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Administrative
Terms modified by Administrative Selected AbstractsPost-Conditionality Politics and Administrative Reform: Reflections on the Cases of Uganda and TanzaniaDEVELOPMENT AND CHANGE, Issue 4 2001Graham Harrison This article contributes to the discussion of the nature of external intervention in the reform processes of indebted states. Looking at administrative reform in Uganda and Tanzania, it is argued that external involvement in sub-Saharan Africa is becoming increasingly differentiated. For some states , including the two cases dealt with here , a key set of continuities and changes allows us to conceptualize a regime of post-conditionality. Post-conditionality regimes exist where extreme external dependence and economic growth produce a set of political dynamics in which external,national distinctions become less useful, in which there emerge a set of unequal mutual dependencies, and in which donor/creditor involvement in reform becomes qualitatively more intimate, pervading the form and processes of the state. Details of this dispensation are provided in an analysis of key ministries and key interventions by donors/creditors. The article finishes by considering the contradictions of the post-conditionality regime, and its prospects. [source] Administrative and Court Reform in Central and Eastern EuropeEUROPEAN LAW JOURNAL, Issue 3 2003Frank Emmert Only relatively recently, it was recognised that successful administrative and court reform would be just as necessary in order to achieve the desired goals, namely that the candidates would eventually be able to take on their obligations as new members of the Union. Unfortunately, it has now become evident that it is easier to write new laws than to get them properly applied in every day practice. This article describes a number of cases to illustrate the problem. It shows that administrators and judges in Central and Eastern Europe have significant difficulties with Western working methods, specifically the application of international norms in the national legal order, due process and procedural safeguards, treatment of precedents, resolution of ambiguities and lacunae in the law, etc., which may in turn result in unjust and sometimes absurd application of laws. These difficulties cannot be resolved merely by organising ever more training courses and other theoretical programmes. The author claims that the majority of efforts promoting administrative and court reform applied so far have rendered only meager results. Therefore, additional and more creative measures have to be designed and implemented and have to be continued for years beyond accession of most of these countries to the EU in 2004. Otherwise, rule of law deserving its name will not materialise in the new Member States. The author concludes by offering some ideas based on many years of experience in the region. [source] The Hidden Politics of Administrative Reform: Cutting French Civil Service Wages with a Low-Profile InstrumentGOVERNANCE, Issue 1 2007PHILIPPE BEZES The article addresses internal and hidden politics of changes in bureaucracies by focusing on the introduction and use of policy instruments as institutional change without radical or explicit shifts in administrative systems. Beneath public administrative reforms, it examines the use of "low-profile instruments" characterized by their technical and goal-oriented dimension but also by their low visibility to external actors due to the high complexity of their commensurating purpose and the automaticity of their use. The core case study of the paper offers a historical sociology of a technique for calculating the growth of the French civil service wage bill from the mid-1960s to the 2000s. The origins, uses, and institutionalisation of this method in the French context are explored to emphasize the important way of governing the bureaucracy at times of crisis through automatic, unobtrusive, incremental, and low-profile mechanisms. While insisting on the salience of techniques for calculating, measuring, classifying, and indexing in the contemporary art of government, it also suggests the need for observing and explaining "everyday forms of retrenchment" in bureaucracies. [source] Reshaping the State: Administrative Reform and New Public Management in FranceGOVERNANCE, Issue 4 2005ALISTAIR COLE This essay examines the administrative reform process in France since the late 1980s. The key reforms undertaken during this period have sought to delegate greater managerial autonomy to the ministerial field-service level. We undertook semistructured interviews with officials in the field services of three French ministries (Education, Agriculture, and Infrastructure) in the Champagne-Ardennes region, as well as with members of the wider policy communities. The capacity of the field services to adopt a proactive approach to management reform depended on five key variables: internal organizational dynamics; the attitude of the central services to mesolevel autonomy; the degree of institutional receptivity to change; the type of service delivery, and the extent of penetration in local networks. The Infrastructure Ministry was more receptive to management