INSTITUTIONAL LAYERING IN GOVERNING HEALTHCARE QUALITY

Since the 1980s, regulated markets and New Public Management have been introduced in the public sector across the world. How they have affected existing governance mechanisms such as self‐regulation and state regulation has remained largely unexplored, however. This article examines the origins and consequences of institutional layering in governing healthcare quality. Dutch health care, where a market‐based system has been introduced, is used as a case study. The results show that this market‐based system did not replace but modified existing institutional arrangements. As a result, hospitals have to deal with the fragmentation of quality demands. Using the concept of institutional layering, this study shows how different arrangements interact. As a consequence, the introduction of a certain policy reform will work out differently in different countries and policy sectors. Our ‘archaeological’ study in this layering can be seen as an example of how such incremental change can be studied in detail.     

"Transcending gynocentric space”: Spatial metaphorics in feminist theory and criticism

Many studies assert that there are new gender constructions among young Scandinavian girls, who seem to be more individualized than earlier generations. In this article questions are raised as to what effect these girls’ newly won status as subjects might have on their construction of bodily gender, especially the part referred to as generative femininity. A “loss” of the generative body is argued to be a general tendency in postmodern discourse, as well as a dilemma in the individual girl's striving for being both individual and gender. This dilemma and its tentative solution is illustrated through the analysis of an 18‐year‐old Norwegian girl, who was the subject of an in‐depth interview in a three‐generational study of gender in change.     

US police officers’ knowledge regarding behaviors indicative of deception: Implications for eradicating erroneous beliefs through training

Abstract

The current study surveyed a random sample of Texas law enforcement officers (n?=?109) about their knowledge regarding behaviors indicative of deception. The officers were not highly knowledgeable about this topic, overall performing at a chance level in assessing how various behavioral cues relate to deception. Confidence in one's skill was unrelated to accuracy, and officers who reported receiving the most training and utilizing these skills more often were more confident but no more accurate in their knowledge of the behaviors that typically betray deception. The authors compare these results to previous studies that have examined officers’ beliefs in other countries and discuss the implication of these results in terms of developing future training programs that may debunk the common misconceptions that officers possess.     

Factors Associated with Physician Discussion of Health Behaviors with Adolescents

Behaviors developed in adolescence influence health later in life. The purpose of this study was to investigate the frequency of health care provider's discussion of health behaviors with overweight and non-overweight adolescents and identify demographic and health behaviors related to exercise, hours of television viewing, and weight issues associated with these discussions. A Cross sectional survey of urban adolescents was conducted. Trained interviewers administered surveys over a three month period in 2001 at an urban academic pediatric and adolescent clinic. The 252 adolescents surveyed had a mean age of 15 with 49% categorized as being at risk for overweight/overweight and 51% as normal weight using the CDC percentiles for BMI. While 16% of the adolescents reported that their physician or nurse discussed the amount of television they watched, rates of discussion related to exercise (58%), and weight (54%) were much higher. In multivariate analyses, health care provider discussions with adolescents regarding exercise were more common for overweight (O.R.=2.42, 95% C.I. [1.28–4.57]) and at risk for overweight (O.R.=1.98, 95% C.I. [1.03–3.81]) adolescents, whereas physician discussion of television viewing was not associated with weight. Discussions of weight were more common for female (O.R.=2.18, 95% C.I. [1.21–3.95]), African-American (O.R.=2.53, 95% C.I. [1.40–4.57]), and overweight (O.R.=3.92, 95% C.I. [1.97–7.81]) adolescents. Even after adjusting for weight, race and gender strongly influenced the frequency of discussions about weight in physician offices. Although health care providers frequently address weight and exercise with adolescents, more discussions related to sedentary behaviors such as television viewing may be warranted to address adolescent obesity.Received PhD in Epidemiology from University of California, San Diego. Research interests include smoking prevention and cessation among adolescents and health promotion interventions.Received MD from University of Missouri-Kansas City and MPH from Johns Hopkins University. Research interests include health services research and research in support of measurable, systematic improvements in the quality of medical care.Received medical degree from Christian Medical College, Punjab, India and Master of Public Health from University of Kansas School of Medicine. Research interests include diet and physical activity behaviors, role of the environment in obesity and obesity prevention, especially among children and adolescents.Received MBBS from Allama Iqbal Medical College, Punjab University, Lahore, Pakistan and MPH from University of Kansas Medical Center. Research interests include smoking cessation, database design, implementation, data management and analysis, and use of information technology in health care settings.Director, Cancer Prevention, Control, and Population Sciences, Kansas Cancer Institute. Received MD/MPH from Tulane University and MS from Harvard School of Public Health. Research interests include disparities in healthcare; smoking cessation among underserved populations, specifically African Americans; diet, nutrition, obesity, and physical activity.     

