Downsizing and Organizational Restructuring: What Is the Impact on Hospital Performance?

Abstract

In recent years, hospitals have radically restructured their operations while significantly downsizing their workforces. To date, little is known about the combined effect of these change processes on organizational functioning. There have been few large‐scale studies investigating how hospitals have performed when both organizational restructuring and downsizing are used concurrently. The research reported here sets out to separate and isolate the independent and combined effect of organizational restructuring and downsizing on hospital performance. In particular, it aims to address the following question: Do hospitals which undergo significant organizational restructuring while maintaining their workforce complement perform any better than hospitals that institute significant restructuring while heavily downsizing, and any better than hospitals which heavily downsize but undertake little or no organizational restructuring? Categorical regression analysis results from a sample of 285 Canadian acute care hospitals suggest that organizational restructuring and downsizing have differential impacts on organizational performance. Hospitals which undertook significant organizational restructuring while heavily downsizing were perceived to perform better than hospitals that heavily downsized but conducted little or no organizational restructuring, but performed worse than hospitals that undertook significant restructuring while maintaining their workforce complement. However, when the method of conducting the change management process was controlled for, these performance differences were reduced or eliminated.     

Performance Management in the Public Sector: Does It Decrease or Increase Innovation and Performance?

An important discussion in the performance management literature is how performance contingent incentives affect goal attainment. Incentivizing management tools are typically implemented to improve performance, but due to motivation crowding they may decrease innovation and performance. This article focuses on public research institutions and uses both existing performance studies of publications and two new innovation studies of patents to investigate effects of both financial incentives and sanctions within and between universities. Our findings indicate that public managers can create an environment supportive of innovation and performance through the use of performance management tools, but that this is no automatic link.     

Performance Implications of Public Managers’ Goal Prioritization: An Empirical Test of the Link between Internal Management and Organizational Performance

Most studies on the goals-performance nexus focus on the implications of goal design. In public organizations with multiple goals, managerial goal prioritization can, however, in itself play a decisive role for performance. This study examines the effects of managerial goal prioritization and employee commitment on organizational performance. Analyses of parallel surveys of principals and teachers in higher secondary education and archival data on school performance show that principals’ goal prioritization is positively related to high school performance. The findings thus indicate that public managers should concentrate not only on how they design goals, but also on how they prioritize them.     

When Does Aid Conditionality Work?

Does aid conditionality—the setting of policy goals in exchange for access to aid—promote reform? Many studies on the impact of aid and reform suggest not. However, few explicitly examine whether the impact of aid on reform is mediated by recipient regime type. I argue that conditional aid is effective but its efficacy depends on recipient countries’ level of democracy because the value of aid to governments depends on the degree to which it helps them maintain power, and recent work shows that the marginal impact of aid on political survival increases with level of democracy. I test this argument on data from 68 countries over the period from 1980 to 1999. I focus on the impact of IMF and World Bank aid on fiscal reform, one of the most commonly stipulated conditions in aid-for-policy arrangements. I find that aid from the Bretton Woods institutions promotes fiscal reform, but only in more democratic countries.     

Funding,Management, and Individual-Level Factors: What Factors Matter in Predicting Perceived Organizational Effectiveness?

Scholars have examined organizational effectiveness in state and federal government agencies to determine which factors matter. Their findings revealed that public organizational effectiveness is affected by environmental, human resource management, organizational, and individual-level factors. However, what is conspicuously absent is the impact funding has on organizational effectiveness. To further previous literature, this article examined agency funding levels as well as management and individual-level factors to determine the relationship these factors had on organizational effectiveness. In doing so, a model was developed to predict perceived organizational effectiveness, and it was tested on 330 United States government workers in the state of New York. The findings from the analysis were clear: perceived organizational effectiveness was impacted by employee perceptions regarding the level of funding the agencies were allocated. Additionally, the level of role ambiguity and employee participation in decision-making as well as employee job performance and public service motivation levels were also found to matter. The implications and limitations of these findings are discussed in the article.     

Are Changes Effective in Performance Management? An Analysis of Japanese Agencies

Agencies are key organizations for implementing and studying performance measurement and management (PMM). This article explores the implementation and effect of PMM in Japanese agencies. In Japan, design of the agency system included New Public Management elements, such as independence and delegation of powers, but also traditional ones, with a strong system of controls. The discourse about the soundness and ambitions of the PMM system permeated the agencies but not so much their effort toward PMM. The performance improvement attained by agencies depends on their agency characteristics, organizational culture, and organizational factors, with a remarkable influence of the organizational culture.     