change than either Education or (especially) Agriculture, a receptivity that reflects the institutional diversity of the French administrative system, and that supports new institutionalist arguments. The essay rejects straightforward convergence to the New Policy Management norm. Changes in public management norms require either endogenous discursive shifts or else need to be interpreted in terms of domestic registers that are acceptable or understandable to those charged with implementing reform. [source] Senior Civil Servants and Bureaucratic Change in BelgiumGOVERNANCE, Issue 3 2003Guido Dierickx The Belgian civil service used to be a Weberian bureaucracy, with a strict division of labor between civil servants and politicians, administrative careers based on both seniority and partisan patronage, and a technocratic culture coupled with a high level of alienation from both politics and politicians. Administrative reform came in the wake of the constitutional reform that transformed unitary Belgium into a federal state with several governments, each with a civil service of its own. The fiscal crisis prompted them to look favorably on the promises of New Public Management (NPM). The new Flemish government was first to take advantage of this opportunity, as it had the financial resources, the tendency to refer to Anglo-Saxon and Dutch examples, and the right political and administrative leadership. The staying power of these as yet precarious reforms depends on the continuity of political leadership, the establishment of an administrative culture matching the institutional innovations, and resistance to the endemic temptation to use them for partisan purposes. [source] Administrative Reform: Changing Leadership Roles?GOVERNANCE, Issue 4 2001Tom Christensen Three interwoven change elements characterize New Public Management: substantial horizontal and vertical specialization, substituting an integrated sector model for a fragmented functional model, and extensive use of contracts as part of a "make the manager manage" kind of incentive system. This article discusses the effects and implications of these reform elements on political-democratic processes in general, and on political, administrative, and public enterprise leadership roles more specifically. Examples from Norway and New Zealand illustrate the discussion. [source] Elevated prevalence of hepatitis C infection in users of United States veterans medical centers,HEPATOLOGY, Issue 1 2005Jason A. Dominitz Several studies suggest veterans have a higher prevalence of hepatitis C virus infection than nonveterans, possibly because of military exposures. The purpose of this study was to estimate the prevalence of anti,hepatitis C antibody and evaluate factors associated with infection among users of Department of Veterans Affairs medical centers. Using a two-staged cluster sample, 1,288 of 3,863 randomly selected veterans completed a survey and underwent home-based phlebotomy for serological testing. Administrative and clinical data were used to correct the prevalence estimate for nonparticipation. The prevalence of anti,hepatitis C antibody among serology participants was 4.0% (95% CI, 2.6%-5.5%). The estimated prevalence in the population of Veterans Affairs medical center users was 5.4% (95% CI, 3.3%-7.5%) after correction for sociodemographic and clinical differences between participants and nonparticipants. Significant predictors of seropositivity included demographic factors, period of military service (e.g., Vietnam era), prior diagnoses, health care use, and lifestyle factors. At least one traditional risk factor (transfusion or intravenous drug use) was reported by 30.2% of all subjects. Among those testing positive for hepatitis C antibody, 78% either had a transfusion or had used injection drugs. Adjusting for injection drug use and nonparticipation, seropositivity was associated with tattoos and incarceration. Military-related exposures were not found to be associated with infection in the adjusted analysis. In conclusion, the prevalence of hepatitis C in these subjects exceeds the estimate from the general US population by more than 2-fold, likely reflecting more exposure to traditional risk factors among these veterans. (HEPATOLOGY 2005;41:88,96.) [source] Post-Conditionality Politics and Administrative Reform: Reflections on the Cases of Uganda and TanzaniaDEVELOPMENT AND CHANGE, Issue 4 2001Graham Harrison This article contributes to the discussion of the nature of external intervention in the reform processes of indebted states. Looking at administrative reform in Uganda and Tanzania, it is argued that external involvement in sub-Saharan Africa is becoming increasingly differentiated. For some states , including the two cases dealt with here , a key set of continuities and changes allows us to conceptualize a regime of post-conditionality. Post-conditionality regimes exist where extreme external dependence and economic growth produce a set of political dynamics in which external,national distinctions become less useful, in which there emerge a set of unequal mutual dependencies, and in which donor/creditor involvement in reform becomes qualitatively more intimate, pervading the form and processes of the