The varied perspectives of organisational effectiveness: What's at stake for early childhood development programmes in Rwanda?

Within global health and development, dissatisfaction with nongovernmental organisations' effectiveness (NGOs) is an increasingly pervasive aspect of programming. Today, the international community no longer accepts that NGOs are doing what they claim. This change in expectations has emphasised the importance of measuring organisational effectiveness for improved health and development impact. Using New Institutionalism as a theoretical framework, we investigated how institutional norms and expectations influence the adoption of structures and processes by NGOs, and Early Childhood Development (ECD) programming effectiveness in Rwanda - since little research connects these concepts. We employed qualitative methods: 45 in-depth interviews and 6 focus group discussions. Findings revealed a misalignment of 'organizational effectiveness' across scales, from global to local. Findings stress that, effectiveness, though an expectation of the institutional environment, may not be a valid construct for NGOs, generating implications for ECD programming. Findings also indicate measurement of global health interventions generally and the notion of effectiveness specifically can yield adverse implications for ECD programming. These findings are relevant for researchers and practitioners trying to better understand organisational effectiveness for ECD programmes because they suggest that effectiveness is socially constructed and measured differently across the different scales.

Two Gender Medicine: Provider-Side Barriers to Caring for Transgender and Gender Diverse Patients.

Experienced and anticipated discrimination during health care visits result in lower health care utilization rates, which contribute to persistent health disparities between transgender and gender diverse (TGD) individuals and the general population. Most strategies for improving health care delivery to TGD patients place the responsibility on providers, overlooking the role of medical systems and institutions in creating the environments where negative health care experiences occur. Relying on the inhabited institutionalism framework, this study explores system- and institutional-level barriers to the provision of quality care to TGD patients identified by health care providers and administrators, including relevant contextual details of, and interactions between, these barriers. Based on interview data from health care providers and administrators from a variety of practices across Texas, we identified two overarching themes and six subthemes. We demonstrate how our interviewees' responses reveal an institutional logic of "two-gender medicine," which creates barriers to health care provision in both formal medical education and training and throughout the managed care model of practice. We also illustrate how health care workers find ways to resist this logic in the course of their practice. Addressing these barriers to delivering competent and compassionate care to TGD patients that providers encounter could make long overdue strides toward addressing health disparities.

Greening Austrian social service and healthcare non-profits.

The climate crisis requires the systematic integration of environmental matters into the management practices of companies across all sectors. The 2022 Corporate Sustainability Reporting Directive (CSRD) has created a need in many large social service and healthcare non-profits (SSHC-NPOs) within the European Union to extend the integration of environmental matters by 2025. While there is plenty of research on environment management practices of large for-profit enterprises, the research on environmental matters in SSHC-NPOs, which gain their legitimacy from social value creation, has been neglected. This study examines how large Austrian SSHC-NPOs are preparing for the environmental requirements set by the CSRD. The integration of environmental considerations into their core strategy, sustainable management control practices, and non-financial reporting poses a significant challenge. To evaluate the status of integration of environmental matters, the paper uses two sequential stage models based on institutional theory. The study is based on data from interviews with 21 Austrian SSHC-NPOs. The findings reveal that the integration of environmental matters is at an early stage, driven by a pragmatic approach with a strong emphasis on social and financial concerns. Cultural controls take precedence in management control practices, while administrative and cybernetic controls lag behind. Environmental reporting does not meet CSRD requirements, and the studied SSHC-NPOs aim for minimal compliance only, when CSRD comes into force in 2025. Additionally, it highlights that these organizations do not conform to the sequential stages proposed by two institutionalist stage models, emphasizing the role of the SSHC sector's context in shaping their behavior and practices.

Ethical consumerism, human rights, and Global Health Impact.

