Theory in Practice: Increasing Professional Effectiveness

The World is Flat: A Brief History of the Twenty-First Century Thomas L. Friedman Farrar, Straus and Giroux, 2005 Thomas Friedman is a widely-acclaimed journalist, foreign affairs columnist for the New York Times, and author of four best-selling books that include From Beirut to Jerusalem (1989). His eminence as a journalist is clearly demonstrated in the way he prepared for The World is Flat. He traveled throughout the world, interviewing in depth the political and business leaders who have the most direct, hands-on knowledge of the truly incredible developments occurring in the business structures and technology of globalization. Only a journalist who moves freely at the highest levels could interview the likes of Sir John Rose, the chief executive of Rolls-Royce; Nobuyuki Idei, the chairman of Sony; Richard Koo, the chief economist for the Nomura Research Institute; Bill Gates of Microsoft; Wee Theng Tan, the president of Intel China; David Baltimore, president of Caltech; Howard Schultz, founder and chairman of Starbucks; Nandan Nilekani, CEO of Infosys in Bangalore - and many others, each of whom gave him the inside story of how, specifically, the barriers of time and space separating economies, workforces, sources of capital, and technical abilities are crumbling. The result of this unfolding story, already far along but with much farther to go, according to Friedman, is that "the world is flat." With some notable exceptions in sub-Saharan Africa and the Islamic swathe, everything is connected with everything else on a horizontal basis, with distance and erstwhile time-lags no longer mattering. Friedman describes in detail the galloping globalization that has unfolded in even so limited a time as the past five years. Under the impetus of a worldwide network of interconnectivity, the world economy is much-changed from what it was at the turn of the century a mere half-decade ago. Friedman quotes the CEO of India's Infosys: "What happened over the last [few] years is that there was a massive investment in technology, especially in the bubble era, when hundreds of millions of dollars were invested in putting broadband connectivity around the world, undersea cables," while (Friedman paraphrases him) "computers became cheaper and dispersed all over the world, and there was an explosion of software - e-mail, search engines like Google, and proprietary software that can chop up any piece of work and send one part to Boston, one part to Bangalore, and one part to Beijing...." Microprocessors today have 410 million transistors compared to the 2800 they had in 1971. And now, "wireless is what will allow you to take everything that has been digitized, made virtual and personal, and do it from anywhere." The effect on productivity is revolutionary: "It now takes Boeing eleven days to build a 737, down from twenty-eight days just a few years ago. Boeing will build the next generation of planes in three days, because all the parts are computer-designed for assembly." The most strikingly informative aspect of this book, however, is not about technology. Most especially, Friedman explores the rapidly evolving global business systems, each constantly regenerating itself to keep ahead of the others. These are systems that span the continents seeking the lowest-cost providers of everything from expert scientific and engineering work to the lowliest grunt work. Friedman points out that India produces 70,000 accounting graduates each year - and that they are willing to start at $100 a month. It is no wonder that Boeing employs 800 Russian scientists and engineers for passenger-plane design when "a U.S. aeronautical engineer costs $120 per design hour, a Russian costs about one-third of that." Friedman describes a call center in India where outbound callers sell "everything from credit cards to phone minutes," while operators taking inbound calls do "everything from tracing lost luggage for U.S. and European airline passengers to solving computer problems for confused American consumers. …

The World Is Flat: A Brief History of the Twenty-First Century

Collaboration is a widely utilized strategy for addressing complex social issues and for facilitating organizational innovation and performance. Evaluators are uniquely positioned to empirically ex...

Evaluating Organizational Collaborations Suggested Entry Points and Strategies

Human aspects of information security in organisations


Background

The establishment of the Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) was the culmination of a number of policy initiatives to bridge the gap between evidence and practice. CLAHRCs were created and funded to facilitate development of partnerships and connect the worlds of academia and practice in an effort to improve patient outcomes through the conduct and application of applied health research.

 
Objectives

Our starting point was to test the theory that bringing higher education institutions and health-care organisations closer together catalyses knowledge mobilisation. The overall purpose was to develop explanatory theory regarding implementation through CLAHRCs and answer the question ‘what works, for whom, why and in what circumstances?’. The study objectives focused on identifying and tracking implementation mechanisms and processes over time; determining what influences whether or not and how research is used in CLAHRCs; investigating the role played by boundary objects in the success or failure of implementation; and determining whether or not and how CLAHRCs develop and sustain interactions and communities of practice.

 
Methods

This study was a longitudinal realist evaluation using multiple qualitative case studies, incorporating stakeholder engagement and formative feedback. Three CLAHRCs were studied in depth over four rounds of data collection through a process of hypothesis generation, refining, testing and programme theory specification. Data collection included interviews, observation, documents, feedback sessions and an interpretive forum.