state. Details of this dispensation are provided in an analysis of key ministries and key interventions by donors/creditors. The article finishes by considering the contradictions of the post-conditionality regime, and its prospects. [source] Characteristics of Emergency Medicine Program DirectorsACADEMIC EMERGENCY MEDICINE, Issue 2 2006Michael S. Beeson MD Objectives: To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. Methods: An online survey was e-mailed in 2002 to all EM PDs of programs that were approved by the Accreditation Council of Graduate Medical Education. The survey included questions concerning demographics, work hours, support staff, potential problems and solutions, salary and expenses, and satisfaction. Results: One hundred nine of 124 (88%) PDs (69.7% university, 27.5% community, and 2.8% military) completed the survey; 85.3% were male. Mean age was 43.6 years (95% confidence interval [CI] = 42.6 to 44.7 yr). The mean time as a PD was 5.7 years (95% CI = 4.9 to 6.5 yr), with 56% serving five years or less. The mean time expected to remain as PD is an additional 6.0 years (95% CI = 5.2 to 6.8). A 1995 study noted that 50% of EM PDs had been in the position for less than three years, and 68% anticipated continuing in their position for less than five years. On a scale of 1 to 10 (with 10 as highest), the mean satisfaction with the position of PD was 8.0 (95% CI = 7.2 to 8.3). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI of difference of means = 0.53 to 3.53). Sixty-five percent of PDs had served previously as an associate PD. Most PDs (92%) have an associate or assistant PD, with 54% reporting one; 25%, two; and 9%, three associate or assistant PDs. A 1995 study noted that 62% had an associate PD. Ninety-two percent have a program coordinator, and 35% stated that they have both a residency secretary and a program coordinator. Program directors worked a median of 195 hours per month: clinical, 75 hours; scholarly activity, 20 hours; administrative, 80 hours; and teaching and residency conferences, 20 hours; compared with a median total hours of 220 previously reported. Lack of adequate time to do the job required, career needs interfering with family needs, and lack of adequate faculty help with residency matters were identified as the most important problems (means of 3.5 [95% CI = 3.2 to 3.7], 3.4 [95% CI = 3.2 to 3.6], and 3.1 [95% CI = 2.9 to 3.3], respectively, on a scale of 1 to 5, with 5 as maximum). This study identified multiple resources that were found to be useful by >50% of PDs, including national meetings, lectures, advice from others, and self-study. Conclusions: Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position. [source] Minting in Vandal North Africa: coins of the Vandal period in the Coin Cabinet of Vienna's Kunsthistorisches MuseumEARLY MEDIEVAL EUROPE, Issue 3 2008Guido M. Berndt This paper offers a re-examination of some problems regarding the coinage of Vandal North Africa. The coinage of this barbarian successor state is one of the first non-imperial coinages in the Mediterranean world of the fifth and sixth centuries. Based on the fine collection in the Coin Cabinet of Vienna's Kunsthistorisches Museum, this article questions the chronology of the various issues and monetary relations between the denominations under the Vandal kings, especially after the reign of Gunthamund (484,96). The Vandals needed and created a solid financial system. In terms of political, administrative and economic structures they tried to integrate their realm into the changing world of late antiquity and the early Middle Ages. [source] Government administrative burdens on SMEs in East Africa: reviewing issues and actionsECONOMIC AFFAIRS, Issue 2 2001Fiona Macculloch The important macroeconomic reforms achieved in East African economies (Kenya, Tanzania and Uganda) during the late 1980s and early 1990s have failed to deliver the magnitude of private sector growth and increased employment expected. Governments in the region have begun to recognize that lower-level policies and administrative procedures impose significant constraints on private sector development, stemming primarily from the command and control bureaucracies that characterised colonial governance. There are three priority areas for administrative reform: business licensing and registration, tax and customs procedures and specialised approvals. Also discussed are the problems of the special position of the informal sector, the impact of corruption and access to commercial justice. [source] Premature termination of treatment in an inpatient eating disorder programmeEUROPEAN EATING DISORDERS REVIEW, Issue 4 2007Philip C. Masson Abstract This retrospective study was conducted to explore rates, timing and predictors of two forms of premature termination of treatment (PTT) in an inpatient eating disorders programme: patient dropout (DO) and administrative discharge (AD). A chart review was conducted to obtain demographic, Eating Disorder Inventory-2 (EDI-2), and Resident Assessment Instrument-Mental Health (RAI-MH) data for 186 patients being treated for bulimia nervosa (BN), anorexia nervosa (AN), or eating disorder not otherwise specified (EDNOS). Overall, of the 37.6% of patients who terminated treatment prematurely, 22.1% of patients dropped out, and 15.5% of patients were administratively discharged. Time at which discharge occurred was found to be associated with the type of premature termination. The presence of DSM-IV Axis-I comorbidity was found to be the only factor associated with an increased risk of being administratively discharged. No factors were predictive of patients dropping out of treatment. The findings support the notion that AD and patient DO are different events that may have different factors influencing their rates and timing. Implications for future research and programme planning are discussed. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source] ,Mad Cows' and Eurocrats,Community Responses to the BSE CrisisEUROPEAN LAW JOURNAL, Issue 5 2004Keith Vincent Responding to criticisms and recommendations made in the aftermath of the initial crisis, particularly by the European Parliament, the EU has embarked on a process of reforming the administrative landscape in this area. This has included the setting-up of a new regulatory agency, the European Food Safety Agency, and a commitment to the more effective use of scientific information. It is submitted that this could lead to the development of new information-based scientific networks that inform and direct EU governance, networks which should contain the European Food Safety Agency at their centre. [source] Administrative and Court Reform in Central and Eastern EuropeEUROPEAN LAW JOURNAL, Issue 3 2003Frank Emmert Only relatively recently, it was recognised that successful administrative and court reform would be just as necessary in order to achieve the desired goals, namely that the candidates would eventually be able to take on their obligations as new members of the Union. Unfortunately, it has now become evident that it is easier to write new laws than to get them properly applied in every day practice. This article describes a number of cases to illustrate the problem. It shows that administrators and judges in Central and Eastern Europe have significant difficulties with Western working methods, specifically the application of international norms in the national legal order, due process and procedural safeguards, treatment of precedents, resolution of ambiguities and lacunae in the law, etc., which may in turn result in unjust and sometimes absurd application of laws. These difficulties cannot be resolved merely by organising ever more training courses and other theoretical programmes. The author claims that the majority of efforts promoting administrative and court reform applied so far have rendered only meager results. Therefore, additional and more creative measures have to be designed and implemented and have to be continued for years beyond accession of most of these countries to the EU in 2004. Otherwise, rule of law deserving its name will not materialise in the new Member States. The author concludes by offering some ideas based on many years of experience in the region. [source] Services of General Interest in EC Law: Matching Values to Regulatory Technique in the Public and Privatised SectorsEUROPEAN LAW JOURNAL, Issue 4 2000Colin Scott All the European Union Member States have long traditions of state activity in providing key services (such as the utilities, health and education) to their citizens and underpinning both such direct provision and provision of services by non-state actors with certain administrative or legal guarantees. In European Community doctrines they are referred to as ,services of general interest' within which is a narrower class of ,services of general economic interest'. The diverse national public service traditions have been challenged both by the requirements of the single market and by other pressures such as fiscal crisis and broader public sector reform. This article examines the means by which services to which special principles should be applied can be identified and focuses on the range of sometimes contradictory values denoted by the term ,services of general interest', examining the range of regime types (based on hierarchical, competition-based and community forms) by which those values might be pursued. The concluding section suggests that the matching of values to techniques should not be made according to the importance of the values to be pursued, but rather by reference to which techniques are likely to be effective given the configuration of interests and capacities and existing culture within the target domain. [source] Women in Academic Emergency MedicineACADEMIC EMERGENCY MEDICINE, Issue 9 2000Rita K. Cydulka MD Abstract. Objective: To evaluate the achievement gof women in academic emergency medicine (EM) relative to men. Methods: This study was a cross-sectional mail survey of all emergency physicians who were employed at three-fourths full-time equivalent or greater at the 105 EM residency programs in the United States from August 1997 to December 1997. The following information was obtained: demographics, training and practice issues, roles and responsibilities in academic EM, percentage of time spent per week in clinical practice, teaching, administrative and research activities, academic productivity, and