In this paper, I raise some doubts about Nicole Hassoun's account of the obligations of states, pharmaceutical firms, and consumers with regard to global health, presented in Global Health Impact. I argue that it is not necessarily the case, as Hassoun claims, that if states are just, and therefore satisfy all of their obligations, then consumers will not have strong moral reasons, and perhaps obligations, to make consumption choices that are informed by principles and requirements of justice. This is because there may be justice-based limits on what states can permissibly and feasibly do both to promote access to existing drugs for all of those who need them, and to promote research and development for new drugs that could treat diseases that primarily affect the global poor. One important upshot of my argument is that there can be reasons for organizations like the Global Health Impact Organization to exist, and to do the kind of work that Hassoun argues is potentially valuable in our deeply unjust world, even in much less unjust worlds in which states and firms largely, or even entirely, comply with their obligations.

Explaining the Green Development Behavior of Local Governments for Sustainable Development: Evidence from China.

Although researchers have examined organizational sustainability practices, a specific interpretation of local government green development practices remains for supplemental analysis. This study conducted an empirical survey of 53 local officials from departments related to green development to understand the key processes and practices of green development behavior of local governments in China. The key findings indicate that the main stakeholders involved in the green development practices of Chinese local governments consist of enterprises and residents. In part, local government green development practices emphasize the greening of enterprises, especially in the step of process environmental regulation. The new institutionalism theory and the organizational process research provide dependable insights into green development behaviors. Our findings further shed light on the process of cross-sectoral cooperation across local government departments in green development, contributing to local multi-sectoral interactions for regional green development.

Conversation analysis, institutions, and rituals.

By relating conversation analysis (CA), in particular CA research on institutional interaction to such research traditions as sociological institutionalism, new materialism, and ritual theory, the article illustrates how CA scholarship can contribute to macrosociological theorizing. This argument is illustrated by how national parliaments are organized as institutions. The main point made in the article is that occasions of what CA calls institutional interaction should be considered as rituals. Although those occasions are scripted ceremonial performances wherein social pressure, material conditions, or avoidance of punishment make actors conform, they still play a role in constituting social order by making participants honor the rules and principles codified in an organization's frontstage events. The article also underlines that organizational arrangements do not determine what actors can say or do, but they impose limits and conditions on people's conduct. Finally, the paper suggests that it is through such arrangements of institutional interaction that social structure is created, maintained, and naturalized.

'Nurses are seen as general cargo, not the smart TVs you ship carefully': the politics of nurse staffing in England, Spain, Sweden, and the Netherlands.

Nurse workforce shortages put healthcare systems under pressure, moving the nursing profession into the core of healthcare policymaking. In this paper, we shift the focus from workforce policy to workforce politics and highlight the political role of nurses in healthcare systems in England, Spain, Sweden, and the Netherlands. Using a comparative discursive institutionalist approach, we study how nurses are organised and represented in these four countries. We show how nurse politics plays out at the levels of representation, working conditions, career building, and by breaking with the public healthcare system. Although there are differences between the countries - with nurses in England and Spain under more pressure than in the Netherlands and Sweden - nurses are often not represented in policy discourses; not just because of institutional ignorance but also because of fragmentation of the profession itself. This institutional ignorance and lack of collective representation, we argue, requires attention to foster the role and position of nurses in contemporary healthcare systems.

New governance of the digital health agency: a way out of the joint decision trap to implement electronic health records in Germany?

Fragmentation in health systems leads to discontinuities in the provision of health services, reduces the effectiveness of interventions, and increases costs. In international comparisons, Germany is notably lagging in the context of healthcare (data) integration. Despite various political efforts spanning decades, intersectoral care and integrated health data remain controversial and are still in an embryonic phase in the country. Even more than 2 years after its launch, electronic health record (elektronische Patientenakte; ePA) users in Germany constitute only 1 per cent of the statutorily insured population, and ongoing political debates suggest that the path to broader coverage is fraught with complexities. By exploring the main stakeholders in the existing (fragmented) health system governance in Germany and their sectoral interests, this paper examines the implementation of ePA through the lens of corporatism, offering insights based on an institutional decision theory. The central point is that endeavours to better integrate health data for clinical care, scientific research and evidence-informed policymaking in Germany will need to address the roles of corporatism and self-governance.

