Pharmacy Benefit Managers (PBM) induce drug manufacturers to offer rebates to insurers and employers by denying coverage through formulary exclusions, impeding physician prescription through prior authorization, and reducing patient drug use through cost sharing. As they tighten these access obstacles, PBMs reduce the net prices received by the manufacturers.

Recently, Congress has focused on reforms to address pharmacy benefit managers’ (PBMs) role in high drug prices for patients. Congress must not excessively restrict PBMs’ ability to negotiate with manufacturers; alternatively, reforms could be paired with other policies that address the high prices of brand-name drugs.

A lack of transparency and concerns over patients costs at the pharmacy counter have increased Congressional focus on pharmacy benefits management practices. However, applying regulations without transparency into pharmacy benefits managers practices could do more harm than good.

Every pharmacist, aware or not, is constantly making ethical choices. Sometimes these choices are dramatic, life-and-death decisions, but often they will be more subtle, less conspicuous choices that are nonetheless important. Assisted suicide, conscientious refusal, pain management, equitable and efficacious distribution of drug resources within institutions and managed care plans, confidentiality, and alternative and non-traditional therapies are among the issues that are of unique concern to pharmacists. One way of seeing the implications of such issues and the moral choices they (...) pose is to look at the experiences of practitioners and the kinds of choices they have had to make in situations typically faced by pharmacists. This book is a collection of those situations based on the real experiences of practicing pharmacists. The use of case studies in health care ethics is not new, but in pharmacy it is. This text is an important teaching tool that will help pharmacy students and pharmacists address the increasing number of ethical problems arising in their profession. It is not merely a compilation of cases, but rather is organized for the systematic study of applied ethics. Part I shows how to distinguish ethical problems from other kinds of evaluative judgments and examines the sources of values in pharmacy, posing basic questions about the meaning and justification of ethical claims. Part II explores the basic principles of ethics as they have an impact on pharmacy. Specific cases from clinical settings present in a systematic way the various questions raised by each of the major ethical principles -- benefiting the patient, distributing resources justly, respecting autonomy, dealing honestly with patients, keeping promises of confidentiality, and avoiding harm. Part II examines some of the special problems of contemporary pharmacy such as the linkages between pharmaceutical care and professional practice, human experimentation, reproductive issues, genetic technology, death and dying, and mental health. (shrink)

Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within (...) healthcare organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

ArgumentIn this article I describe the establishment and early development of an institution that is unique to the history of Chinese medicine – the Imperial Pharmacy (惠 民 藥 局). Established in 1076 during the great reforms of the Song dynasty, the Imperial Pharmacy was a remarkable institution that played different political, social, economic, and medical roles over the years of its existence. Initially it was an economic institution designed to curb the power of plutocrats who were manipulating (...) medicinal drug markets in their favor. A few decades later, I claim, the Imperial Pharmacy became a public-health-oriented institution focusing on selling readymade prescriptions in addition to simples. Various records, including local gazetteers and local maps, indicate that the Imperial Pharmacy expanded about a century after it was established to include dozens of branches throughout the empire. The Pharmacy's impact on the practices of physicians during these years is somewhat vague. It seems, however, to have posed an unwelcome addition to the medical scene, since it enabled uninitiated practitioners who relied on the Pharmacy's formulary to fit patients' symptoms to their own prescriptions and dispense medications with relative ease. (shrink)

Promoting Farmer Managed Natural Regeneration (FMNR) aims to increase the productive capacities of farmer households. Under FMNR, farmers select and manage natural regeneration on farmlands and keep them under production. While FMNR contributes to the wealth of farming communities, its contribution to household food security has rarely been researched. We, therefore, used a mixed-methods approach to address the research gap by measuring FMNR’s contribution to food security among farmer households in the Talensi district of Ghana. We adopted the Household Dietary (...) Diversity Score (HDDS) and Food Consumption Score (FCS) to estimate food security status among 243 FMNR farmer households and 243 non-FMNR farmer households. Also, we performed a Chi-square test of independence to compare the frequency of each food group (present vs not present) between FMNR adopters and non-FMNR adopters to establish the relationship between adopting FMNR and consuming the FCS and HDDS food groups. Our results reveal that FMNR farmer households are more food secure than non-FMNR farmer households. The HHDS of the FMNR farmer households was 9.6, which is higher than the target value of 9.1. Conversely, the HHDS of the non-FMNR farmer households was 4.3, which is lower than the target value of 9.1. Up to 86% and 37% of the FMNR farmer households and non-FMNR farmer households fell within acceptable FCS; 15% and 17% of FMNR farmer households and non-FMNR farmer households fell within borderline FCS. While none of the FMNR farmer households fell within poor FCS, 46% of non-FMNR farmer households fell within poor FCS. Adopting FMNR is significantly related to consuming all food groups promoted and benefiting from FMNR practices. The paper recommends enabling farmers in semi-arid environments to practice and invest in FMNR for long-term returns to food security. (shrink)