funding. Results: Of the 1,575 self-administered questionnaires distributed by the office of the chairs, 1,197 (76%) were returned. Two hundred seventy-four (23%) of the respondents were women, and 923 (77%) were men. There was a significant difference noted between men and women in all demographic categories. The numbers of respondents who were nonwhite were extremely small in the sample and, therefore, the authors are hesitant to draw any conclusions based on race/ethnicity. There was no difference in training in EM between men and women (82% vs 82%, p = 0.288), but a significantly higher proportion of male respondents were board-certified in EM (84% vs 76%, p < 0.002). Women in academic EM were less likely to hold major leadership positions, spent a greater percentage of time in clinical and teaching activities, published less in peer-reviewed journals, and were less likely to achieve senior academic rank in their medical schools. Conclusions: These findings mirror those of most medical specialties: academic achievement of women in academic EM lags behind that of men. The paucity of minority physicians in academic EM didn't permit analysis of their academic achievements. [source] (RE)MAPPING INDIGENOUS ,RACE'/PLACE IN POSTCOLONIAL PENINSULAR MALAYSIA,GEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 3 2006Alice M. Nah ABSTRACT. This paper focuses on how indigeneity has been constructed, deployed and ruptured in postcolonial Malay(si)a. Prior to the independence of Malaya in 1957, British colonial administrators designated certain groups of inhabitants as being ,indigenous' to the land through European imaginings of ,race'. The majority, politically dominant Malays were deemed the definitive peoples of this geographical territory, and the terrain was naturalized as ,the Malay Peninsula'. Under the postcolonial government, British conceptions of the peninsula were retained; the Malays were given political power and recognition of their ,special (indigenous) position' in ways that Orang Asli minorities,also considered indigenous - were not. This uneven recognition is evident in current postcolonial political, economic, administrative and legal arrangements for Malays and Orang Asli. In recent years, Orang Asli advocates have been articulating their struggles over land rights by drawing upon transnational discourses concerning indigenous peoples. Recent judicial decisions concerning native title for the Orang Asli potentially disrupt ethno-nationalist assertions of the peninsula as belonging to the ,native' Malays. These contemporary contests in postcolonial identity formations unsettle hegemonic geopolitical ,race'/place narratives of Peninsular Malaysia. [source] How is geriatrics different from general internal medicine?GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 4 2004Thomas E Finucane Geriatrics and general internal medicine overlap greatly: most sick patients seen by a generalist are elderly and geriatricians care for nearly the full spectrum of diseases seen in internal medicine. Differences between the two disciplines can be seen in the areas of patient care, research and administration. As a group, geriatric patients are different from young adults because they are more likely to have multiple chronic illnesses, to depend on others, to be frail and to die in the near future. Each of these characteristics requires special knowledge on the part of the physician. The research agenda in geriatrics extends from attempts to find the molecular basis of sarcopenia and frailty to clinical research on the support of caregivers, who are themselves critically important to patients. In the US, nursing homes are required to have medical directors; this position is largely administrative and requires a distinct set of knowledge and attitudes. Clinical care, research and administrative efforts must all respond to the enormous number of patients who will develop cognitive impairment over the next three decades. Because the number of elderly patients so far exceeds the ability of geriatricians to provide care, education and ,geriatricizing' other specialties will also be an important mission for geriatricians. Proper reimbursement presents a serious challenge to physicians who care for the frail elderly. If geriatricians take care of the frailest, sickest and most vulnerable patients, but reimbursement mechanisms cannot recognize this fact, then all geriatricians will soon go bankrupt. [source] The Hidden Politics of Administrative Reform: Cutting French Civil Service Wages with a Low-Profile InstrumentGOVERNANCE, Issue 1 2007PHILIPPE BEZES The article addresses internal and hidden politics of changes in bureaucracies by focusing on the introduction and use of policy instruments as institutional change without radical or explicit shifts in administrative systems. Beneath public administrative reforms, it examines the use of "low-profile instruments" characterized by their technical and goal-oriented dimension but also by their low visibility to external actors due to the high complexity of their commensurating purpose and the automaticity of their use. The core case study of the paper offers a historical sociology of a technique for calculating the growth of the French