Abstract: This paper identifies the development of and gaps in knowledge in business and management research on resilience, based on a systematic review of influential publications among 339 papers, books and book chapters published between 1977 and 2014. Analyzing these records shows that resilience research has developed into five research streams, or lines of enquiry, which view resilience as (1) organizational responses to external threats, (2) organizational reliability, (3) employee strengths, (4) the adaptability of business models or (5) design principles that reduce supply chain vulnerabilities and disruptions. A review of the five streams suggests three key findings: First, resilience has been conceptualized quite differently across studies, meaning that the different research streams have developed their own definitions, theories and understandings of resilience. Second, conceptual similarities and differences among these streams have not yet been explored, nor have insights been gleaned about any possible generalizable principles for developing resilience. Third, resilience has been operationalized quite differently, with few insights into the empirics for detecting resilience to future adversity (or the absence thereof). This paper outlines emerging research trends and pathways for future research, highlighting opportunities to integrate and expand on existing knowledge, as well as avenues for further investigation of resilience in business and management studies.

Abstract: While systematic literature reviews (SLRs) have contributed substantially to developing knowledge in fields such as medicine, they have made limited contributions to developing knowledge in the supply chain management domain. This is due to the ontological and epistemological idiosyncrasies of research in supply chain management, which need to be accounted for when retrieving, selecting, and synthesizing studies in an SLR. Therefore, we propose a new paradigm for SLRs in the supply chain domain that is based on both best practice and the unique attributes of doing supply chain management research. This approach involves exploring existing studies with attention to theoretical boundaries, units of analysis, sources of data, study contexts, and definitions and the operationalization of constructs, as well as research methods, with the goal of refining or revising existing theory. This new paradigm will push supply chain management research to the frontier of current methodological standards and build a foundation for improving the contribution of future SLRs in the supply chain and adjacent management disciplines.

Abstract: Concerns about problematic gaming behaviors deserve our full attention. However, we claim that it is far from clear that these problems can or should be attributed to a new disorder. The empirical basis for a Gaming Disorder proposal, such as in the new ICD-11, suffers from fundamental issues. Our main concerns are the low quality of the research base, the fact that the current operationalization leans too heavily on substance use and gambling criteria, and the lack of consensus on symptomatology and assessment of problematic gaming. The act of formalizing this disorder, even as a proposal, has negative medical, scientific, public-health, societal, and human rights fallout that should be considered. Of particular concern are moral panics around the harm of video gaming. They might result in premature application of diagnosis in the medical community and the treatment of abundant false-positive cases, especially for children and adolescents. Second, research will be locked into a confirmatory approach, rather than an exploration of the boundaries of normal versus pathological. Third, the healthy majority of gamers will be affected negatively. We expect that the premature inclusion of Gaming Disorder as a diagnosis in ICD-11 will cause significant stigma to the millions of children who play video games as a part of a normal, healthy life. At this point, suggesting formal diagnoses and categories is premature: the ICD-11 proposal for Gaming Disorder should be removed to avoid a waste of public health resources as well as to avoid causing harm to healthy video gamers around the world.

Abstract: The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

Abstract: Background: In electronic health (eHealth) evaluations, there is increasing attention for studying the actual usage of a technology in relation to the outcomes found, often by studying the adherence to the technology. On the basis of the definition of adherence, we suggest that the following three elements are necessary to determine adherence to eHealth technology: (1) the ability to measure the usage behavior of individuals; (2) an operationalization of intended use; and (3) an empirical, theoretical, or rational justification of the intended use. However, to date, little is known on how to operationalize the intended usage of and the adherence to different types of eHealth technology. Objective: The study aimed to improve eHealth evaluations by gaining insight into when, how, and by whom the concept of adherence has been used in previous eHealth evaluations and finding a concise way to operationalize adherence to and intended use of different eHealth technologies. Methods: A systematic review of eHealth evaluations was conducted to gain insight into how the use of the technology was measured, how adherence to different types of technologies was operationalized, and if and how the intended use of the technology was justified. Differences in variables between the use of the technology and the operationalization of adherence were calculated using a chi-square test of independence. Results: In total, 62 studies were included in this review. In 34 studies, adherence was operationalized as “the more use, the better,” whereas 28 studies described a threshold for intended use of the technology as well. Out of these 28, only 6 reported a justification for the intended use. The proportion of evaluations of mental health technologies reporting a justified operationalization of intended use is lagging behind compared with evaluations of lifestyle and chronic care technologies. The results indicated that a justification of intended use does not require extra measurements to determine adherence to the technology. Conclusions: The results of this review showed that to date, justifications for intended use are often missing in evaluations of adherence. Evidently, it is not always possible to estimate the intended use of a technology. However, such measures do not meet the definition of adherence and should therefore be referred to as the actual usage of the technology. Therefore, it can be concluded that adherence to eHealth technology is an underdeveloped and often improperly used concept in the existing body of literature. When defining the intended use of a technology and selecting valid measures for adherence, the goal or the assumed working mechanisms should be leading. Adherence can then be standardized, which will improve the comparison of adherence rates to different technologies with the same goal and will provide insight into how adherence to different elements contributed to the outcomes.

