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Competing Goals (competing + goal)
Selected AbstractsThe Impact of Competing Goals, Experience, and Litigation Consciousness on Auditors' JudgmentsINTERNATIONAL JOURNAL OF AUDITING, Issue 3 2009Stephen K. Asare This study uses an experiment to examine the interactive effect of goals and experience on auditors' inventory write-off assessments and the role of litigation consciousness in mediating this effect. We find that when presented with a competing compliance and client relations goal, more experienced auditors were more likely to recommend an inventory write-off than less experienced auditors. However, when presented with only a compliance goal, auditors were equally likely to recommend an inventory write-off. The finding that less experienced auditors are more influenced by client relations goals suggests that the early socialization into the profession may be dominated by client relations concerns rather than litigation concerns. Mediation results suggest that auditors' litigation consciousness is a significant mechanism which helps drive the interactive effect of goals and experience on auditors' inventory write-off assessments. Implications for research, practice, and regulation are discussed. [source] The role of user charges and structural attributes of quality on the use of maternal health services in MoroccoINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2005David R. Hotchkiss Abstract Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households. Copyright © 2005 John Wiley & Sons, Ltd. [source] Balancing the Need to Develop Coastal Areas with the Desire for an Ecologically Functioning Coastal Environment: Is Net Ecosystem Improvement Possible?RESTORATION ECOLOGY, Issue 1 2005R.M. Thom Abstract The global human population is growing exponentially, close to a majority lives and works near the coast, and coastal commerce and development are critical to the economies of many nations. Hence, coastal areas will continue to be a major focus of development and economic activity. People desire the economic advantages provided by coastal development along with the fisheries and social commodities supported by estuarine and coastal ecosystems. Because of these facts, we view the challenge of balancing coastal development with enhancing nearshore marine and estuarine ecosystems (i.e., net ecosystem improvement) as the top priority for coastal researchers in this century. Our restoration research in Pacific Northwest estuaries and participation in nearshore project design and impact mitigation has largely dealt with these competing goals. To this end, we have applied conceptual models, comprehensive assessment methods, and principles of restoration ecology, conservation biology, and adaptive management to incorporate science into decisions about uses of estuarine systems. Case studies of Bainbridge Island and the Columbia River demonstrate the use of objective, defensible methods to prioritize tidally influenced shorelines and habitats (i.e., riparian forests, marshes, unvegetated flats, rocky shores, seagrass meadows, kelp forests) for preservation, conservation, and restoration. Case studies of Clinton, Washington, and Port Townsend, Washington, demonstrate the incorporation of an ecological perspective and technological solutions into design of overwater structures to minimize impacts on nearshore ecosystems. Adaptive management has allowed coastal development and restoration uncertainties to be better evaluated, with the information used to improve management decisions. Although unproven on a large scale, we think these kinds of methods can contribute to the net improvement of already degraded ecosystems. The ingredients include applied science to understand the issues, education, incentives, empirical data, cumulative impact analysis, and an effective adaptive management program. Because the option of net ecosystem improvement is often more costly than alternatives such as no net loss, commitment by the local or regional community to this approach is essential. [source] Effect of Trainees on Length of Stay in the Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 9 2009Catherine James MD Abstract Background:, Emergency departments (EDs) in teaching hospitals have competing goals of timely patient care and supervised trainee education. Previous investigations have indicated that trainees add time to the length of ED patient encounters. However, no studies have quantified the effect of trainees on pediatric ED length of stay (LOS). Objectives:, The objectives were to measure the effect of trainees on pediatric ED LOS by comparing LOS for patients managed by a pediatric emergency physician (PEP) alone to LOS for patients seen by a trainee and a precepting PEP (Trainee+PEP). A secondary objective was to identify factors other than provider type associated with LOS differences observed in teaching hospital pediatric EDs. Methods:, Data were extracted from a computerized ED tracking system in an urban tertiary care children's hospital with approximately 52,000 visits annually. All patients were seen by a PEP alone, an urgent care physician, or a trainee (a pediatric emergency medicine fellow; a pediatric, emergency medicine, or combined internal medicine/pediatrics resident; or a medical student) plus a precepting PEP. The primary comparison was the ratio of median LOS for the PEP group versus the Trainee+PEP group. Results:, There were 92,193 visits eligible for inclusion over a 2-year period. Median patient age was 5.75 years (interquartile range [IQR] = 21 months to 12.9 years). The PEP group managed 9,141 patients (10%), while the Trainee+PEP group treated 72,135 patients (78%). Overall LOS for an ED visit was 221 minutes. The median LOS was 192 minutes for PEP patients and 225 minutes for Trainee+PEP patients (difference of means = 17%, p < 0.001). Laboratory and imaging studies were associated with LOS increases of 111 and 74 minutes, respectively; both were performed more frequently in Trainee+PEP patients (44% vs. 33% for laboratory studies and 41% vs. 39% for imaging studies, both comparisons p < 0.001). When LOS was analyzed after adjusting for confounding factors including patient acuity, laboratory or radiologic testing, and trainee year, LOS for Trainee+PEP was higher by 17 minutes, or 9% (95% confidence interval [CI] = 6% to 12%, p < 0.001). When LOS was examined for four specific diagnoses (asthma, gastroenteritis, appendicitis, foot/ankle sprain), there were no significant differences in LOS between the PEP and Trainee+PEP groups. Conclusions:, In the pediatric ED of a teaching hospital, ED LOS is on average 9% higher in patients seen by trainees. In an era of increasing efforts to accelerate throughput while training future providers, these findings provide an important metric for the delivery of pediatric emergency care. [source] | ||||||||||