civil service wage bill from the mid-1960s to the 2000s. The origins, uses, and institutionalisation of this method in the French context are explored to emphasize the important way of governing the bureaucracy at times of crisis through automatic, unobtrusive, incremental, and low-profile mechanisms. While insisting on the salience of techniques for calculating, measuring, classifying, and indexing in the contemporary art of government, it also suggests the need for observing and explaining "everyday forms of retrenchment" in bureaucracies. [source] Reshaping the State: Administrative Reform and New Public Management in FranceGOVERNANCE, Issue 4 2005ALISTAIR COLE This essay examines the administrative reform process in France since the late 1980s. The key reforms undertaken during this period have sought to delegate greater managerial autonomy to the ministerial field-service level. We undertook semistructured interviews with officials in the field services of three French ministries (Education, Agriculture, and Infrastructure) in the Champagne-Ardennes region, as well as with members of the wider policy communities. The capacity of the field services to adopt a proactive approach to management reform depended on five key variables: internal organizational dynamics; the attitude of the central services to mesolevel autonomy; the degree of institutional receptivity to change; the type of service delivery, and the extent of penetration in local networks. The Infrastructure Ministry was more receptive to management change than either Education or (especially) Agriculture, a receptivity that reflects the institutional diversity of the French administrative system, and that supports new institutionalist arguments. The essay rejects straightforward convergence to the New Policy Management norm. Changes in public management norms require either endogenous discursive shifts or else need to be interpreted in terms of domestic registers that are acceptable or understandable to those charged with implementing reform. [source] Between EU Requirements, Competitive Politics, and National Traditions: Re,creating Regions in the Accession Countries of Central and Eastern EuropeGOVERNANCE, Issue 4 2002Martin Brusis The article studies the impact of the European Union (EU) on the reforms of regional administration in Central and East European (CEE) accession countries. It analyzes the motives, process and outcomes of regional, or mesolevel administrative reforms in five countries,Bulgaria, the Czech Republic, Hungary, Poland, and Slovakia,considering whether the EU has shaped these reforms to a higher degree than in relation to its incumbent member states. The article finds that the EU Commission's interest in regional self,governments with a substantial fiscal and legal autonomy has provided an additional rationale and an incentive to re,create regional self,governments. Advocates of regional self,government and an institutionalization of regions in the accession countries have referred to European trends and (perceived) EU expectations of regionalization. Thus, the Commission and the preaccession framework have become catalysts for a process in which most CEE regions have already enhanced and will further increase their political salience. However, the trajectories and outcomes of regional,level reforms can be better explained by a combination of domestic institutional legacies, policy approaches of reformers and their adversaries, and the influence of ethnic/historical regionalism. [source] Administrative Reform: Changing Leadership Roles?GOVERNANCE, Issue 4 2001Tom Christensen Three interwoven change elements characterize New Public Management: substantial horizontal and vertical specialization, substituting an integrated sector model for a fragmented functional model, and extensive use of contracts as part of a "make the manager manage" kind of incentive system. This article discusses the effects and implications of these reform elements on political-democratic processes in general, and on political, administrative, and public enterprise leadership roles more specifically. Examples from Norway and New Zealand illustrate the discussion. [source] Centralization and Decentralization in Administration and Politics: Assessing Territorial Dimensions of Authority and PowerGOVERNANCE, Issue 1 2001Paul D. Hutchcroft Throughout the world, diverse countries are implementing programs of decentralization as a means of promoting both democratic and developmental objectives. Unfortunately, however, scholarship has yet to offer a comprehensive framework within which to assess and reform central-local relations. This article seeks to overcome the "division of labor" that has long separated analyses of administrative and political structures, and to provide stronger conceptual vocabulary for describing and analyzing the complexities of centralization and decentralization in both administration and politics. After developing two distinct continua of administrative and political centralization/decentralization, the paper then combines them in a single matrix able to highlight the wide range of strategies and outcomes that emerge from the complex interplay of the two spheres. Depending on where a country lies