indicators (the conception and architecture of a pertinent approach, the construction of different indicators and the articulation among them, and finally the exploitation and the updating of these indicators) based on three field studies conducted in public managements. The first contribution of this study is practical. The results and recommendations concerning the crucial periods of the construction and the application of indicators provide actionable knowledge to the concerned professionals. Secondly, a methodological contribution may be highlighted as multi-methods have been used (two action-researches, one participant observation, and one quantitative analysis). The combination of these different approaches reinforces the validity of the results. Moreover, this study draws up a literature review on the management control related to specific form of organisations and on the level of practices and different actors. Finally, the study shows how to articulate, for the same process of activities modelling, between measurements related to shared vision and more objective measurements. It is the articulation of these two types of measurements which strengthens the applied system and assures the adhesion of the field actors

Thesis (B.Sc)--University of Hong Kong, 2004. / Includes bibliographical references (p. 97-101)

<p> Issues around sustainably managing freshwater resources are one of the most challenging and timely issues affecting the globe. In response to rising social and ecological complexities, decision makers are faced with designing new policies and programs to effectively govern water resources. This shift towards new freshwater resource management approaches is in line with recent movement toward incentive-based mechanisms such as &ldquo;Investments in Watershed Services&rdquo; (IWS). The western United States contains one of the most concentrated IWS populations, in a time when population growth, intensifying land uses, and climate-induced environmental changes are stressing ecological systems in the region. My dissertation focuses on understanding this new arena of environmental governance aimed at freshwater conservation in the US West. Through three sets of data and analytical lenses I explore: the characterization of this new arena of governance, what led to its recent and significant growth, and what changes have occurred with respect to how such water resources were traditionally governed. I employ a mixed methods approach, using quantitative approaches to characterize the study population and temporal changes, and qualitative approaches to dive deeper into understanding specific phenomena. First, I improve understanding of IWS as an institution, and demonstrate the importance of dynamics between institutional factors for external context, program structure, and other related analytical domains in shaping how PWS is applied to water resources challenges globally. Through an institutional analysis of IWS and the use of cluster analysis to group programs around buyer types and management actions, I highlight the role of government, influence of geographic context, and role of both regional and local conditions in shaping IWS design and structure. Second, I demonstrate that government actors are essential to IWS in the region, expanding beyond existing regulations and traditional roles. This exploration of the role of government within adaptive governance shows the evolving and expanding role of government over time, from federal regulations driving early water quality management, then state legislation driving water quantity programs, and more recently, federal agencies partnering on local water source protection efforts. Third, I show how key individuals and organizations create voluntary IWS in response to risk, aligning policies, politics and problems into solution framing, which suggests policy process theories more explicitly consider social-ecological complexities. These programs constitute the most recent expansion of IWS in the US West, and applying a policy process theory sheds light into the formation of the IWS, and the political, economic, ecological and social components that aligned to make the programs possible. My research shows this new arena of environmental governance as adaptive, place and problem-based, learning and collaboration-focused, accepting of uncertainty, and containing nimble and adaptive government across scale. My work also creates a baseline of IWS in the region, and identifies areas for future research as IWS matures over time.</p>

<p> The Department of Defense, at the time of this study, had over 38 combat Forward Operating Bases (FOB) with both U.S. military and non-military personnel residing and engaged in the mission. Also in these FOBs, are local nationals of the countries, who are employed to perform certain duties in these FOBs after having had certain security and medical background checks. However, while on military mission in Afghanistan and other Middle Eastern countries between 2009 and 2011, this researcher, observed and detected more than once, local nationals (LNs), Afghans, with certain infectious skin conditions working in the DIFACs (dining facilities) at major FOBs, serving food to soldiers inside the base. These LNs reside outside the FOB facility and gain entrance into the FOB daily, passing through already set security parameters put in place by the Department of Defense (DoD). There are Tactics, Techniques, and Procedures (TTP) to prevent or mitigate Person-borne Improvised Explosive Device (PBIED), Vehicle-borne Improvised Explosive Device (VBIED), and to also respond to, or recover from, Chemical, Biological, Radioactive, and Nuclear (CBRN) attacks on FOBs. Researcher is unaware of any TTP specific for HB-BA terrorist, capable of detecting, deterring or destroying a terrorist with bioagents breaching a combat post ECP; nor the training of soldiers of how to conduct a search on a bio-agent (BA) &ndash; or even what a bio-agent would look like if they found one. The purpose of this research was to determine whether there are current military counter bioterrorism measures in place to combat a human-borne with a bioagent (HB-BA) terrorist attempting to breach a combat FOB at the ECP, and how effective they are. </p><p> To accomplish this, a survey tool had to be developed and employed to determine the perceptions about the effectiveness of current ECP TTPs in detecting, deterring preventing, and mitigating a HBBA terrorist at the ECP, from military personnel. A survey tool (questionnaire) was developed, validated, and subjected to a reliability testing using Cronbach&rsquo;s Alpha on a mix-method cross sectional survey, a pretest. Results showed a Cronbach&rsquo;s Alpha of 0.82 and 0.89 for the survey&rsquo;s two constructs. Also, 92.3% of respondents had recently been in combat deployment. All of them claimed that bioterrorism is very possible, but 61.5% believe it is either very possible or possible for a terrorist with a bioagent (BA) to successfully breach a FOB ECP. Only 3.8% felt that it would be impossible to breach the FOB ECP with a bioagent. Similarly, only 28% of respondents surveyed believe that current ECP TTPs are effective against a BA, 48% believe that current CBRN TTPs are either not effective, or somewhat effective, against BA at the ECP. In conclusion, the preliminary study, indicated that combat FOBs are vulnerable to breach by human-borne with BA terrorist at the ECP, as there exists no currently effective ECP TTP that could detect, deter or destroy a terrorist with a biological agent at a combat FOB ECP.</p>