The aim of this research is to investigate the mediating role of relationship quality in the relationship between relational benefits and customer citizenship behavior. Data were gathered through a systematic sampling from 334 passengers. A Survey technique was used to collect the data from respondents from multiple airports. Data were analyzed through partial least square structural equation modeling using SmartPLS 3.3. The results of the study reveal that altruistic benefits, confidence, and self-expression benefits have a positive relationship with relationship quality (...) while socialization benefits have a non-significant relationship with relationship quality. Similarly, relationship quality mediates the relationship between altruistic benefits, confidence and self-expression benefits, and customer citizenship behavior while relationship quality does not mediate the relationship between socialization benefits and customer citizenship behavior. This study uncovers the relational benefits and its role in the generation of customer citizenship behavior in the aviation sector and the role of relationship quality that could help managers to cultivate the benefits of customer citizenship behaviors. (shrink)

This article analyses whether benefits arising for human resource management from environmental management activities drive environmental management system implementation. Focusing on employee satisfaction and recruitment/retention, it tests this for German manufacturing firms in 2001 and 2006 and incorporates a rare longitudinal element into the analysis. It confirms positive associations of the benefit levels for both variables with environmental management system implementation on a large scale. Also it provides evidence that increasing levels of environmental management system implementation result from higher (...) economic benefits in the human resource domain. In doing so the article supplies needed quantitative evidence on important aspects of how sustainability relates to human resource management. (shrink)

Drawing on ethical principles of fairness and integrative social contracts theory, moral obligations of fair dealing exist between the firm and all shareholders. This study investigates empirically whether privileged investors of publicly traded firms engage in legal, but morally questionable, trading that at the expense of non-privileged institutional or atomistic investors. In this context, we define privilege as the access to material, nonpublic earnings surprise information. Our results show that the opportunity for procedural unfairness increases with the presence of privileged (...) investors. However, this procedural unfairness does not appear to lead to distributive unfairness even though the level of abnormal trading also increases with the presence of privileged investors. That is, our findings suggest that other shareholders are in fact better off from an outcome perspective given that the abnormal stock price returns upon the announcement of an earnings surprise are either more positive or less negative when the firm has a high proportion of privileged investors. We extract the important implications of our study for future research on the fairness of capital markets and information asymmetry amongst classes of investors, as well as for public policy. (shrink)

Using private benefits of control and earnings management data from 41 countries and regions, we provide strong evidence that cultures, together with legal rules and law enforcement, play a critical role in shaping corporate behavior. More specifically, we find that private benefits of control are larger and earnings management is more severe in collectivist as opposed to individualist cultures, consistent with the argument that agency problems between corporate insiders and outside investors are severe in collectivist culture. These results are robust (...) to the inclusion of controls for country wealth, economic heterogeneity across countries, and international differences in ownership concentration. (shrink)

Does being green facilitate product innovation? This study examines whether green management in firms operating in China fosters radical product innovation to a greater extent than it does incremental product innovation and investigates the underlying institutional mechanisms involved in the relationship between green management and product innovation. The findings show that green management is more likely to lead to radical product innovation than to incremental product innovation. Moreover, government support as a formal institutional benefit more strongly mediates the effect (...) of green management on radical product innovation than its effect on incremental product innovation; whereas social legitimacy as an informal institutional benefit more strongly mediates the effect of green management on incremental product innovation than its effect on radical product innovation. These findings provide important implications for explaining how firms employ green management to facilitate product innovation. (shrink)

According to the broaden-and-build theory of positive emotions, the frequency of positive emotions is associated with the development of positive attitudes, cognitions, and behaviors in organizational contexts. However, positive and negative attitudes at work might also be influenced by different personal and job resources. While emotional intelligence has been significantly associated with positive job attitudes and personal well-being, no studies have yet examined the joint role of teacher happiness and emotional intelligence in key teacher job attitudes. The present study assesses (...) whether emotional intelligence interacts with levels of teacher happiness to jointly explain important teacher job attitudes. A total sample of 685 teaching professionals filled out a battery of scales including subjective happiness, emotional intelligence, job satisfaction, and turnover intention. Our results revealed that subjective happiness was significantly associated with both higher job satisfaction and lower turnover intention. Likewise, emotional intelligence was positively related to happiness and job satisfaction, and negatively related to turnover intention. Finally, interaction analysis showed the main effects of happiness and emotional intelligence in explaining teacher job attitudes. Beyond the main effects, the interaction effects of happiness and emotional intelligence were significant in predicting all teachers' job attitude indicators, even controlling for the effects of their sociodemographic variables. This work expands our knowledge about the role of teachers' positive emotions in the development of positive work attitudes, and also supports the inclusion of emotional skills in future teacher preparation programs as resources to facilitate work-related well-being. (shrink)