The Trajectory of Brazilian Immunization Program between 1980 and 2018: From the Virtuous Cycle to the Vaccine Coverage Decline.

BACKGROUND: Public health policies are crossed by economic and political interests that can affect the maintenance of the immunization programs and their vaccination coverages. The aim was to investigate the political and economic conditions that marked the trajectory of the Brazilian immunization program from 1980 to 2018. METHODS: Documentary research gathered data on public expenditures with epidemiological surveillance and vaccine procurement and nationwide estimates of vaccine coverage. The scientific literature on the program's implementation and the country's political and economic conditions was examined. The theoretical approach was based on historical institutionalism. RESULTS: The results showed rising, high rates maintaining and falling vaccination coverages in the period. As of 2010, there was a tendency for a reduction in total federal spending on epidemiological surveillance, putting pressure on the budgets of the sub-national governments in their respective areas of coverage, and on federal spending in dollars for the acquisition of immunobiologicals and inputs. CONCLUSIONS: The amplitude and complexity of the program's trajectory have been crossed by diverse dynamics conditioned by economic and political interests reflecting at a deeper level the advance of capitalism through fiscal austerity measures over democracy's aspirations for greater balance and justice in the distribution of resources.

Sustaining transformations: changing marine governance, environmental meaning, and 'left behind' Brexit narratives on the Yorkshire East Coast.

Transformations to sustainability are frequently framed as key to blue growth, but they often engender complex consequences for communities. This article illustrates the role of environmental meaning in these processes through the lens of the Brexit vote on the Yorkshire East Coast. Based on discursive institutionalist analysis of narrative materials from semi-formal interviews conducted in 2017 alongside textual documentation from media, policy, and regional archives, I trace connections between transforming marine governance regimes, environmental meaning, and the British relationship with the EU from the Cod Wars to today. The transformation towards ecosystem-based management in British maritime governance post UNCLOS III left local communities feeling 'left behind' not only economically but also in terms of marginalised local meanings of place, labour, and environment. The Brexit vote, in this context, shows the multivalence of transformational processes and the importance of considering environmental meaning as part of their just execution.

Health poverty alleviation in China from the perspective of historical institutionalism: policy changes and driving factors.

Health poverty alleviation is an effective tool for improving the living quality and developmental conditions of impoverished populations. Since 1978, China has been actively implementing health poverty alleviation projects, resulting in a more robust rural healthcare service network and increased convenience for the local population to access medical treatment. However, it is crucial to acknowledge that China still faces a complex situation with the simultaneous existence of multiple disease threats and the interweaving of various health influencing factors. Ongoing risks of emerging infectious diseases persist, and some previously controlled or eliminated infectious diseases are at risk of resurgence. The incidence of chronic diseases is on the rise and exhibits a trend toward affecting younger populations. Therefore, examining the successful experiences of China's health poverty alleviation over the past 40 years becomes a critically important issue. The study focuses on China's health poverty alleviation policies, employing historical institutionalism as a theoretical perspective to analyze the historical changes and evolutionary logic of health poverty alleviation policies. A historical institutionalist analytical framework for health poverty alleviation policies is constructed. The research findings reveal that China's health poverty alleviation policy has undergone three distinct periods since 1978: the initial phase (1978-2000), the exploratory phase (2000-2012), and the stable development phase (2013-present). At the macro level, the political, economic, and social contexts of different periods have influenced the evolution of health poverty alleviation policies. On the meso level, coordination effects and adaptive expectations have had an impact on China's health poverty alleviation policy. At the micro level, various actors, including the central government, local governments at different levels, social forces, and impoverished communities, interact during the evolution of health poverty alleviation policies. This paper summarizes the theoretical aspects of China's health poverty alleviation policy experience. The research conclusions, viewed through the lens of historical institutionalism, offer practical insights into the evolution of government policies. This provides directional guidance for enhancing health poverty alleviation projects.

