Catch-22

Since the publication of the initial American College of Cardiology (ACC)/American Heart Association (AHA) Methodology for the Selection and Creation of Performance Measures,1 there has been an explosion in the development and application of performance measures. Although initially envisioned as a means for physician-led quality-improvement efforts, performance measures have been primarily used as tools for accountability and performance-based reimbursement instead. Given the centrality of and experience with performance measures for quantifying healthcare quality, the American College of Cardiology Foundation (ACCF)/AHA Task Force on Performance Measures sought to update its methodology so that ongoing efforts to measure performance could benefit from emerging insights. The original methodology, proposed in 2005,1 remains the foundation for developing process performance measures. The principal recommendations of the 2005 report are summarized in Table 1. The 2010 report does not address detailed issues of analysis,3 pay for performance,4 or nonfinancial rewards for better performance5 because these topics have been addressed in other statements. The focus of the 2010 report is to provide a state-of-the-art perspective on the construction, collection, and emerging directions of performance measurement as a means to improve healthcare quality. View this table: Table 1. ACCF/AHA Attributes of Performance Measures Figure 1. An overview of the steps in providing care by domain. Reprinted from Spertus et al.1 Performance measures that articulate discrete processes of care, as opposed to structural aspects of care or outcomes, are distinctly different from both clinical practice guidelines and appropriate use criteria because they represent a subset of the clinical guidelines for which the evidence is sufficiently strong: typically where the highest-quality evidence of benefit unequivocally exceeds risk (Class I recommendation, Level of Evidence: A),8 failure to provide the therapy to an eligible patient meaningfully reduces the likelihood that the patient will experience the best possible outcome. In this report, …

<p>Peacekeeping operations have unintended consequences —a fact long ignored by both practitioners and researchers. The deployment of a large number of soldiers, police officers, and civilian personnel inevitably has various effects on the host society and economy. These consequences are especially serious when they cause harm to the local community, as in the case of sexual abuse and exploitation, corruption, or the creation of a false economy. Unintended side effects can also negatively affect the ability of a peacekeeping mission to achieve its mandate. Bringing together field experiences and academic analyses, this book investigates the unintended consequences of peacekeeping operations on individuals and groups, on the host society and economy, and on the troop-contributing countries. It also analyzes the degree to which the United Nations has tried to manage some of these side effects, as well as the UN's accountability in the context of the international legal framework. The aim of the book is not to discredit peace operations but to improve the ways in which they are planned and managed. The contributors identify the need to develop a culture of accountability —one that includes procedures to anticipate unintended consequences and to monitor any side effects during the operation, so that steps can be taken to prevent and manage negative consequences as early as possible.</p>

PurposeThis paper seeks to provide a method which increases the chance of successful implementation and use of a performance management system (PMS). This method should incorporate both the instrumental and behavioral sides of performance management, be based on a solid theoretical foundation, and have been proven in practice.Design/methodology/approachThe method is called the strategic performance management development cycle, which consists of three stages: design a strategic management model; design a strategic reporting model; and design a performance‐driven behavioral model. The workings of the cycle are illustrated with a case study of a publishing company which used the method during the implementation of a new PMS.FindingsApplying the strategic performance management development cycle makes it possible for an organization to create in a short time period a new PMS, which will then improve the organization's results dramatically.Practical implicationsDuring the implementation of a PMS an organization has to expressly pay attention to all three stages of the strategic performance management development cycle, in order to increase the chance of a successfully implemented and used PMS.Originality/valueIt has been reported that 56 percent of PMS implementations fail, meaning that these implementations do not result in a PMS that is used regularly by all people in the organization. This article describes an implementation approach which is based on a solid theoretical foundation, has been proven in practice, and will give organizations a better chance of a successful PMS implementation.

Purpose The literature highlights the relevance of performance measurement and management system in small and medium enterprises (SMEs) to face the current competitive environment. However, a number of studies investigate how performance measurement and management system is effective for evolving and how contingency factors could influence this change. Newer experiences are sporadic and rarely investigated by researchers and practitioners. The purpose of this study is to identify the feasible evolutionary path of performance measurement and management system in leading SMEs to respond to current business challenges. Furthermore, it aims to contribute to the understanding of the role of key contingency factors influencing this evolution. Design/methodology/approach A longitudinal case study, based on retrospective and real-time investigations, is performed to investigate the primary evolutions of the performance measurement and management system and its key determinants. Findings The findings highlight two evolution paths, increasing the maturity of performance measurement. The first path highlights a strong command and control of performance management; the second path shows a democratic and participative of performance management. Moreover, management information system, organizational culture and management style are highlighted as key contingency factors in the change of performance management. Originality/value The authors contribute to knowledge in performance measurement field, showing how the efforts for developing performance measurement and management system in a leading SME could determine two different evolutionary paths. Furthermore, the paper describes the increasing role of organizational culture, management style and management information system in performance management evolution, as well as the relevance of online chats and social media in performance management activities.