Diabetes self-management is a crucial part in the management of diabetic patients. Most randomized controlled clinical trials reported significant benefits by diabetes self-management education on DSM behaviors and metabolic control. Although the randomized clinical trials are the gold standard method in assessing the effectiveness of any intervention, including DSME interventions, the outcomes of these studies may reflect exaggerated effects; because in most of these studies, subjects in control group receive usual care with no any DSME. The lack of such education (...) in the control group had many drawbacks: make blindness impossible; at which non blinded studies may result in false-positive findings; it may be unethical to recruit patients for participation in DSME studies as control subjects, most of these studies with long periods of follow up, without any direct benefit to them during the study period; the lack of direct benefit to control subjects in any clinical trial may results in high attrition rate. The high attrition rate in clinical trials especially in the control group can lower the statistical power of the study results; thus, the DSME program would appear to have positive effects even if the program had no real benefit. This problem of the DSME exaggerated effects can be solved partially through providing control subjects with education about some DSM behaviors or comparing the effect of DSME through different educational approaches. (shrink)

Leah Andress,1 Anjali Gupta,2 Nida Siddiqi,3 Kwaku Marfo2,3 1University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, 2Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine Department of Abdominal Organ Transplant Program, Bronx, 3Montefiore Medical Center, Department of Pharmacy, Bronx, NY, USA: Rabbit anti-thymocyte globulin has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates (...) of complications such as infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation. Keywords: anti-thymocyte globulin, renal transplantation, induction therapy. (shrink)

The Problem Economic efficiency is naturally thought to be a virtue of social policies and decisions, and cost-benefit analysis is commonly regarded as a technique for measuring economic efficiency. It is not surprising, then, that CB analysis is so widely used in social policy analysis. However, there is a great deal of controversy about CB analysis, including controversy about its underlying philosophical rationale. The rationales that have been proposed fall into three basic, though not mutually exclusive categories. There are (...) moralist views to the effect that an acceptable CB analysis would provide, or contribute to, an ethical appraisal of proposed policies or projects. There are rationalist views to the effect that an acceptable CB analysis would contribute to the selection of social policies and projects that are “socially rational.” Finally, there are so-called management science views to the effect that the purpose of CB analysis is to promote the achievement of objectives held by the policy maker, whatever they may be. Different positions are available within each of these categories. But there is also the possibility that CB analysis lacks any viable rationale. I will examine some of the major rationales for CB analysis in this paper, and I will suggest that the last view is close to the truth. (shrink)

Cultural heritage management is essential for protecting the historical and cultural significance of sites while contributing to economic growth. This study's objective is to ascertain and evaluate modern management techniques for heritage sites that maximize economic benefits while ensuring sustainable protection. It seeks to discover methods that effectively stabilize heritage conservation with economic development goals. This study investigates the relationship between Economic benefits, Cultural preservation, Public Engagement, Community Impact, Sustainability of Management Practices, and Innovative approaches to managing cultural heritage utilizing (...) Partial Least Squares Structural Equation Modeling (PLS-SEM). A systematic questionnaire with a Likert scale rating was used to collect data from 450 populations. The measurement model assessed the validity and reliability of latent constructs, while the structural model analyzed the relationship between constructs based on the proposed hypotheses. The structural model revealed that EB, CP, and SMP are positively connected to the IMCH, between cultural heritages for economic benefit. (β = 0.55,0.50,and 0.56,p < 0.05), providing well support for hypothesis 1, 2, and 5. The result shows there are no significant changes to managing cultural heritage for economic benefit. (shrink)

Patient-centered pharmacy practice involves increased pharmacist engagement in patient care. This increased involvement can sometimes require diverse decision-making when handling various situations, ranging from simple matters to major ethical dilemmas. There is literature about pharmacy ethics in developed Western countries. However, little is known about pharmacists’ practices in many developing countries. For example, there is a paucity of research conducted in the area of pharmacy ethics in Jordan. This study aimed to explore the manner in which ethical (...) dilemmas were handled by Jordanian pharmacists, the resources used and their attitudes towards them. Semi-structured, face to face interviews were carried out with 30 Jordanian registered pharmacists. The transcribed interviews were thematically analysed for emerging themes. Four major themes were identified: legal practice; familiarity with the code of ethics; personal judgement, cultural and religious values; and Experience. Findings showed that ethical decision-making in pharmacy practice in Jordan was decisively influenced by pharmacists’ personal moral values, legal requirements and managed by exercising common sense and experience. This pointed to gaps in Jordanian pharmacists’ understanding and application of basic principles of pharmacy ethics and highlighted the need for professional ethics training, incorporating pharmacy ethics courses in pharmacy undergraduate curricula, as well as professional development courses. This study highlighted that paternalism, personal values and legal obligations were major drivers influencing decision-making processes of Jordanian pharmacists. Findings also highlighted an inclination towards lack of respect for patient autonomy. This illuminated the need for increasing pharmacists’ literacy in professional ethics. (shrink)