What Does Dabiq Do? ISIS Hermeneutics and Organizational Fractures within Dabiq Magazine

The Islamic State of Iraq and Syria (ISIS)'s flagship English-language magazine, Dabiq, is a puzzle. The magazine is not, despite appearances, primarily designed for direct recruiting efforts or inciting violence against the West. In fact, the primary audiences of Dabiq are English-speaking second generation Muslims or converts, Western policymakers, and a third group of current or would-be members of ISIS who are not integrating with the organization itself. The third audience—those members who are failing to function within the organization—is strange to include in an English-language magazine. Why publish organizational weaknesses, in English? One possibility for this puzzle is that the fundamentalist hermeneutics of ISIS is reflected in their own media efforts. One of the assumptions that ISIS holds about their sacred texts is that each text carries a single meaning that reflects the author's original intent. There might be multiple applications of that intent, but each text can only have one intent, and therefore one meaning. Following this logic, a message meant for one person is unlikely to be of utility for another, and so this may be why ISIS exposes their weaknesses as part of the process of correcting their own members.     

Improving the Health Coverage of the Rural Poor: Does Contracting-Out Mobile Medical Teams Work?

Low population density in rural developing countries coupled with deficient infrastructure, weak state capacity and limited budgets makes increasing health care coverage difficult. Contracting-out mobile medical teams may be a helpful solution in this context. This article examines the impact of a large-scale programme of this type in Guatemala. We document large impacts on immunisation rates for children and prenatal care provider choices. The programme increased substantially the role of physician and nurses at the expense of traditional midwives. The results indicate that mobile medical teams substantially increased coverage of health care services in Guatemala, and could be effective in other developing countries.     

Enhancing Employees’ Work Performance through Organizational Justice in the Context of Financial Crisis. A Study of the Greek Public Sector

In a period of economic crisis, the increasing pressure of sparse financial resources and the structural reforms in labor law are factors pushing and forcing managers of both public and private organizations to do more with less. The current study explores how employees’ performance in the public sector is affected by perceptions of organizational justice in terms of resource allocation (e.g., benefits and compensation). The responses received from a sample of 490 employees working for public organizations in Greece indicated that work performance is significantly and positively related not only to employees’ satisfaction with pay, but also to employees’ perceptions of distributive and procedural justice.     

Does Decentralization Reform Always Increase Economic Growth?: A Cross Country Comparison of the Performance

This study aims to test the impact of decentralization on the economic growth of a country. Based on the longitudinal data set of 63 countries with a time series spanning 1960 to 2007, the test result reveals that there is a negative relationship both between fiscal decentralization and GDP growth and between political decentralization and GDP growth. In order to examine the different impacts of decentralization, the same analysis was applied to subsets of countries categorized into three groups according to the economic stage of the country. This further analysis found that there is a negative relationship between political decentralization and growth in developing countries, between fiscal decentralization and growth in semi-developed countries, but no relationship in developed countries. These results show that decentralization is not always instrumental in economic growth, which means that the time variable, or more precisely the stage of economic development of a country, is an important factor when introducing decentralization reforms.     

Does the Gown Help the Town? Examining Town–Gown Relationship Influence on Local Environmental Sustainability in the United States

A US municipality environmental sustainability index, the OSSPI (Opp-Saunders Sustainability Practices Index), found an overwhelming percentage of top-ranked sustainable cities were home to higher education institutions. While this may be a coincidence, this research seeks to determine if and how local communities partner or collaborate with higher education institutions for environmental sustainability purposes. The results of two case studies, San Antonio, Texas and Dubuque, Iowa, suggest there is considerable variability in the town-gown relationships. However, it is found that larger, public universities are more likely to have stronger relationships and effects on local sustainability efforts.     

The Limits of Governance: How Far Does Policy Analysis Travel in International Relations?

ABSTRACT

This article retraces the mutual rapprochement between Policy Analysis and International Relations and addresses its limits. Looking beyond the circle of advanced liberal-democratic economies, three limits are discussed: the need to specify the prerequisites of different modes of governance; to consider the relations of power and domination in these processes; and to look beyond regulatory issues at the political and societal conflicts surrounding policy diffusion.     

HRM: Performance Relationship: Need for Further Development?

The last decade of empirical research on the HRM value additions, also known as the “HRM and performance” debate, demonstrates evidence that HRM does matter (Huselid, 1995 Huselid, M. 1995. The impact of human resource management on turnover, productivity and corporate financial performance. Academy of Management Journal, 38(3): 635–672. [Crossref], [Web of Science ®] , [Google Scholar]; Guest et al., 2003 Guest, D.E., Michie, J., Conway, N. and Sheehan, M. 2003. Human resource management and corporate performance in the UK. British Journal of Industrial Relations, 41(2): 291–314. [Crossref], [Web of Science ®] , [Google Scholar]; Wright et al., 2003 Wright, P., Gardner, M. and Moynihan, L. 2003. The impact of HR practices on the performance of business units. Human Resources Management Journal, 13(4): 21–36.  [Google Scholar]; Rehman et al., 2010). Unfortunately, the relationships are often statistically weak and the results ambiguous. This article reviews and attempts to extend the theoretical and methodological issues in this debate. Its aim is to build an agenda for future research in this area. A brief overview of achievements to date is followed by the theoretical and methodological issues related to what constitutes HRM, what is meant by the concept of performance, and the nature of the link between these two. In the final section, it is argued that research designs should start from a multi-dimensional concept of performance, including the perceptions of employees, and build on the premise of HR systems as an enabling device for a whole range of strategic options. This implies a reversal of the strategy-HRM linkage.     