The article is concerned with defining the concept of the paradigm of strategic management of telecommunications enterprises and its adaptation in the digital economy to form a mechanism for the strategic development of enterprise and its efficient functioning. The article emphasises that the modern paradigm of strategic management of telecommunications enterprises is based on a humancentred approach, which is based on the potential of management personnel in accordance with the strategic directions of enterprise development. For telecommunications enterprises that ensure the development and functioning of the digital economy, the management objectives should be: global digitalisation of business and society; adaptation of the enterprise's operation to the consequences of digital transformation; development of corporate digital culture; introduction of modern management methods corresponding to the digitalisation and digitalisation of the social, financial and economic spectrum of society development. The analytical review made it possible to compare the advantages and disadvantages of strategic, situational and process management, which became the basis for the formation of a paradigmatic digital strategy for managing telecommunications enterprises, which involves determining the overall strategy, strategic directions of activity, scenarios for their implementation in accordance with management situations, taking into account management signals from the external and internal environments.The study of modern concepts of strategic management of enterprises has made it possible to determine that most of the paradigmatic directions of strategic management are based on the known approaches to the formation of a synergistic system of strategic, situational, operational and process management to achieve the goals of enterprise development. Focusing on the strategic management of telecommunications enterprises has made it possible to outline the basic paradigms that are practical for determining effective procedures for making strategic management decisions and implementing the strategic management process; allows telecommunications enterprises to form a form of effective management with due regard for digital transformations.

Virulence factors of pathogens, such as toxin production and biofilm formation, often exhibit a public character, providing benefits to nearby non-producers. Consequently, anti-virulence drugs targeting these public traits may not select for resistance, as resistant mutants that resume production of the virulence factor share the benefits of their resistance with surrounding sensitive cells. In agreement with this, we show that even after long-term treatment with a 2-amino-imidazole (2-AI) biofilm inhibitor, Salmonella populations remained as susceptible to biofilm inhibition as the ancestral populations. Nonetheless, further genotypic and phenotypic analysis revealed that the Salmonella populations did adapt to the treatment and accumulated mutations in efflux pump regulators and alternative sigma factors. These mutations resulted in a reduced biofilm-forming capacity and increased efflux activity. Their selection was due to a growth delaying side effect of the biofilm inhibitor. Enhanced efflux activity helped overcome this growth delay, providing a fitness advantage over the ancestor. Finally, we demonstrate that chemical modification of the inhibitor enhances its specificity by partially alleviating the unintended growth delay while retaining the anti-biofilm activity, which in turn eliminated the selection pressure for increased efflux. Overall, our findings highlight that while unintended side effects can complicate anti-virulence strategies, adaptation to these effects does not necessarily restore the inhibited virulence trait. Moreover, chemical modification can mitigate these unintended side effects and enhance drug specificity.

Barium (Ba) leaching from soils and certified reference materials

Like any revolution, the options revolution that began with the publication of the Black-Scholes-Merton option pricing formula has had some unintended side effects. Of concern to all investors should be the potentially dangerous increase in market instability created by the trading strategies option sellers use to hedge their market exposures. Dynamic hedging rules that call for buying as market prices rise and selling as they fall have wreaked havoc with markets in the past and are likely to do so again in the future.

Ecological Vulnerability Through Insurance? Potential Unintended Consequences of Livestock Drought Insurance

The maternity benefit scheme piloted as Indira Gandhi Matritva Sahyog Yojana (IGMSY) since 2011 and recently rolled out as Pradhan Mantri Matru Vandana Yojana (PMMVY) incentivizes mothers to participate in infant health-promoting activities. It has become India's largest conditional cash transfer program ever, outrivaling the country's first-generation maternity benefit scheme Janani Suraksha Yojana (JSY), which incentivizes institutional delivery and has been criticized for its unintended side effects on fertility. We approach IGMSY's geographically targeted pilot phase as a natural experiment and use data from a large national health survey to estimate its effects by a matched-pair difference-in-differences approach. Consistent with the program's conditions, we find increases in infant immunization. As side effect, long-term utilization of public health facilities becomes more frequent and intervals between eligible births increase by 17%. Our findings suggest that India'ns second-generation maternity benefit scheme has been more carefully designed than its predecessor, with side effects that support the program's broader objectives. But both direct and indirect effects are small and can make only a small contribution to redressing India's dismal maternal and child health record.

Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

This paper aimed to clarify the role that the Balanced Scorecard (BSC) as a performance measurement tool in the company of Algeria Post. The BSC is a strategic performance management system, has been proven suitable for the public sector as the financial aspect is not their only concern. The BSC is « A multidimensional performance measurement system that should serve as decision support for managers. It includes indicators of progress and delay as well as internal and external indicators. It organizes the measures in a coherent system around four balanced perspectives: financial perspective, customer perspective, internal process, learning, and growth ». (Kaplan. S & Norton, 2004, P186). This study focused to improve the company of Algeria Post overall performance, the management control systems established should be re-evaluated and its tools should be improved to ensure reactivity in the decision-making and the measuring of the company performance. Our work consists of proposing a new approach to the performance management system for the model of the BSC as a performance measurement tool in the company of Algeria Post. The purpose of this article is to answer the main question of the study: should the company rely on the balanced scorecard as a performance measurement tool to achieve its strategic goals? First able, we counted on the stages of scientific research by gathering information about the company of Algeria Post, after that to conduct our study, we opted for a qualitative approach, using documentary research, interviews, and observation as tools for data collection. In the course of our designing of the proposed model of the BSC for the company. During our design of the proposed model of the balanced scorecard for the company we decided to follow a specific methodology to obtain the desired results taking into account the governmental nature of the organization of the company’s. We deemed it necessary to apply a public sector BSC model, using a top-down principle from (Kaplan and Norton, 2014) combined with the implementation procedures described in the theoretical side by (Alain Fernandez, 2013). It is noted that through the performance indicators of the customer perspective that the company realized some respectful objectives, but most of them are short lived ones, simultaneously, the internal processes perspective was the most performing by focusing on improving the quality of electronic services and the commercial network as a whole.

PurposeThe aim of this paper is to examine how performance management (PM) is adopted in the public university sector and the problems it faces in an environment of conflicting management cultures.Design/methodology/approachThis paper draws on institutional logics as a theoretical framework and inductive qualitative interviews as a research approach.FindingsThe results reveal that the conflicting values instilled in key players aligned with the different cultures have resulted in PM assuming a hybrid form, rather than the corporate form. Three identified problematic factors further demonstrate that the level of hybridity varies across the sector. The paper alludes to a theory-practice gap as a result of the findings and the concept of negative hybridity and its risk to effective governance aligned with the corporate approach.Research limitations/implicationsThe results are limited to Australian public universities. In addition, interviews were conducted with a specific set of university management staff. A different perspective on the findings may have been generated with a different set of management or operational staff.Practical implicationsThe results provide policymakers and university management with information on the theory practice gap and the problematic factors contributing to it. It also informs policymakers to the risks associated with negative hybridity.Originality/valueThe results reveal the existence of a theory–practice gap because of a number of common problematic factors in the adoption of a corporate-oriented PM system in Australian public universities. The results highlight the need for further studies to establish the extent to which the current hybrid PM system deviates from the expected corporate-oriented PM system, and whether this poses a risk to effective governance aligned with the corporate approach.

The paper examines the link between strategic management and performance measurement in the public sector. The main hypothesis is that the stages of strategic management development are positively correlated with the number of performance dimensions measured by public organisations. In order to examine the stated hypothesis results from the empirical research conducted in Croatian public administration are being presented. A questionnaire has been sent to 253 central and local organisations and additional interviews have been conducted. The results confirm the hypothesis and determine that the enhancement of strategic planning and management is one of the main stimuli for performance measurement in Croatia.

Experiments in ecology can have unintended side effects. Recently, it has been suggested that the act of visiting a plant, inherent to studying herbivory, may alter plant performance and interactions. To evaluate the generality of this inference, we examined plant performance and herbivory on 14 plant species in three geographic regions. Visitation did not significantly affect any of the variables that we measured, including leaf damage, height, biomass, or survivorship, for any species. However, rates of herbivory varied significantly among sites and regions. Thus, our data do not support the generality of visitation impacting estimates of herbivory. We propose that future studies of herbivory will gain more by evaluating spatial heterogeneity in interaction outcomes than by quantifying possible experimenter-caused variation.