– Pharmacy sales of over‐the‐counter medicines in the UK represent an economically significant and important mechanism by which customers self‐medicate. Sales are supervised in pharmacies, but this paper seeks to question whether patients' electronic health records – due to be introduced nationally – could be used, ethically, by pharmacists to ensure safe medicines sales., – Using theoretical arguments, three areas of ethical concern are identified and explored in relation to pharmacists' access to EHRs‐consequentialsim, analogies and confidentiality/privacy., – Consequentialist arguments (...) include positive benefits to customer's welfare and control of medicine of abuse, but negative economic healthcare burdens and consequences due to potentially increased or paradoxically, decreased presentation of patients to doctors. Socially accepted analogous practices – credit checks, existing pharmacy access to information and hospital treatment – are then argued to be ethically relevant and supportive of access. Privacy and confidentiality are then considered as reasons not to allow EHR access. A contrasting view is that pharmacy access to EHRs is another form of surveillance and hence the question of pharmacists' assess to EHRs may be answered negatively by empirical research that locates pharmacy customers as expert users and identifies confidentiality and privacy concerns about information technology in healthcare more generally., – This paper offers a unique and valuable contribution to the debate about healthcare professionals' role‐based access to patients' medical records and offers a reflection on the ethical concerns surrounding patient information and the rival concerns of patient qua customer autonomy and safety. (shrink)

The text presents the results of a survey among 58 owners or managers of commercial companies that have sustainably implemented an environmental management system through their ISO 14001 certification. The study of management representatives is based on the understanding that business organizations play the role of intermediaries in environmental policy and the potential change of their behavior multiplies the effects of the interventions on the behavior of others - business partners, employees, and consumers. The data can be used to explain (...) the real processes of pro-environmental policies in the country and improve them taking into account the established barriers and obstacles to the pro-environmental behavior of the studied group. (shrink)

Positive reappraisal strategies have been found to reduce negative affect following the recall of negative personal events. This study examined the restorative effect of two mood-repair instructions (self-compassion vs benefit-focused reappraisal) and a control condition with no instructions following a negative Mood Induction Procedure by using the guided recall of a negative autobiographical event. A total of 112 university students participated in the online study (81% women, Mage: 21.0 years). Immediately following the negative memory recall, participants were randomised to (...) each condition [(self-compassion: n = 36, benefit-focused: n = 39) or a control condition (n = 37)]. Repeated measures ANOVAs 3 (Repair condition) × 3 (Time of mood assessment: pre-recall, post-recall, post-regulation) showed that, as expected, negative mood (sadness, shame, and guilt) worsened significantly after the guided recall in all groups (p <.001). After the mood-repair intervention, participants in the self-compassion and benefit-focused conditions showed a significant reduction in negative mood (p <.019), while such improvement was not observed in the control group. Self-compassion and benefit-focused reappraisal functioned similarly as mood repair strategies after experiencing negative affect induced by the recall of negative personal memories. Implications in the context of autobiographical memory biases are discussed. (shrink)

Strategic management is now essential in the ever-changing digital media ecosystem to fully use creative content ideas. Focussing on how strategic management has driven innovation, this research study traces the development of content strategies in the digital media business. Successful content production methods are identified by analysing significant trends, technology, and business models in the research. Content creation and delivery have been revolutionised by digital platforms, data analytics, and audience interaction strategies. This study delves into these changes. In order to (...) provide light on best practices and new initiatives, it also analyses case studies of prominent digital media firms. According to the results, companies that want to stay competitive and successfully engage audiences in the digital age need to have a proactive and adaptable strategy management approach. Policymakers, academics, and professionals in the digital media sector may all benefit from this study's findings by better comprehending the factors that drive content creation and strategic management. (shrink)

This article addresses a set of exploratory questions related to emergency contraception and the right to refuse to dispense such drugs. The paper first address the roles of the pharmacist in American society, i.e., as professional, employee, and business owner, and the pharmacists's identity and belief system; second, the paper reviews the status of state law and proposed legislation concerning patient/consumer access to emergency contraceptives; third, it offers an in-depth stakeholder analysis of the ethical and legal responsibilities of pharmacies to (...) stakeholders; and fourth, the paper provides overview of the salient ethical and legal issues concerning patient/customer access to emergency contraceptives relevant to management. The conclusions discuss questions for further research as well as strategic/human policy recommendations that balances the economic, legal, and ethical concerns of all primary stakeholders of the company/business, such as designing a management system which refers customers in a timely fashion; recognizing "conscience clauses," while ensuring that pharmacists "do no harm" to the consumer; and disseminating management "best practices" on "conscience clauses" through joint professional/industry sponsorship. (shrink)