How Much Does Having a Bank Account Help the Poor?

Having a bank account is widely regarded as the first step toward financial inclusion of the poor. Funds deposited in a bank account are also observed to lead to higher savings. Exploiting special features of the National Rural Employment Guarantee Scheme (NREGS) of India, our estimates indicate that households that receive NREGS wages through a bank do not appear to spend more on education than other comparable households that receive cash payment. The district level intention to treat specification produces similar results. The findings suggest that the rural poor face constraints in accessing their bank accounts due to financial illiteracy and other problems.     

How Dependent Are the Baltic States on Russia?

Abstract

This article explores the impact of international trade on private investment in the three post-Soviet Baltic states—Estonia, Latvia and Lithuania—by applying the business cycle synchronisation theory and highlighting the importance of big neighbours for small open economies. The study covers 1995–2015. The study shows that changes in the GDP growth of trading partners can have a greater effect on domestic private investment in small open economies than GDP changes in their own economies. The ongoing business cycle synchronisation between Russia and the Baltic countries means that the impact of Russia as a big neighbour remains an important issue for the latter.     

Does Ideology Matter? Incentive,Efficiency and Management in the Public Sector

Contracting out has become increasingly popular as a strategy for public sector management for reducing costs, alleviating the burden on government agencies providing services, as well as taking advantage of the practices that have succeeded in the private sector. Generally, the system of management in capitalist liberal democratic systems of government that emphasize rule of law, transparency, performance measurement, and accountability are expected to be more efficient, while socialist regimes are considered to be inefficient due to the lack of these features. This article compares two dissimilar cases of the Hong Kong Special Administrative Region and Shenzhen Special Economic Zone of China. An examination of the management of contract in the area of public housing in these cities reveal that the socialist city of Shenzhen has achieved a higher level of efficiency, while capitalist Hong Kong lags behind in establishing an effective system of management of contracts in the public sector. The finding challenges the traditional assumptions related to efficiency under different ideological regimes.     

The Role of Competition in Best Value: How Far Does it Differ from CCT?

This article investigates the role of ‘competition’ within Best Value (BV) and compares it with that of Compulsory Competitive Tendering (CCT). Utilising results of a survey of BV lead officers, the article reveals that ‘competition’ is not being used as widely as may have been expected. However, in terms of outcomes, services subject to BV seem to be at least as likely to be provided externally as would have been the case under CCT. Further analysis also considers the impact that party political control and service type have on the use and outcomes of competition.     

The New Panopticon? Examining the Effect of Home Confinement on Criminal Recidivism

Due to its versatility within the criminal justice system, home confinement has broad appeal as a sentencing option. This meta-analysis examines the effectiveness of house arrest and electronic monitoring on the recidivism of adult offenders. Fourteen effect sizes (from 11 studies) that present recidivistic outcomes were quantitatively pooled, and separate meta-analyses were conducted on varying categories of recidivism severity to assess the differing impact of home confinement. The findings suggest that home confinement helps adult offenders successfully reintegrate into the community upon release from closed custody and deters future offending. Implications for correctional policies and practices toward home confinement as a community-based prevention strategy to supervise offenders are discussed.     

Explaining Organizational Variety in Evaluation Quality Assurance: Which Conditions Matter?

The growth in evaluation practice has not always gone hand in hand with an increase in the actual quality of these evaluations. This article addresses this concern, by examining the factors that explain organizational variety in the application of evaluation quality assurance measures. We present the results of an analysis of 18 Flemish (Belgian) public sector organizations. To unravel different explanatory trajectories, we combine two comparative methods that rely on Boolean analysis: the most similar different outcome/most different similar outcome technique on the one hand, and crisp set qualitative comparative analysis on the other hand.     

Islamism in Azerbaijan: How Potent?

Azerbaijan is deemed to be the most secular of all post-Soviet Muslim counties. Nevertheless, growing independent Islamic activism, inspired by the international Islamic discourse and helped by foreign Islamic actors, and combined with a repressive regime response to this activity carried out under the banner of antiterrorism may contribute to make Islamism a potent factor in Azerbaijan. This article maps out independent Shi’a and Sunni activism and regime response in Azerbaijan. By assessing the dynamics between these two factors the article draws conclusions on the potential for politicization and radicalization of Islam in Azerbaijan.