Biodefense and emergency use authorization: different originations, purposes, and evolutionary paths of institutions in the United States and South Korea.

BACKGROUND: Emergency-use-authorization (EUA) is the representative biodefense policy that allows the use of unlicensed medical countermeasures or off-label use of approved medical countermeasures in response to public health emergencies. This article aims to determine why the EUA policies of the United States and South Korea produced drastically different outcomes during the COVID-19 pandemic, and how these outcomes were determined by the originations and evolutionary paths of the two policies. METHOD: Historical institutionalism (HI) explains institutional changes-that is, how the institution is born and how it evolves-based on the concept of path dependency. However, the HI analytical narratives remain at the meso level of analysis in the context of structure and agency. This article discusses domestic and policy-level factors related to the origination of the biodefense institutions in the United States and South Korea using policy-learning concepts with the Event-related Policy Change Model. RESULTS: The 2001 anthrax letter attack (Amerithrax) and the 2015 Middle East Respiratory Syndrome (MERS) outbreak prompted the establishment of biodefense institutions in the United States and South Korea, respectively. Due to the different departure points and the mechanism of path dependency, the two countries' EUAs evolved in different ways-the United States EUA reinforced the Post-Exposure Prophylaxis (PEP) function, while the South Korea EUA strengthened the Non-Pharmaceutical Intervention (NPI) function. CONCLUSIONS: The evolution and outcomes of the two EUAs are different because both policies were born out of different needs. The United States EUA is primarily oriented toward protecting homeland security against CBRN (chemical, biological, radiological, and nuclear) threats, whereas the South Korea EUA is specifically designed for disease prevention against infectious disease outbreak.

Critical junctures and events in the trajectory of information modeling in Curitiba / Coyuntura y eventos críticos en la trayectoria del modelado de información en Curitiba / Conjunturas e eventos críticos na trajetória da modelagem da informação em Curitiba

Abstract Although it is a promising theory for understanding complex ongoing political processes, historical institutionalism has rarely been used to adress urban management and urban planning issues. We aim to (re)construct the trajectory of management and dissemination of communication and information technologies (ICTs) in Curitiba to identify critical junctures and events. Methodologically, it is a case study based on documents and discourse analysis. The results show that Curitiba used to be avant-garde in technological diffusion but today it develops more responsive than anticipatory actions; over time, the role of technology diffusion and management shifted from the urban management and planning structure to the direct municipal administration structure; technological initiatives have always taken place and are taking place sharply and decentrally for the consolidation of an ecosystem; the ideals of forming a digital or a smart city were motivators of Curitiba's current situation. The ideology underlying the game of politicians and party affiliations has been put aside in alignments of local groups to carry out technological adjustments; and that the management and diffusion of ICTs remain controversial in political disputes. The conclusion is that the political-technology dyad has absorbed the impacts of critical events, resulting in the remodeling of municipal institutions and organizations linked to the management and diffusion of ICTs that also need to deal with the game of interests and external pressures.