BackgroundAs opioid use disorder (OUD) incidence and its associated deaths continue to persist at elevated rates, the development of novel treatment modalities is warranted. Recent strides in this therapeutic area include novel anti-opioid vaccine approaches. This work compares logistical and ethical considerations surrounding currently available interventions for opioid use disorder with an anti-opioid vaccine approach.MethodsThe opinions of student pharmacists and practicing pharmacists assessing knowledge, perceptions, and attitudes toward current and future OUD management strategies were characterized using a staged, multi-modal research (...) approach incorporating a focus group, pilot survey development and refinement, and final survey deployment. Survey responses were assessed using one- and two-way parametric and non-parametric analyses where appropriate, and multi-dimensional matrix profiles were compared using z-tests following an exhaustive combinatorial sum of differences calculation between items within each compared matrix.ResultsFocus group content analysis revealed a high level of agreeableness among participants regarding anti-opioid vaccine technology and a sense of shared ownership regarding solutions to the opioid epidemic at large. Pilot survey results demonstrated subject ability to consider both pragmatic and ethical considerations related to current therapeutics and novel interventions in a single instrument, with high endurance amongst engaged subjects. Access inequality was the most concerning ethical consideration identified for anti-opioid vaccines. Support for anti-opioid vaccine implementation across various clinical scenarios was strongest for voluntary use amongst individuals in recovery, and lowest for mandatory use in at-risk individuals.ConclusionsEthical and logistical concerns surrounding anti-opioid vaccines were largely similar to those for current OUD therapeutics overall. Anti-opioid vaccines were endorsed as helpful potential additions to current OUD therapeutic approaches, particularly for voluntary use in the later stages of clinical progression. (shrink)

Managing integrity -- Identifying ethical and legal issues in the workplace -- Understanding decision making in the workplace -- Managing organizational culture for integrity -- Increasing legal pressure for ethical compliance -- Developing an effective organizational integrity program -- Implementing ethics and legal compliance training -- Managing integrity in a global economy -- Creating the good citizen organization -- Benefiting from best practices.

Social alliance is defined as the collaboration between for-profit and nonprofit organizations. Building on the insights derived from the resource-based theory, we develop a conceptual framework to explain how socially entrepreneurial nonprofit organizations can improve their social alliance performance by adopting strategic alliance management routines. We test our framework using the data collected from 203 UK-based SENPOs in the context of cause-related marketing campaign-derived social alliances. Our results confirm a positive relationship between social alliance management routines and social alliance performance. (...) We also find that relational mechanisms, such as mutual trust, relational embeddedness, and relational commitment, mediate the relationship between social alliance management routines and social alliance performance. Moreover, our findings suggest that different types of social alliance motivation can influence the impact of social alliance management routines on different types of the relational mechanisms. In general, we demonstrate that SENPOs can benefit from adopting social alliance management routines and, in addition, highlight how and when the social alliance management routines–social alliance performance relationship might be shaped. Our study offers important academic and managerial implications, and points out future research directions. (shrink)

Background: Nurse managers are expected to continuously ensure that ethical standards are met and to support healthcare workers’ ethical competence. Several studies have concluded that nurses across various healthcare settings lack the support needed to provide safe, compassionate and competent ethical care. Objective: The aim of this study was to explore and understand how nurse managers perceive their role in supporting their staff in conducting ethically sound care in nursing homes and home nursing care. Design and participants: Qualitative individual interviews (...) were performed with 10 nurse managers with human resources responsibilities for healthcare workers in four nursing home wards and six home nursing care districts. Content analysis was used to analyse the data. Ethical considerations: The Norwegian Centre for Research Data granted permission for this study. Findings: The analysis resulted in seven subcategories that were grouped into three main categories: managers’ perception of the importance of the role, managers’ experiences of exercising the role and managers’ opportunities to fulfil the role. Challenges with conceptualizing ethics were highlighted, as well as lack of applicable tools or time and varying motivation among employees. Discussion: The leaders tended to perceive ethics as a ‘personal matter’ and that the need for and benefit of ethical support (e.g., ethics reflection) depended on individuals’ vulnerability, attitudes, commitment and previous experiences. The managers did not seem to distinguish between their own responsibility to support ethical competence and the responsibility of the individual employee to provide ethical care. Conclusions: Our findings suggest that nurse managers need support themselves, both to understand and to carry out their responsibilities to foster their staffs’ ethical conduct. Supporting staff in conducting ethically sound care requires more than organizing meeting places for ethical reflection; it also requires greater awareness and understanding of what ethical leadership means. (shrink)

Background: There is general consensus internationally that unfair distribution of the benefits of research is exploitative and should be avoided or reduced. However, what constitutes fair benefits, and the exact nature of the benefits and their mode of provision can be strongly contested. Empirical studies have the potential to contribute viewpoints and experiences to debates and guidelines, but few have been conducted. We conducted a study to support the development of guidelines on benefits and payments for studies conducted by the (...) KEMRI-Wellcome Trust programme in Kilifi, Kenya. Methods: Following an initial broad based survey of cash, health services and other items being offered during research by all programme studies (n = 38 studies), interviews were held with research managers (n = 9), and with research staff involved in 8 purposively selected case studies (n = 30 interviewees). Interviews explored how these ‘benefits’ were selected and communicated, experiences with their administration, and recommendations for future guidelines. Data fed into a consultative workshop attended by 48 research staff and health managers, which was facilitated by an external ethicist.FindingsThe most commonly provided benefits were medical care (for example free care, and strengthened quality of care), and lunch or snacks. Most cash given to participants was reimbursement of transport costs (for example to meet appointments or facilitate use of services when unexpectedly sick), but these payments were often described by research participants as benefits. Challenges included: tensions within households and communities resulting from lack of clarity and agreement on who is eligible for benefits; suspicion regarding motivation for their provision; and confusion caused by differences between studies in types and levels of benefits. Conclusions: Research staff differed in their views on how benefits should be approached. Echoing elements of international benefit sharing and ancillary care debates, some research staff saw research as based on goodwill and partnership, and aimed to avoid costs to participants and a commercial relationship; while others sought to maximise participant benefits given the relative wealth of the institution and the multiple community needs. An emerging middle position was to strengthen collateral or indirect medical benefits to communities through collaborations with the Ministry of Health to support sustainability. (shrink)