Abstract: This study explores social enterprises’ strategies for addressing mission drift. Relying on an inductive comparative case study of two Italian social enterprises, we show how stakeholder engagement combined with social accounting can successfully support a social venture to re-balance its positioning between wealth generation and social value creation. Indeed, stakeholder engagement helps the internal actors of a social enterprise to rationalize and embody pro-social values previously abandoned, while social accounting reinforces this embodiment process by showing the reintroduced social commitment of the social enterprise to external audiences. Conversely, strategies focused only on social accounting and without significant engagement of external stakeholders prove to be unsuccessful in counterbalancing mission drift because they fail to activate the necessary process of internal re-introduction and operationalization of pro-social values and objectives.

Abstract: Background: Despite rapid growth in eHealth research, there remains a lack of consistency in defining and using terms related to eHealth. More widely cited definitions provide broad understanding of eHealth but lack sufficient conceptual clarity to operationalize eHealth and enable its implementation in health care practice, research, education, and policy. Definitions that are more detailed are often context or discipline specific, limiting ease of translation of these definitions across the breadth of eHealth perspectives and situations. A conceptual model of eHealth that adequately captures its complexity and potential overlaps is required. This model must also be sufficiently detailed to enable eHealth operationalization and hypothesis testing. Objective: This study aimed to develop a conceptual practice-based model of eHealth to support health professionals in applying eHealth to their particular professional or discipline contexts. Methods: We conducted semistructured interviews with key informants (N=25) from organizations involved in health care delivery, research, education, practice, governance, and policy to explore their perspectives on and experiences with eHealth. We used purposeful sampling for maximum diversity. Interviews were coded and thematically analyzed for emergent domains. Results: Thematic analyses revealed 3 prominent but overlapping domains of eHealth: (1) health in our hands (using eHealth technologies to monitor, track, and inform health), (2) interacting for health (using digital technologies to enable health communication among practitioners and between health professionals and clients or patients), and (3) data enabling health (collecting, managing, and using health data). These domains formed a model of eHealth that addresses the need for clear definitions and a taxonomy of eHealth while acknowledging the fluidity of this area and the strengths of initiatives that span multiple eHealth domains. Conclusions: This model extends current understanding of eHealth by providing clearly defined domains of eHealth while highlighting the benefits of using digital technologies in ways that cross several domains. It provides the depth of perspectives and examples of eHealth use that are lacking in previous research. On the basis of this model, we suggest that eHealth initiatives that are most impactful would include elements from all 3 domains. [J Med Internet Res 2017;19(10):e324]

Abstract: The concept of affordances has been increasingly applied to the study of information and communication technologies (ICTs) in organizational contexts. However, almost no research operationalizes affordances, limiting comparisons and programmatic research. This article briefly reviews conceptualizations and possibilities of affordances in general and for media, then introduces the concept of organizational media affordances as organizational resources. Analysis of survey data from a large Nordic media organization identified six reliable and valid organizational media affordances: pervasiveness, editability, self-presentation, searchability, visibility, and awareness. Eight media scales based on frequency of use of 10 media within each of three organization levels were differentially associated with these affordances. The conceptualization, measurement approach, and results from this study provide the foundation for considerable future organizational communication and ICT research.