 
Findings

Knowledge mobilisation in CLAHRCs was a function of a number of interconnected issues that provided more or less conducive conditions for collective action. The potential of CLAHRCs to close the metaphorical ‘know–do’ gap was dependent on historical regional relationships, their approach to engaging different communities, their architectures, what priorities were set and how, and providing additional resources for implementation, including investment in roles and activities to bridge and broker boundaries. Additionally, we observed a balance towards conducting research rather than implementing it. Key mechanisms of interpretations of collaborative action, opportunities for connectivity, facilitation, motivation, review and reflection, and unlocking barriers/releasing potential were important to the processes and outcomes of CLAHRCs. These mechanisms operated in different contexts including stakeholders’ positioning, or ‘where they were coming from’, governance arrangements, availability of resources, competing drivers, receptiveness to learning and evaluation, and alignment of structures, positions and resources. Preceding conditions influenced the course and journey of the CLAHRCs in a path-dependent way. We observed them evolving over time and their development led to the accumulation of different types of impacts, from those that were conceptual to, later in their life cycle, those that were more direct.

 
Conclusions

Most studies of implementation focus on researching one-off projects, so a strength of this study was in researching a systems approach to knowledge mobilisation over time. Although CLAHRC-like approaches show promise, realising their full potential will require a longer and more sustained focus on relationship building, resource allocation and, in some cases, culture change. This reinforces the point that research implementation within a CLAHRC model is a long-term investment and one that is set within a life cycle of organisational collaboration.

 
Funding

The National Institute for Health Research Health Services and Delivery Research programme.

/pdf/collective-action-for-knowledge-mobilisation-a-realist-o5prkuopne.pdf

Collective action for knowledge mobilisation: a realist evaluation of the Collaborations for Leadership in Applied Health Research and Care

https://www.journalofnursingregulation.com/article/S2155-8256(15)30303-3/pdf

Promoting and Regulating Safe Medication Administration in Nursing Homes

There are multiple gaps in our collective knowledge that surgical research has yet to address. These include: functional outcomes of limb or organ-based surgery; optimal margins in different cancer resections and patient-reported outcomes from different procedures. Clinical trials may be the gold-standard to investigate these gaps but they take years to plan, fund and deliver results. Furthermore, the data to answer these questions already exist and are generated daily by National Health Service (NHS) surgeons. We live in a world of ‘big data’ generation which is continuously being collected. This data has the potential to be automatically analysed and outcomes immediately actioned with a more dynamic and agile approach to data collections. A new approach is required. We propose a solution that builds these repositories, and carries additional advantages to patients, surgeons, and Hospital Trusts. 

A new horizon for surgical research in a digital world: A national operation notes system.

Identifying opportunities to safely reduce antibiotic prescribing is necessary for prescribers and antibiotic stewardship teams to minimise unwarranted antibiotic use. We aimed to quantify excess antibiotic use in General Surgery. We retrospectively audited the antibiotic prescribing for patients discharged from the General Surgery specialty in an acute hospital in the south-west of England for one month using an audit tool developed by Public Health England. The appropriateness of prescribing was determined for each patient at three antibiotic decision time-points: at initiation, the pre-72-h antibiotic review, and treatment duration. Two infection specialists and a general surgeon reviewed each patient. Indication and excess days of therapy (DOTs) were calculated at each decision time-point and expressed as a proportion of total DOTs. Eighty-six patients were prescribed 1162 DOTs; 192 (16.5%) excess DOTs were prescribed in 38 patients (44%), with zero excess days identified in the remaining 48 patients (56%). Seventy-five of 192 (39%) excess DOTs occurred at initiation; 55/192 (29%) after the pre-72-h antibiotic review; and 62/192 (32%) due to protracted antibiotic courses. There was concordance between the general surgeon and infection specialist for most apportioned excess DOTs. However, the surgeon apportioned fewer excess DOTs 160/1162 (13.8%). Overall IV antibiotics accounted for 53.4% of total DOTs. Seventy-two of 86 (83.7%) patients received 620 intravenous DOTs; of these, 79 (12.7%) IV DOTS were unnecessary. We have identified excess antibiotic prescribing in General surgery with comparable excess DOTs at all three time-points.

/pdf/identification-of-intervention-opportunities-through-q9yvo2je.pdf

Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit

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Evaluating Organizational Collaborations Suggested Entry Points and Strategies

Promoting and Regulating Safe Medication Administration in Nursing Homes

A new horizon for surgical research in a digital world: A national operation notes system.

Identification of Intervention Opportunities through Assessment of the Appropriateness of Antibiotic Prescribing in Surgical Patients in a UK Hospital Using a National Audit Tool: A Single Centre Retrospective Audit