<p> In the aftermath of the tragic events of September 11, 2001, the role of the local police has undergone a continual expansion process that has become a vital component in safeguarding our national security. Despite numerous technological advancements in intelligence operations, the local police remains the only 24/7 emergency operations entity that is capable of gathering intelligence, investigating, mobilizing operations, and apprehending threats to our nation. With this expanded role in national security, police leadership and management is faced with increased levels of accountability, including the safeguarding of critical infrastructure in their respective jurisdictions, often without financial commitments and resources acquisitions. This qualitative study served to address the local police as a component of national security through five police chiefs&rsquo;/directors&rsquo; perceptions of their roles in safeguarding critical infrastructure, examining their perceptions as they pertain to their current delivery mission model, through interviews and the development of pervasive themes. Themes from the data were well-saturated, as well as overarching, and emerged as follows: (a) critical infrastructure (CI) identification, (b) policy and patrol practice, (c) police officer knowledge, (d) technology impacts on critical infrastructure, and (e) budget. Identification regarding the relationships between local police and civil/national security, leadership/management and policy were made that suggest changes and sweeping support for future frameworks. The paper concludes with a discussion of the research, along with recommendations for policy, practice and future research.</p>

<p> Durable power of attorney has been recognized as a powerful legal document that is used to financially exploit the elderly across the United States. The existing research indicated elder financial abuse undermines the economic security of the financially exploited older adult. </p><p> Despite the findings, however, a recent review of the existing literature showed a lack of research that computed how much elder financial abuse was attributed to durable power of attorney abuse. Studies, such as the one published by the MetLife Market Institute, reported that $2.9B was stolen from the elderly nationwide in 2010. If the durable power of attorney is used to financially exploit the elderly, then the question becomes: How much money is stolen from the elderly by the misuse of a durable power of attorney? The existing research that quantified elder financial abuse did not delineate and show how much was attributed to durable power of attorney abuse. That is the missing link. </p><p> Adult Protective Services is a nationwide government agency that receives and investigates reports of suspected elder abuse, physical and financial. The elder financial abuse cases include those in which a durable power of attorney was used to gain access to the older adults&rsquo; money. </p><p> This dissertation was the first attempt to calculate in dollars how much money was taken from older persons in Bergen County, New Jersey through the misuse of a durable power of attorney, with a sole focus on durable power of attorney abuse apart from the other ways in which senior citizens are financially exploited. This researcher examined an open-source document prepared by Bergen County Adult Protective Services and estimated in dollars how much money was taken from the elderly in Bergen County, New Jersey over a specific period of time. </p><p> This researcher examined civil security, the human security paradigm, and national security. The focus was on the economic component of the human security paradigm and through a narrow lens, the study results demonstrated that durable power of attorney abuse is a critical threat to the economic security of the nation&rsquo;s older population and poses a potential threat to our nation&rsquo;s security. </p><p> The most significant result was that the data compiled in this study seemed to indicate that between January 1, 2010, and December 31, 2013, the majority of the elder financial abuse cases reported to and investigated by Bergen County Adult Protective Services were committed by a means other than the misuse of a durable power of attorney. When it was used, however, it resulted in the older persons having their monthly social security income stolen on a regular basis, or in other cases hundreds of thousands of dollars were taken over time.</p>