体系、社会和国家:理解《美韩自由贸易协定》

2007年6月,美韩双方签署了《美韩自由贸易协定》。美韩之间为什么要签署该协定?该协定对两国国内分别产生了哪些影响?该协定为何至今没能获得美国国会的通过?针对上述问题,本文结合美国贸易政策理论,从体系、国家和社会三个层面对其进行了分析。《美韩自由贸易协定》的签署及其实施,在体系层面上将会为双方带来经济、政治和战略上的多重收益,而在社会层面上却产生了不同的反应。尽管由于国内经济困难和利益集团的掣制使得协定的通过还面临不小的阻力,但基于协定所蕴含的重要价值和两国政府对此认识的高度一致,协定获得通过只是时间上的问题。     

Managing for Legitimacy: Agency Governance in Its “Deep” Constitutional Context

Recent literature on bureaucratic structure has gone further than studying discretions given to bureaucrats in policy making, and much attention is now paid to understanding how bureaucratic agencies are managed. This article proposes that the way in which executive governments manage their agencies varies according to their constitutional setting and that this relationship is driven by considerations of the executive's governing legitimacy. Inspired by Charles Tilly (1984), the authors compare patterns of agency governance in Hong Kong and Ireland, in particular, configurations of assigned decision‐making autonomies and control mechanisms. This comparison shows that in governing their agencies, the elected government of Ireland's parliamentary democracy pays more attention to input (i.e., democratic) legitimacy, while the executive government of Hong Kong's administrative state favors output (i.e., performance) legitimacy. These different forms of autonomy and control mechanism reflect different constitutional models of how political executives acquire and sustain their governing legitimacy.     

Ingredients of institutional reputations and citizen engagement with regulators

The purpose of this study is to examine the link between the reputational components of efficacy and moral reliability of institutions, and citizens' compliance with institutional recommendations. Research on bureaucratic reputations highlights the significance of positive political reputations based on credibility and legitimacy, but the impact of these components is not systematically isolated and studied. We draw insights from political psychology to move beyond a positive‐negative valence‐based approach of reputation, and highlight the different effect of efficacy and moral reliability components of reputation on citizens' cooperation, engagement in water saving activities, and levels of complaints. We use the Cypriot Water Authority as a case study and inquire how its institutional reputation influences Cypriot citizens' behavior regarding water use. Our data was collected via a representative national survey administered to a random sample of 800 Cypriots in the spring of 2009 and show that favorable perceptions of particular components of institutional reputation shape the levels of satisfaction with specific organizational outputs.     

E‐government and public service quality in Ghana

This article contributes to the growing discourse on the potential of e‐government to transform the operations of public sector institutions, thereby improving public services. It does so by conceptualizing public service quality into efficiency, economy (cost reduction), customer satisfaction, and service accessibility and draws on qualitative data from the Ghanaian narrative for illustration. As previous studies have demonstrated, this study also affirms the potential of e‐government in improving public services delivery by increasing efficiency, reducing the cost of operations, expanding access to services, and achieving customer satisfaction. Yet, there remains a repertoire of challenges such as weak ICT infrastructure especially in towns and villages, incessant power outages and illiteracy, which are drawbacks to fully harnessing the benefits of e‐government in Ghana. The study recommends that these challenges should feature prominently in e‐government policies to increase the chances of solving them.