The adoption of artificial intelligence (AI) in small and medium-sized enterprises (SMBs) has emerged as a key strategy for improving quality management. This article discusses the main benefits and challenges of implementing AI in this context. A systematic review of the academic literature and relevant business reports was carried out, in order to collect and analyze empirical evidence on the application of AI in the quality management of SMEs, obtaining as results that the main benefits of the implementation of AI (...) in the quality management of SMEs include: Improved data-driven decision-making, process automation and error reduction, early detection of quality issues, customization of products and services, and resource optimization and cost reduction. On the other hand, the main challenges were: Lack of knowledge and skills in AI, high implementation costs, concerns about data security and privacy, resistance to cultural change, and integration of AI with existing systems and processes, concluding that the implementation of AI in SMB quality management offers significant benefits, but it also entails challenges that must be addressed strategically. SMEs that manage to overcome these challenges will be able to take advantage of the competitive advantages offered by AI, improving their efficiency, quality and adaptability in an increasingly dynamic business environment. (shrink)

The study aimed to identify the knowledge management processes and their role in achieving competitive advantage at Al-Quds Open University. The study was based on the descriptive analytical method, and the study population consists of academic and administrative staff in each of the branches of Al-Quds Open University in (Tulkarm, Nablus and Jenin). The researchers selected a sample of the study population by the intentional non-probability method, the size of (70) employees. A questionnaire was prepared and supervised by a number (...) of specialists in order to obtain the results of the study. The study concluded that there is a positive direct relationship, that is, the higher the degree of application of knowledge management processes, the greater the degree of competitive advantage. Knowledge Technology came first with a score of 80.02% on all items. Competitive advantage came second with 81.74%. In the third place came "knowledge generation" where the total score on all paragraphs in this area (78.24%). In the fourth place, "knowledge transfer" (77.21%). "Developing and storing knowledge" came in fifth place (77.13%). "Acquisition of knowledge" came in sixth place (76.45%). Knowledge Organization ranked seventh (74.26%). The study recommended that the university should enable the employees to benefit from the experiences and expertise available to help generate knowledge. The University encourages the creation of knowledge through the system of incentives and open the way for creators to apply their creations and spread and invest in excellence and creativity. The university should design work performance levels based on the integration of knowledge and organize it according to policies that support freedom of research. The need for Palestinian universities to adopt a knowledge management approach. The need to adopt a system of incentives that rewards cognitive efforts, and give workers enough freedom to enable them to apply their knowledge. (shrink)

Risk management of nanotechnology is challenged by the enormous uncertainties about the risks, benefits, properties, and future direction of nanotechnology applications. Because of these uncertainties, traditional risk management principles such as acceptable risk, cost–benefit analysis, and feasibility are unworkable, as is the newest risk management principle, the precautionary principle. Yet, simply waiting for these uncertainties to be resolved before undertaking risk management efforts would not be prudent, in part because of the growing public concerns about nanotechnology driven by risk (...) perception heuristics such as affect and availability. A more reflexive, incremental, and cooperative risk management approach is required, which not only will help manage emerging risks from nanotechnology applications, but will also create a new risk management model for managing future emerging technologies. (shrink)

The aim of this paper is to show how the incorporation of metaphoric and poetic ways of thinking into the evaluation of a leadership development programme both captured the imagination of the employees and benefited the core business of a manufacturing production plant. Qualitative data evaluating the effectiveness of a substantial leadership programme were presented back to all members of a manufacturing plant (executive and non-executive) in the form of composite narratives over an eighteen-month period. Recommendations were derived from the (...) text of the narrative and were progressively implemented. Such was the positive response to the written narratives that senior management asked the researchers to present the narratives in the form of a ‘live’ performance. Evaluation through qualitative methodology lends itself to an imaginative interpretation and presentation. Although qualitative and quantitative data tend to be regarded as complementary in applied research, it was management’s decision to employ only a qualitative process in this instance. The decision was fortuitous, given that the leadership development programme was initially judged to be a failure, as it triggered a subsequent imaginative engagement that turned a failure into a success. Indo-Pacific Journal of Phenomenology , Volume 7, Edition 1 May 2007. (shrink)

Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated jobs focused on (...) one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

Talk of mechanisms is ubiquitous in the natural sciences. Interdisciplinary fields such as biochemistry and pharmacy frequently discuss mechanisms with the assistance of diagrams. Such diagrams usually depict entities as structures or boxes and activities or interactions as arrows. While some of these arrows may indicate causal or componential relations, others may represent temporal or operational orders. Importantly, what kind of relation an arrow represents may not only vary with context but also be underdetermined by empirical data. In this (...) manuscript, we investigate how an analysis of pharmacological mechanisms in terms of producing and underlying mechanisms—as discussed in the contemporary philosophy of science—may shed light on these issues. Specifically, we shall argue that while pharmacokinetic mechanisms usually describe causal chains of production, pharmacodynamics tends to focus on mechanisms of action underlying the in vivo effects of a drug. Considering the action of thyroid gland hormones in the human body as a case study, we further demonstrate that pharmacodynamic schemes tend to incorporate entities and interactions on multiple levels. Yet, traditional pharmacodynamic schemes are sketched “flat”, i.e., non-hierarchically. We suggest that transforming flat pharmacodynamic schemes into mechanistic multi-level representations may assist in disentangling the different kinds of mechanisms and relations depicted by arrows in flat schemes. The resulting Baumkuchen model provides a powerful and practical alternative to traditional flat schemes, as it explicates the relevant mechanisms and relations more clearly. On a more general note, our discussion demonstrates how pharmacology and related disciplines may benefit from applying concepts from the new mechanist philosophy to guide the interpretation of scientific diagrams. (shrink)

Only a small percentage of PhD students manage to complete their PhD thesis on time. How can a student plan his/her PhD program in such a way that it will be completed within a set period? Project Management for PhDs shows how to plan and manage a PhD program, no matter how complex and unique the project may be. The writing process receives special attention, as it has been proven to be one of the most important factors in delaying PhD (...) progress. Offering a practical step-by-step plan, the book uses an associated planning system so the student can create a custom-made project schedule. Project Management for PhDs will benefit students and supervisors from all fields and any type of PhD program - not only for those in the classic four-year program, but also for those working part-time, either on their own time or combining the PhD with other commitments. (shrink)

The present study explores the discursive practice of the hospitality industry in addressing competence-based, benevolence-based, and integrity-based accusations of trust violation made by dissatisfied customers on TripAdvisor. Authentic negative online reviews written by dissatisfied customers and the corresponding responses by hotel management downloaded directly from TripAdvisor are analyzed qualitatively with Nvivo10. Results show that hotel management has the strongest preference for apology, followed by implicit denial and then explicit denial when dealing with the three different types of accusations of trust (...) violation. The findings will enhance our understanding of trust and its repair, and benefit hospitality practitioners responsible for handling online criticisms and complaints. (shrink)

This article analyzes process management and its financial impact on industrial companies in Ecuador and Latin America. Through a literature review and case analysis, process management practices, their benefits and challenges, and how these practices influence the financial results of companies are explored. It highlights the key aspects that contribute to improving operational efficiency and profitability, providing recommendations for successfully implementing process management in the industrial sector.

Confronted with mounting pressure to ensure accountability vis-à-vis customers, citizens and beneficiaries, organizational leaders need to decide how to choose and implement so-called accountability standards. Yet while looking for an appropriate standard, they often base their decisions on cost-benefit calculations, thus neglecting other important spheres of influence pertaining to more broadly defined stakeholder interests. We argue in this paper that, as a part of the strategic decision for a certain standard, management needs to identify and act according to the (...) needs of all stakeholders. We contend that the creation of a dialogical understanding among affected stakeholders cannot be a mere outcome of applying certain accountability standards, but rather must be a necessary precondition for their use. This requires a stakeholder dialogue prior to making a choice. We outline such a discursive decision framework for accountability standards based on the Habermasian concept of communicative action and, in the final section, apply our conceptual framework to one of the most prominent accountability tools (AA 1000). (shrink)

This paper examines the ethical issues faced by health workers managing a fictional case of a female sex worker who is hepatitis B positive with a high level of virus but is asymptomatic. According to guidelines she does not require treatment herself, but is potentially highly infectious to others. Recent legal cases in the UK show it can be criminal to pass on HIV or hepatitis B infection sexually if the risk is known and the partner has not been informed. (...) However, there is no statute or case law showing that health workers are required to intervene to prevent such a potential ‘crime’, particularly when the partners are unknown, as in this case. The health workers could respond in various ways. They could do nothing, thus making further infection probable. They could advise the sex worker to use condoms and to inform her clients. They could treat the sex worker to reduce her level of infectivity, although there is no benefit to her. They could disclose the sex worker's status, although breaking confidentiality is a serious matter ethically and may be of no benefit to the unknown client group. Regulating prostitution might help; but sex workers with infection may work off licence. This paper discusses the clinical, moral and ethical issues associated with such a scenario and concludes that the most beneficial course is to target clients, through health education, to recognise the potential risks of infection from a sex worker and to take suitable precautions including immunisation against hepatitis B. (shrink)