Abstract: Purpose Hofstede’s model of national culture has enjoyed enormous popularity but rests partly on faith. It has never been fully replicated and its predictive properties have been challenged. The purpose of this paper is to provide a test of the model’s coherence and utility. Design/methodology/approach Analyses of secondary data, including the World Values Survey, and a new survey across 56 countries represented by nearly 53,000 probabilistically selected respondents. Findings Improved operationalizations of individualism-collectivism (IDV-COLL) suggest it is a robust dimension of national culture. A modern IDV-COLL index supersedes Hofstede’s 50 year-old original one. Power distance (PD) seems to be a logical facet of IDV-COLL, rather than an independent dimension. Uncertainty avoidance (UA) lacks internal reliability. Approval of restrictive societal rules and laws is a facet of COLL and is not associated with national anxiety or neuroticism. UA is not a predictor of any of its presumed main correlates: importance of job security, preference for a safe job, trust, racism and xenophobia, subjective well-being, innovation, and economic freedom. The dimension of masculinity-femininity (MAS-FEM) lacks coherence. MAS and FEM job goals and broader values are correlated positively, not negatively, and are not related to the MAS-FEM index. MAS-FEM is not a predictor of any of its presumed main correlates: achievement and competition orientation, help and compassion, preference for a workplace with likeable people, work orientation, religiousness, gender egalitarianism, foreign aid. After a radical reconceptualization and a new operationalization, the so-called “fifth dimension” (CWD or long-term orientation) becomes more coherent and useful. The new version, called flexibility-monumentalism (FLX-MON), explains the cultural differences between East Asian Confucian societies at one extreme and Latin America plus Africa at the other, and is the best predictor of national differences in educational achievement. Research limitations/implications Differences between subsidiaries of a multinational company, such as IBM around 1970, are not necessarily a good source of knowledge about broad cultural differences. A model of national culture must be validated across a large number of countries from all continents and its predictions should withstand various plausible controls. Much of Hofstede’s model (UA, MAS-FEM) fails this test while the remaining part (IDV-COLL, PD, LTO) needs a serious revision. Practical implications Consultancies and business schools still teach Hofstede’s model uncritically. They need to be aware of its deficiencies. Originality/value As UA and MAS-FEM are apparently misleading artifacts of Hofstede’s IBM data set, a thorough revision of Hofstede’s model is proposed, reducing it to two dimensions: IDV-COLL and FLX-MON.

Abstract: The ecosystem services concept provides a valuable framework for analyzing and acting on the linkages between people and their environment. By making the values of nature explicit, it allows discussions about trade-offs between services and thus a prioritization of management options. The integration of the ecosystem services concept into decision making remains however challenging. Based on a thorough literature review of 68 tools for integrating ecosystem services into decision making, we analyze the current state, gaps and trends in the operationalization of the ecosystem services concept. We evaluate how well various policy sectors are covered with the tools and highlight gaps where more development is needed. While for some policy sectors such as agriculture or forestry several tools have been developed to support the integration of nature's benefits into concrete decisions, tools are missing where the link between policies and ecosystem services is less evident for example regarding cultural services related to land use policies as well as services supported by soils. Furthermore, the successful implementation of tools requires a good understanding of decision-making processes to bridge gaps in the science-policy interface. Based on the analysis of the application of tools in case studies, we evaluate the establishment of tools over time in different policy sectors and the frequency of their application.

Abstract: Purpose The purpose of this paper is to provide an updated and authoritative measure of individualism vs collectivism (IDV-COLL) as a dimension of national culture. Design/methodology/approach Rather than focus solely on Hofstede’s classic work, the authors review the main nation-level studies of IDV-COLL and related constructs to identify the salient cultural differences between rich societies and developing nations. The authors conceptualize and operationalize IDV-COLL on the basis of those differences and propose a new national IDV-COLL index, using new data from large probabilistic samples: 52,974 respondents from 56 countries, adequately representing the national cultures of all inhabited continents. Findings The proposed index is a new, valid measure of IDV-COLL as it is strongly correlated with previous measures of closely associated constructs. As a predictor of important cultural differences that can be expected to be associated with IDV-COLL, it performs better (yields higher correlations) than any known measure of IDV-COLL or a related construct. Research limitations/implications An important facet of IDV-COLL – in-group favoritism vs out-group neglect or exclusionism – does not transpire convincingly from the authors’ operationalization of IDV-COLL. The study relies on self-construals. Respondents are unlikely to construe their selves in terms of such concepts. Practical implications The new IDV-COLL measure can be used as a reliable, up-to-date national index in studies that compare the cultures of rich and developing nations. The new IDV-COLL scale, consisting of only seven items, can be easily used in future studies. Originality/value This is the first IDV-COLL measure based on the communalities of previous studies in this domain and derived from large probabilistic samples that approach national representativeness. The superior predictive properties of the authors’ new measure with respect to extraneous variables are another important strength and contribution.

