Role of Individual Motivations and Privacy Concerns in the Adoption of German Electronic Patient Record Apps—A Mixed-Methods Study

Germany’s electronic patient record (“ePA”) launched in 2021 with several attempts and years of delay. The development of such a large-scale project is a complex task, and so is its adoption. Individual attitudes towards an electronic health record are crucial, as individuals can reject opting-in to it and making any national efforts unachievable. Although the integration of an electronic health record serves potential benefits, it also constitutes risks for an individual’s privacy. With a mixed-methods study design, this work provides evidence that different types of motivations and contextual privacy antecedents affect usage intentions towards the ePA. Most significantly, individual motivations stemming from feelings of volition or external mandates positively affect ePA adoption, although internal incentives are more powerful.

How Can Implementation of a Large-Scale Patient Safety Program Strengthen Hospital Safety Culture? Lessons From a Qualitative Study of National Patient Safety Program Implementation in Two Public Hospitals in Brazil

Large-scale (e.g., national) programs could strengthen safety culture, which is foundational to patient safety, yet we know little about how to optimize this potential. In 2013, Brazil’s Ministry of Health launched the National Patient Safety Program, involving hospital-level safety teams and targeted safety protocols. We conducted in-depth qualitative case studies of National Patient Safety Program implementation in two hospitals, with different readiness, to understand how program implementation affected enabling, enacting, and elaborating processes that produce and sustain safety culture. For both hospitals, external mandates were insufficient for enabling hospital-level action. Internal enabling failures (e.g., little safety-relevant senior leadership) hindered enactment (e.g., safety teams unable to institute plans). Limited enactment and weak elaboration processes (e.g., bureaucratic monitoring) failed to institutionalize protocol use and undermined safety culture. Optimizing the safety culture impact of large-scale programs requires effective multi-level enabling and capitalizing on the productive potential of interacting national- and local-level influences.

We’re Not Like Those Crazy Hippies: The Dynamics of Jurisdictional Drift in Externally Mandated Occupational Groups

External actors often advocate for organizations to address a wide range of societal concerns, such as diversity, equality, and sustainability, and organizations have frequently responded by establishing new positions to oversee these demands. However, calls to address social problems can be broad and unrelated to an organization’s primary objectives, so the external mandates that underpin these new positions do not easily translate to clear task jurisdictions inside organizations. Furthermore, previous studies have found that the tasks that are pursued by occupations established through external pressure often diverge from what external groups had envisioned for these new roles. This study addresses the question of why this divergence occurs. It does so by examining the formation of the occupational group of sustainability managers in higher education. Through fieldwork, interviews, and analyses of longitudinal archival data, this paper uncovers the dynamics of jurisdictional drift and shows how jurisdictional drift unfolded first through sustainability managers’ confrontation of their jurisdictional ambiguity, and then through their efforts at performing neutrality, in particular by trading external Politics for internal politics and trading values for standards. Additionally, it uncovers how the sustainability managers attempted to partially realign their jurisdiction with their external mandate, but did so in a concealed manner. This study illuminates the process of how jurisdictions can come to drift away from mandates, highlights the importance of studying how mandates are translated into jurisdictions, and also furthers our understanding of the formation of externally mandated occupational groups.

Du Projet européen à l’Europe des projets: Soixante ans de présence et d’influence françaises à la Banque européenne d’investissement (1958-2018)

This article aims to better define the vectors as well as the objectives of French influence at the European Investment Bank (EIB), a European institution created in 1957 which annually mobilises a volume of funding equivalent to the Commission’s budget. For the main part, French influence was exercised individually, through the French members of the Management Committee as well as the French managers of the Bank, in a context where the French Ministry of Finance, which represents the French government at the Bank’s governing bodies, is sometimes reluctant, often inactive, and exceptionally proactive on new initiatives. Based on visions, models and experiences in which France retained a comparative advantage, this influencewas instrumental in the promotion of key policies in three areas: EIB finances and the promotion of a common currency, the financing of small and medium-sized enterprises and innovation and external mandates (Mediterranean and ACP States in particular). Over the past twenty years, successive enlargements, the erosion of France's comparative advantages and the decline of its linguistic and cultural influence have precipitated, as in the European Commission, the loss of an influence which had really started in the mid-1970s.