within the matrix, it is argued, strategies of decentralization may do more harm than good. Strategies of devolution are especially problematic in settings with strong local bosses, and should never be attempted without careful analysis of the preexisting character of central-local ties. [source] Governance Reform in Thailand: Questionable Assumptions, Uncertain OutcomesGOVERNANCE, Issue 3 2000Bidhya Bowornwathana This article examines the nature of governance reform in Thailand. The argument is that Thai citizens are not especially benefiting from the public reform initiatives of Thai governments because government reformers made fourquestionable assumptions about reform which have in turn produced uncertain outcomes and provided the opportunity for government reformers to avoid responsibility for their reform choices. First, the reformers support the belief that a global reform paradigm with ready-made reform packages exists which can be easily transplanted in the Thai public sector. Second, the reformers prefer to define success largely as reform output rather than reform outcomes or long term reform consequences. Third, Thai government reformers have overemphasized the efficiency aspects of the new public management at the expense of other governance goals. Fourth, governance reform in Thailand has been portrayed as a managerial problem instead of a political one. The author supports his arguments by drawing on theoretical debates in the international literature on administrative reform, and relating these debates to the Thai case. Governance reform in Thailand is still at an early stage, but the role of unintended consequences is important to administrative reform. Furthermore, the Thai case may reflect governance reform in other countries as well. [source] Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community-Based and Hospital Outpatient ClinicsHEALTH SERVICES RESEARCH, Issue 5p1 2010Chuan-Fen Liu Objective. To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. Data Sources/Study Setting. VA administrative and Medicare claims data from 2001 to 2004. Study Design. Retrospective cohort study of outpatient service use by 8,964 community-based and 6,556 hospital-based VA primary care patients. Principal Findings. A significant proportion of VA patients used Medicare-reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3,4 percent). Community-based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare-reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital-based patients. Community-based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare-reimbursed specialty care visits (p<.0001) than hospital-based patients, but no difference in total visits (p=.80). Conclusions. Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care. [source] Measuring the Quality of Diabetes Care Using Administrative Data: Is There Bias?HEALTH SERVICES RESEARCH, Issue 6p1 2003Nancy L. Keating Objectives. Health care organizations often measure processes of care using only administrative data. We assessed whether measuring processes of diabetes care using administrative data without medical record data is likely to underdetect compliance with accepted standards for certain groups of patients. Data Sources/Study Setting. Assessment of quality indicators during 1998 using administrative and medical records data for a cohort of 1,335 diabetic patients enrolled in three Minnesota health plans. Study Design. Cross-sectional retrospective study assessing hemoglobin A1c testing, LDL cholesterol testing, and retinopathy screening from the two data sources. Analyses examined whether patient or clinic characteristics were associated with underdetection of quality indicators when administrative data were not supplemented with medical record data. Data Collection/Extraction Methods. The health plans provided administrative data, and trained abstractors collected medical records data. Principal Findings. Quality indicators that would be identified if administrative data were supplemented with medical records data are often not identified using administrative data alone. In adjusted analyses, older patients were more likely to have hemoglobin A1c testing underdetected in administrative data (compared to patients <45 years, OR 2.95, 95 percent CI 1.09 to 7.96 for patients 65 to 74 years, and OR 4.20, 95 percent CI 1.81 to 9.77 for patients 75 years and older). Black patients were more likely than white patients to have retinopathy screening underdetected using administrative data (2.57, 95 percent CI 1.16 to 5.70). Patients in different health plans also differed in the likelihood of having quality indicators underdetected. Conclusions. Diabetes quality indicators may be underdetected more frequently for elderly and black patients and the physicians, clinics, and plans who care for such patients when quality measurement is based on administrative data alone. This suggests that providers who care for such patients may be disproportionately affected by public release of such data or by its use in determining the magnitude of financial incentives. [source] A spy on the payroll?HISTORICAL RESEARCH, Issue 220 2010William Herle, the mid Elizabethan polity A body of recent work focusing on the components