Abstract: Background: Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. Method: Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). Results: The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. Conclusion: A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.

Abstract: Solving complex problems is a challenge faced by many governments. Academic and practical discussions on how to solve said problems look at policy integration as a solution to the negative implications that fragmented government actions have on addressing public problems or providing public services. Notwithstanding important recent contributions, we still lack a precise understanding of what policy integration is, an explanation of how it differs from other “solutions” to complex problems, such as coordination or policy coherence, and a practical operationalization. In this paper, we argue that coordination, coherence, and integration are related but substantively different concepts. We offer a new way of understanding and observing policy integration in a manner that is theoretically distinguishable from policy coordination and coherence and empirically observable. We argue that policy integration is the process of making strategic and administrative decisions aimed at solving a complex problem. Solving this complex problem is a goal that encompasses—but exceeds—the programs’ and agencies’ individual goals. In practical terms, it means that, at every moment of the policy process, there is a decision-making body making decisions based on a new logic—that of addressing a complex problem.

Abstract: Purpose The purpose of this paper is to investigate the relationships between environmental consciousness (ECO), green purchase attitude (GPA), green purchase intention (GPI), perceived customer effectiveness (PCE), green behaviour (GRB) and green purchase behaviour (GPB). Based on the statistical analyses, this paper offers some further research directions to advance the extant literature. Design/methodology/approach The theoretical model is firmly grounded in extant literature. To test the study hypotheses, the authors have developed a survey instrument following a two-stage process. The constructs were first operationalized by the authors and then pre-tested by experts. Dillman’s (2007) guidelines were then followed to gather data. Finally, the theoretical model was tested using multivariate statistical tools. Findings Results indicate that ECO has an influence on GPA and PCE; GPA has an influence on PCE and GRB; GPI has an influence on PCE; and GRB has an influence on GPB. Environmental benefit still ranks at the sixth position among eight product-selection criteria, as is evident from qualitative in-depth interviews indicating a primarily rationalistic and not an altruistic purchase approach. The gap in translation of ECO into GB and GPB can be attributed to costliness, non-availability with less variety, lack of brand reputation of green products and budget constraints for customers. Research limitations/implications The study faces the limitation of generalizability of the results because it was carried out in a particular state in India; it may not be the perception of the country as a whole. The bias owing to social desirability, selective memory and telescoping with the use of self-reported data could also be a limitation for the current empirical study. Originality/value This study aimed to extend pro-environmental behaviour studies beyond developed countries and to empirically validate the models built on the theory of ECO leading to GPB, especially for India, a rising market. A novel approach to empirically discuss the situational and market factors will provide a much-needed thrust for research on these lines.

Abstract: The measurement of community disaster resilience through the development of a comprehensive set of composite indicators is becoming increasingly commonplace. Despite this growing trend, there is neither an agreement upon a standard procedure nor a comprehensive assessment of existing measurement frameworks in the relevant literature. To tackle these challenges, this study (1) proposes an overarching eight-step procedure for composite indicator building and (2) develops a meta-level assessment framework to allow for a systematic review of existing disaster resilience measurement frameworks in application of composite indicator building. This meta-level framework was established on the basis of the proposed eight-step composite indicator building procedure and qualified with the introduction of 19 dimensions and 36 metrics for quality assessment. In order to select relevant disaster resilience measures for this analysis, the study applied a systematic survey to collect measures based on four inclusion criteria: community-based, multifaceted, quantitative, and operationalized. Accordingly, 17 resilience measurement frameworks were chosen for further analysis in this review. The results of the quality assessment demonstrated that, from the theoretical perspective, resilience assessments originate from either the socio-ecological or engineering fields and can be classified into two main types of resilience indices and tools. This differs from results of the methodological perspective, which indicate that resilience measures can be characterized as deductive or similar to hierarchical and inductive assessments.

Abstract: Organizational ambidexterity has been established as an important antecedent of organizational innovation and performance. Recently, researchers have started to argue that ambidexterity is not only essential at the organizational, but also at the individual level. Thus, to be innovative, individuals need to engage in both explorative and exploitative behaviours. However, questions remain regarding the optimal balance of explorative and exploitative behaviours and how ambidexterity can be operationalized. At the organizational level, most empirical research utilized either the difference between, or the product of, exploration and exploitation. In this article, we criticize these approaches on conceptual and methodological grounds and argue for an alternative operationalization of ambidexterity: polynomial regression and response surface methodology. In two diary studies with daily and weekly data, we demonstrate the advantages of this approach. We discuss implications for ambidexterity research and innovation practice.