Resumen Aunque sea una teoría prometedora para comprender procesos políticos complejos en curso, el institucionalismo histórico ha sido poco utilizado en temas de planificación y gestión urbana. Así, el objetivo de este estudio es (re)construir la trayectoria de gestión y difusión de las tecnologías de la información y la comunicación en el municipio de Curitiba para identificar coyunturas y eventos críticos. Metodológicamente, se utilizan los procedimientos de levantamiento documental y análisis del discurso. Los resultados muestran que Curitiba fue vanguardista en difusión tecnológica, pero hoy desarrolla acciones más responsivas que anticipatorias; con el tiempo, el papel de la difusión y gestión de la tecnología pasó de la estructura de gestión y planificación urbana a la estructura de administración municipal directa; las iniciativas tecnológicas siempre se han dado y se están dando de manera acentuada y descentralizada para la consolidación de un ecosistema; los ideales de formar una ciudad digital o una ciudad inteligente fueron motivadores de la coyuntura más reciente; la ideología que subyace al juego de los políticos y las afiliaciones partidarias parece haber sido dejada de lado en alineamientos de grupos locales para realizar ajustes tecnológicos; y que la gestión y difusión de las TIC sigue siendo controvertida en las disputas políticas. La conclusión es que la díada política-tecnología ha absorbido los impactos de los eventos críticos, lo que termina redundando en la remodelación de las instituciones y organismos municipales vinculados a la gestión y difusión de las TIC que también necesitan lidiar con el juego de intereses y las presiones externas.

Resumo Embora seja uma teoria promissora para compreender complexos processos políticos continuados, o institucionalismo histórico tem sido pouco utilizado em questões de gestão e planejamento urbano. Assim, o objetivo deste estudo é (re)construir a trajetória de gestão e difusão tecnologias de comunicação e informação do município de Curitiba para identificar conjunturas e eventos críticos. Metodologicamente, utilizam-se os procedimentos de levantamento documental e análise de discurso. Os resultados mostram que Curitiba foi vanguardista na difusão tecnológica, mas hoje desenvolve ações mais responsivas do que antecipativas; com o passar do tempo o protagonismo da difusão e gestão tecnológica se deslocou da estrutura de gestão e planejamento urbano para a estrutura da administração municipal direta; as iniciativas tecnológicas sempre ocorreram e vêm ocorrendo acentuada e descentralizadamente para a consolidação de um ecossistema; os ideais de formação de uma cidade digital ou uma cidade inteligente foram motivadores da conjuntura mais recente; a ideologia subjacente ao jogo dos políticos e das filiações partidárias parece ter sido posta de lado em alinhamentos dos grupos locais para realizar ajustes tecnológicos; e que a gestão e a difusão de TIC's se mantém controversa nas disputas políticas. A conclusão é que a díade política-tecnologia tem absorvido os impactos dos eventos críticos, o que acaba por resultar na remodelagem das instituições e organizações municipais ligadas à gestão e à difusão das TIC's que também precisam lidar com o jogo de interesses e as pressões externas.

A historical review of performance appraisal of public hospitals in China from the perspective of historical institutionalism.

The government performance appraisal of public hospitals serves as an effective management tool to promote high-quality development. It is also an important means of realizing the "Healthy China" initiative. Since the founding of the People's Republic of China, changes in performance appraisal have been divided into the following four periods: the early stage of performance appraisal (1949-1977), the exploration period (1978-2008), the development period (2009-2018), and the integration period (2019-present). This clarifies the regional practice of public hospital performance and identifies the institutional factors of the evolution. It also demonstrates that administrative forces, market-driving forces, and mission-driving forces combine to bring about change in the public hospital performance appraisal system. However, problems such as insufficient application of performance appraisal and coordination between health administrative departments and medical insurance departments still loom large.

Muting Science: Input Overload Versus Scientific Advice in Swiss Policy Making During the Covid-19 Pandemic.

This article explores why the Swiss Federal Council and the Swiss Federal Parliament were reluctant to follow the majority views of the scientific epidemiological community at the beginning of the second wave of the Covid-19 pandemic. We propose an institutionalist take on this question and argue that one major explanation could be the input overload that is characteristic of the Swiss federal political system. We define input overload as the simultaneous inputs of corporatist, pluralist, federalist and direct democratic subsystems. Adding another major input-this time from the scientific subsystem-may have threatened to further erode the government's and parliament's discretionary power to cope with the pandemic. We assume that the federal government reduced its input overload by fending off scientific advice.