of Tudor policy has drawn attention to those ,second-rank' figures crucial for the efficient running of the Elizabethan administration. After close archival excavation, men like Robert Beale, largely marginal to the historiography of the period for so long, have now been identified and credited with a role which was fundamental to the smooth operation of the Tudor political system. In this group of men, participating on the fringes of the polity and whose activities, whether clerical or more recondite, contributed to the formation of domestic and international policy, is found William Herle, an agent, diplomatic envoy and intelligencer for Elizabeth I's ministers. An elusive figure, and passed over by many scholars, Herle's epistolary contribution to the administrative and intelligence bureaux of William Cecil, Lord Burghley, Robert Dudley, earl of Leicester, and Sir Francis Walsingham reveals the information channels and structures behind the decision-making process of this triumvirate of political heavyweights and their conciliar fraternity. [source] Extending Gregory VII's ,Friendship Network': Social Contacts in Late Eleventh-Century FranceHISTORY, Issue 312 2008KRISTON R. RENNIE In the last quarter of the eleventh century, the Roman Church had a capable ruler and defender in Pope Gregory VII (1073,85). Despite his otherwise charismatic authority, however, Gregory's ability to extend his influence beyond the papacy's more immediate control of Rome and the Campagna was limited. Filling this administrative and legal gap was the emerging office of legation, developing ad hoc under Gregory VII in matters of reform and law. Papal legates such as the French representative, Bishop Hugh of Die (later archbishop of Lyons), became crucial figures in the machinery of papal government. They assumed a vital role in the transmission of reforming legislation north of the Alps while effectively widening Gregory VII's ,friendship network' to encompass influential members of the local and regional clerical and lay elite. With the assistance of this ecclesiastical office, moreover, the papacy significantly enhanced its opportunity for social contacts, thereby strengthening its hold on the more distant provinces of Western Christendom. By focusing on existing and growing social networks in late eleventh-century France, this article examines Hugh of Die's role as an instrument of church reform, and assesses this legate's impact on the larger papal reform initiative in France. [source] Are antidepressants warranted in the treatment of patients who present suicidal behavior?,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2008Michele Raja Abstract Objective The aim of the study was to ascertain the clinical course of patients admitted to a psychiatric intensive care unit (PICU) just after a suicide attempt (SA) and to evaluate the effectiveness of 2nd generation antipsychotics and mood stabilizers in these patients. Methods We examined all the 129 patients discharged in a three-year period, who had been admitted after a SA and considered in the analysis the 82 cases non-transferred (in the first 72 h) to other PICUs for administrative or logistic reasons. Among them, 47 received a complete neuropsychiatric assessment. We distinguished between patients who had been treated with Antidepressants (AD) or not in the three months preceding hospitalization. Results We treated all patients with mood stabilizers and 2nd generation antipsychotics. Only one patient was treated with AD in the course of current hospitalization. Both cases treated and not treated with AD before admission improved significantly, especially in symptoms of anxiety and depression, as well as in suicidality. The suicidal risk abated without AD treatment. Conclusions In patients with impending suicide risk, AD should not be considered standard treatment. Mood stabilizers and 2nd generation antipsychotics can be effective. Copyright © 2008 John Wiley & Sons, Ltd. [source] Perceived purposes of performance appraisal: Correlates of individual- and position-focused purposes on attitudinal outcomesHUMAN RESOURCE DEVELOPMENT QUARTERLY, Issue 3 2007Satoris S. Youngcourt Performance appraisals have traditionally been directed at individuals, serving either an administrative or developmental purpose. They may serve a role definition purpose as well. This study sought to identify and more broadly define the purposes of performance appraisals to include this role definition purpose. Furthermore, this study examined purposes of performance appraisals as perceived by the role incumbent, as opposed to the stated organizational purposes. The relationships between these perceived purposes with several attitudinal outcomes, including satisfaction with the performance appraisal, job satisfaction, affective commitment, and role ambiguity, are reported. Data from 599 retail service employees were used to test the hypothesized relationships. Results suggested support for a model consisting of three performance appraisal purposes having differential relationships with the outcomes examined, suggesting the purpose of the performance appraisal may influence ratees' perceptions of and attitudes toward their jobs. [source] | ||||||||||||||||||||||||||||