Abstract: Government policy increasingly supports engaging communities to promote health. It is critical to consider whether such strategies are effective, for whom, and under what circumstances. However, ‘community engagement’ is defined in diverse ways and employed for different reasons. Considering the theory and context we developed a conceptual framework which informs understanding about what makes an effective (or ineffective) community engagement intervention. We conducted a systematic review of community engagement in public health interventions using: stakeholder involvement; searching, screening, appraisal and coding of research literature; and iterative thematic syntheses and meta-analysis. A conceptual framework of community engagement was refined, following interactions between the framework and each review stage. From 335 included reports, three products emerged: (1) two strong theoretical ‘meta-narratives’: one, concerning the theory and practice of empowerment/engagement as an independent objective; and a more utilitarian perspective optimally configuring health services to achieve defined outcomes. These informed (2) models that were operationalized in subsequent meta-analysis. Both refined (3) the final conceptual framework. This identified multiple dimensions by which community engagement interventions may differ. Diverse combinations of intervention purpose, theory and implementation were noted, including: ways of defining communities and health needs; initial motivations for community engagement; types of participation; conditions and actions necessary for engagement; and potential issues influencing impact. Some dimensions consistently co-occurred, leading to three overarching models of effective engagement which either: utilised peer-led delivery; employed varying degrees of collaboration between communities and health services; or built on empowerment philosophies. Our conceptual framework and models are useful tools for considering appropriate and effective approaches to community engagement. These should be tested and adapted to facilitate intervention design and evaluation. Using this framework may disentangle the relative effectiveness of different models of community engagement, promoting effective, sustainable and appropriate initiatives.

Abstract: Background: The prioritization of sustainable patient-centered care in contemporary health care has resulted in an increased focus on patient empowerment, which in turn is considered to facilitate patient independence, self-management, and self-efficacy. However, a definitional consensus of empowerment remains elusive, impeding efforts to translate the conceptual ideals of empowerment into a measurable entity associated with changes in health care behavior or outcomes. The rapid integration of technology in health care serves to add another layer of complexity in the measurability and operationalization of empowerment and helps to create a specific context in which this conceptual entity should be further examined. Objective: The primary objective of this scoping review was to explore the concept of patient empowerment within the electronic health (eHealth) context. A further focus on the association or measurement of this concept in conjunction with tethered patient portal use was also employed. Methods: In this scoping review, a six-step framework was used to guide the search and paper selection process. The review was initiated with two broad research questions, which are as follows: (1) What is the relationship between empowerment and the use of eHealth technologies from a patient perspective? (2) How is patient empowerment (and/or engagement or activation) influenced by accessing personal health information through a tethered patient portal? Multiple databases were employed in a comprehensive search strategy, and papers were primarily evaluated and selected for inclusion by 2 review authors, and a third author was consulted to resolve any issues in reaching consensus. Results: From an initial count of 1387 publications, this review returned nine systematic or literature review papers and 19 empirical studies that pertained to patient empowerment (and/or engagement and activation) in relation to the use of tethered patient portals providing access to electronic health records (EHRs). Of the 19 empirical publications, only four were found to have used specific patient empowerment measures with significant variety in their identified conceptual elements. Conclusions: There is a persistent lack of conceptual clarity in patient empowerment research, and this has extended to study within the eHealth context. The interchangeable use or conflation of terms such as patient empowerment, engagement, and activation, has further complicated the advancement of distinct conceptual measures. To more strongly align changes in patient empowerment with supportive eHealth solutions, the challenges of achieving a consensus on how best to operationalize and measure patient empowerment must be met. [J Med Internet Res 2017;19(9):e329]

Abstract: While tackling interdependencies among food, energy, and water security is promising, three fundamental challenges to effective operationalization need addressing: the feasibility of science-policy integration, cross-scale inequalities, and path-dependencies in infrastructure and socio-institutional practices.

Abstract: Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal-agent theory, theory of common pool resources, North's institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified as well as replicate and scale-up examples of good practice.

Abstract: The thesis of this article is that the lack of evidence related to the identification and development of therapist expertise is due to the inadequate definition and operationalization of the concep...