During the past decade, Medicaid has experienced extraordinary growth, in both number of beneficiaries and total expenditures. Between 1988 and 1993, the number of Medicaid beneficiaries grew from 22 million to 32 million. While the number of Medicaid beneficiaries increased by 45 percent, expenditures increased by 145 percent, from 51 billion to 125 billion. Expressed in terms of its percentage of state budgets, Medicaid doubled from 10 percent to 20 percent over the same time period, to the point that it (...) is currently the second largest budget item for most states.Faced with unsustainable rates of program budget growth and serious concerns about the level of access and the continuity of care afforded by the Medicaid program, states have turned to managed care. Almost every state has introduced some form of managed care for a subset of their Medicaid beneficiary population. Twenty-three states have gone farther, and implemented, proposed, or are developing section 1115 waivers to overhaul their Medicaid programs. These waivers allow states to develop and introduce nonstandard approaches to benefits, eligibility, service delivery, and financing for the Medicaid beneficiary population. (shrink)

In this paper we discuss ‘sustainable management’ which is being advocated by some in the business community. It may be that a professed commitment to sustainable development is merely a way for contemporary businesses to continue with ‘business as usual’ behind its façade. We believe that if business practices are to change, then education must change to allow students to live the ‘good’ lives promoted both by early philosophers and now by those professing the merits of sustainable development. The sustainable (...) development paradigm, if adopted fully, may result in the best of business decisions being made; it may provide humankind with a way to avoid the self-destruction which has been threatening throughout the 20th Century. Sustainable management requires business decision makers to consider how their decisions will affect the social and natural environments as well as their organisations’ profitability. It encourages a moral approach to business decision making and requires managers to recognise that genuinely long-term decision criteria will ultimately benefit their businesses, their societies, the natural environment and humankind. Although sustainable management is promoted as a ‘new’ paradigm, we argue that its principles should have been promoted through our educational systems for many centuries; they have not been. (shrink)

Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to (...) universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research. (shrink)

Stakeholder theory advocates that firms bear responsibility for the implications of their actions. However, while a firm affects or can affect stakeholders, stakeholders can also affect the corporation. Previous stakeholder theorising has neglected the reciprocal nature of responsibility. The question can be asked whether—in a spirit of reciprocity, loyalty and fairness—stakeholders should treat the corporation in a fair and responsible way. This study based on different definitions of stakeholders argues that various stakeholder attributes differ for different categories of stakeholders. This (...) analysis presumes that the attribute of stakeholder reciprocity can probably be restricted to real stakeholders, labelled stakeowners: genuine stakeholders with a legitimate stake, the loyal partners who strive for mutual benefits. Stakeowners own and deserve a stake in the firm. Stakeholder reciprocity could be an innovative criterion in the corporate governance debate as to who should be accorded representation on the board. Corporate social responsibility should imply corporate stakeholder responsibility. (shrink)

Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body integrity identity disorder (BIID). In seeking treatment, these individuals request surgery that challenges both the statutory provisions that sanction surgical operations and the limits of consent as a defence in New Zealand. In doing so, questions as to the influence of public policy and the extent of personal autonomy (...) become important. Beyond legal issues, BIID confronts dominant conceptions of bodily integrity, medical treatment, and ethical obligations. This paper seeks to identify the relevant public policy concerns raised by BIID in New Zealand and the limits of autonomy, before moving on to consider how BIID sufferers may legally seek the treatment they require and how a doctor might be protected from criminal proceedings for assault for performing this treatment. It will be argued that it is possible to legally consent to the amputation of a healthy limb as medical treatment and that public perception should not be allowed to take precedence over this right. (shrink)

David KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USA: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the lack of availability of deceased human organs and cells for clinical transplantation. Developments in the genetic engineering of pigs have enabled considerable progress to be made in the experimental laboratory in overcoming the immune barriers to successful xenotransplantation. With regard to (...) pig organ xenotransplantation, antibody- and cell-mediated rejection have largely been overcome, and the current major barrier is the development of coagulation dysregulation. This is believed to be due to a combination of immune activation of the vascular endothelial cells of the graft and molecular incompatibilities between the pig and primate coagulation–anticoagulation systems. Pigs with new genetic modifications specifically directed to this problem are now becoming available. With regard to less complex tissues, such as islets, neuronal cells, and corneas, the remaining barriers are less problematic, and graft survival in nonhuman primate models extends for >1 year in all three cases. In planning the initial clinical trials, consideration will be concentrated on the risk–benefit ratio, based to a large extent on the results of preclinical studies in nonhuman primates. If the benefit to the patient is anticipated to be high, eg, insulin-independent control of glycemia, and the potential risks low, eg, minimal risk of transfer of a porcine infectious agent, then a clinical trial would be justified.Keywords: infection, pigs, genetically-engineered, xenotransplantation, islets, xenotransplantation, organs. (shrink)