Comply, Embrace, Cope, Countercrusade, Subvert: Teach For America Corps Members Respond to (Internal) and External Mandates

In this empirical, qualitative study, Teach For America (TFA) corps member teachers’ lives are examined through the lens of George Posner’s seven “frame factors,” namely, (a) temporal, (b) physical, (c) cultural, (d) economic, (e) organizational, (f) political-legal, and (g) personal, which offer insight into the contextualized TFA experience from induction at Corps Training Institute (CTI) through the 2-year TFA teaching commitment. Hundreds of corps member responses to these frame factors and external mandates were coded and analyzed, using unpublished categories developed by Barone, with particular attention to the developmental time line of one’s educational platform on TFAers’ professional practice.

Evaluation of Tobacco Control Policies in San Francisco Homeless Housing Programs

Background. The 2014 Surgeon General’s Report noted that high smoking rates in vulnerable populations such as the homeless have been a persistent public health problem; smoking prevalence among individuals experiencing homelessness exceeds 70%. Historically, service providers for the homeless have not enacted comprehensive tobacco control policies. Method. We conducted a qualitative study of homeless housing programs in San Francisco. Administrators representing 9 of the city’s 11 homeless service agencies were interviewed to assess institutional smoking-related policies and cessation programs and perceived barriers and receptivity to instituting tobacco control interventions. Results. Respondents indicated that although most programs had adopted smoke-free grounds and some had eliminated evidence of staff smoking, the smoking status of clients was assessed only when required by funders. None of the programs offered smoking cessation interventions. Most administrators were receptive to adopting policies that would promote a tobacco-free culture; however, they noted that their clients had unique challenges that made traditional smoking cessation programs unfeasible. Conclusions. Homeless housing programs in San Francisco have not yet adopted a tobacco-free culture. Existing policies were created in response to external mandates, and smoking cessation programs may need to be modified in order to effectively reach clients.

Implementing a Multifaceted Quality-Improvement Curriculum in an Obstetrics-Gynecology Resident Continuity-Clinic Setting: A 4-Year Experience

Background Although many residency programs are instituting quality improvement (QI) curricula in response to both institutional and external mandates, there are few reports of successful integration of resident initiated projects into these QI curricula with documented impact on health care processes and measures. Intervention We introduced a multifaceted curriculum into an Obstetrics-Gynecology continuity clinic. Following a needs assessment, we developed a didactic session to introduce residents to QI tools and the how to of a mentored resident-initiated project. Resident projects were presented to peers and faculty and were evaluated. A postgraduation survey assessed residents' satisfaction with the curriculum and preparedness for involvement in QI initiatives after residency. We also assessed whether this resulted in sustained improvement in health care measures. Results The curriculum was presented to 7 classes of residents (n = 25) and 17 resident initiated projects have been completed. Twenty-one residents (84%) completed the preintervention survey and 12 of 17 (71%) residents who completed the entire curriculum completed the postintervention survey. Sustained change in surrogate health measures was documented for 4 projects focused on improving clinical measures, and improvement in clinical systems was sustained in 9 of the remaining 13 projects (69%). Most of the respondents (75%, n = 9) agreed or strongly agreed that the projects done in residency provided a helpful foundation to their current QI efforts. Conclusion This project successfully demonstrates that a multifaceted program in QI education can be implemented in a busy Obstetrics-Gynecology residency program, resulting in sustained improvement in surrogate health measures and in clinical systems. A longitudinal model for resident projects results in an opportunity for reflection, project revision, and a maintenance plan for continued clinical impact.

Technology Supported Systems in Scde: Myth Versus Reality

The College of Education Assessment Infrastructure Survey was developed and administered to 1011 institutions over a 12-month period ending April 2007. The survey examined the capacity of university-based teacher preparation programs to respond to the growing and increasingly complex data management requirements that accompanies assessment and accountability edicts. The summarized responses of 266 institutions (26%) confirmed that education units have responded to accreditation and accountability mandates, though none have relied solely on the institutional-level infrastructure. This has resulted in the implementation of a variety of assessment systems that vary widely in sophistication and cost. The qualitative responses of 52 institutions highlighted the major benefits and challenges encountered with the implementation and use of these assessment systems. The dominant 3 benefits reported were improved communication with internal and external stakeholders, data-supported program improvements, and data-supported assessment improvements. The top 3 reported challenges were responding to increasing and complex assessment requirements coupled with inadequate resources, inadequate assessment systems, and the loss of professionalism that comes with responding to external mandates.