Exploring the Effectiveness of Sustainability Measurement: Which ESG Metrics Will Survive COVID-19?

This paper aims to investigate the current state of play on Environmental Social and Governance (ESG) integration and check the validity of the current metrics system by assessing if it will survive the COVID-19 crisis. By adopting a qualitative research approach through semi-structured anonymous interviews with 14 senior managers of six European listed companies we use a framework by assessing the mechanisms of reactivity on the effectiveness of ESG measures in times of COVID-19. By interpreting the practitioners' points of view through the lens of the sociological framework by Espeland and Sauder (Am J Sociol 113:1-40, 2007) our findings show different mechanisms of reactivity by companies on the effectiveness of ESG measures in times of COVID-19, i.e., active and passive conformity and active resistance. We also identified the main Corporate Social Responsibility (CSR) institutional factors that affect managers' reactivity. An extensive re-formulation of the ESG metrics is required in the light of times of crisis, given that accountability and transparency are strongly linked to quantitative measures which can play a critical role in the financial system and investors' engagement. Particularly, the strict distinction between "E", "S" and "G" issues should be abandoned claiming a different holistic re-design of sustainability measures by considering the increasing relevance of the Social dimension in time of COVID-19. This study provides a valuable contribution to the existing literature on the measurement of sustainability within the link of accountability and crisis by highlighting new corporate needs to re-design the ESG metrics system.

An Evolutionary Institutionalist Explanation of the Philippines' Militaristic COVID-19 Approach.

The Philippines undertook a "militaristic" approach to COVID-19. This has been attributed, directly or indirectly, to the strong political will of their current president, Rodrigo Duterte. Going against this narrative, this work presents an alternative framing of the issue. Drawing on concepts from institutionalist theory, this work argues that such a militaristic policy should be viewed as a continuation of the long-standing presence of militaristic ideas in civilian affairs. The dominance of such ideas has been normalized, not recently via Duterte but decades ago, owing to the failure to have a genuine liberal democracy after the fall of the Marcos regime. Overall, this work presents a historical grounding, using a new evolutionary framework, as to why institutions or policies - in this case the militaristic COVID-19 approach - come to fruition.

An incongruous intervention: Exploring the role of anti-institutionalism in less-educated individual's limited uptake of nutrition information.

Despite many efforts, nutritional health interventions have been largely unable to reduce health inequalities between less- and more-educated individuals, since their effectiveness among the former is often limited. Conventionally, adverse financial circumstances and poorer health literacy are argued to explain this. Drawing on recent sociological insights, we propose a complementing and novel sociocultural explanation based on how contemporary power relations in society breed anti-institutionalism among less-educated individuals. Using a survey of a representative sample of the Dutch population (n = 2398), we focus on the strategic case of the lower uptake of nutrition information among less-educated individuals. We find that two aspects of anti-institutionalism, i.e. institutional distrust and antipaternalism, substantially account for the educational gap in the uptake of nutrition information. This indicates that current nutrition information inspires opposition among less-educated individuals. More generally, it suggests that the development of nutritional health interventions should avoid invoking institutional connotations, to increase their acceptance by those who commonly need these most.

Sino-U.S. Decoupling: The Roles of U.S. Congress.

The Sino-U.S. relations tumbled during the Trump Administration. The talk of decoupling permeated the decision-making circle in Washington D.C. Many factors have contributed to the free fall. The roles Congress has played are undoubtedly one of them. Based on the new institutionalist approach, this study provides three analyses of recent China-related legislative activities. First, the historical analysis of legislative data illustrates a surge in congressional activism on China-related legislative activities. Second, the content analysis reveals some of the triggers in the deterioration of bilateral relations in recent years. Third, the political analysis of the critical congressional players and the structures and procedures Congress created provides some insight into the domestic and political logic of the congressional crusade against China. Finally, the paper ends with assessing the impact of the surge in Congressional activism on the new Biden Administration.