Comparative Evaluation of Quality Management Practices in the Public and Private Hospitals in Visakhapatnam District: An Original Research.

Background: In the Visakhapatnam District, this study compares the quality management procedures used by public and private hospitals. Knowing how these practices are similar and different from one another can help inform policy decisions and improve the quality of health care. Materials and Methods: A cross-sectional study design was used, and 100 hospitals from both public (50 hospitals) and private (50 hospitals) were included in the sample size. A standardized questionnaire that evaluated different aspects of quality management practices was used to gather the data. Descriptive statistics and inferential tests were used in the quantitative analysis. Results: Significant variations in quality management procedures between public and private hospitals were found. In terms of patient happiness, service responsiveness, and technological use, private hospitals scored better. Regarding accessibility, cost, and equity of healthcare services, public hospitals fared better. Conclusion: The report emphasizes the necessity of focused initiatives to improve quality management procedures in both public and commercial institutions. Collaboration between the two sectors can make it easier to deploy evidence-based tactics and share best practices to raise overall healthcare quality in the Visakhapatnam area.

Biosecurity adoption in Québec dairy farms: results from a risk assessment questionnaire analyzed using conventional and unsupervised artificial intelligence methods.

This study documents the current state of biosecurity on dairy farms in Québec following the implementation of a mandatory biosecurity risk evaluation that was part of the proAction® accreditation program developed by Dairy Farmers of Canada. Using a cross-sectional design, 3,825 risk assessment questionnaires completed between 2018 and 2021 were extracted from Vigil-Vet database, which is a software utilized by veterinarians for conducting the proAction® risk assessment. Descriptive statistics were used to summarize the practices adopted by dairy producers. Additionally, multiple correspondence analysis was used to explore the association between the diseases of most concern and the adoption of biosecurity practices. Moreover, we used a hierarchical cluster analysis on principal components to identify distinct patterns of biosecurity practices among dairy producers. This analysis enabled the identification of typologies or clusters of farms based on the specific biosecurity practices they currently employ. The results of the descriptive statistics indicated that mastitis was the disease of most concern for most dairy farmers (40%). Moreover, given that only 10% of the 2,237 dairy farmers who acquired animals adhered to quarantine practices, there seems to be a need for improved implementation of biosecurity measures aimed at restricting the introduction of diseases when introducing new animals. Conversely, cleaning stalls and health equipment were adequately addressed by 95% and 86% of dairy producers, respectively. The multiple correspondence analysis indicated no significant association between the disease of most concern and the farm's biosecurity profile, except for respondents who identified digital dermatitis as their disease of most concern. Through the hierarchical cluster analysis, 3 clusters were identified among 3,581 farms: (1) Cluster 1 included farms with good management of sick animals; (2) Cluster 2 included farms with good management of young animals; and (3) Cluster 3 included farms with poor management of sick animals and young animals. Our study makes an important contribution by providing valuable insights into the biosecurity practices currently adopted on Québec dairy farms. It establishes a baseline for assessing progress in biosecurity practices adoption and serves as a reference point for future evaluations. In addition, these findings play a key role in monitoring the effectiveness of interventions aimed at improving biosecurity on dairy farms. By making use of this knowledge, stakeholders can make informed decisions that prioritize animal health, increase productivity, and ensure sustainability of the dairy industry.

Does green HRM really matter for sustainable performance? The role of environmental consciousness and green intellectual capital.

The purpose of this study is to investigate the impact of a set of green human resource management (HRM) practices on sustainable performance in Pakistani higher education institutions (HEIs), while also taking into account the mediating influence of environmental consciousness and green intellectual capital. Furthermore, the study aims to assess the association between environmental consciousness and green intellectual capital, along with the sustainable outcome. The study data was collected from 250 HR managers and executive officers who were responsible for implementing green HRM practices and sustainable performance in the education sector of Pakistan. Smart PLS-4 software was used to perform the statistical analysis of the data. According to the results of this study, green HRM practices play a substantial role in enhancing sustainable performance. The study also identified a link between green HRM practices and sustainable performance via environmental awareness and green intellectual capital. The research contributes to the theoretical paradigm's social cognitive theory by offering information on green HRM practice bundles and sustainable performance. The research also demonstrates that green intellectual capital and environmental consciousness operate as a bridge between green HRM practices and long-term sustainable performance. The study's findings have real-world applications for education, policymakers, and human resource managers at the highest levels. In order to achieve sustainable performance, the study emphasizes the significance of developing green intellectual capital and implementing green HRM practices.

Considerations for Using Alternative Technologies in Nutrient Management on Cape Cod: Beyond Cost and Performance.

Mitigating non-point source nitrogen in coastal estuaries is economically, environmentally, logistically, and socially challenging. On Cape Cod, Massachusetts, nitrogen management includes both traditional, centralized wastewater treatment and sewering as well as a number of alternative technologies. We conducted semi-structured interviews with 37 participants from governmental and non-governmental organizations as well as related industries to identify the barriers and opportunities for the use of alternative technologies to mitigate nitrogen pollution. The interviews were recorded, transcribed, and then analyzed using content analysis and rhetorical analysis. Cost and technical capacity to reduce nitrogen were the most discussed considerations. Beyond those, there were a slew of additional considerations that also impacted whether a technology would be installed, permitted, and socially accepted. These included: maintenance and monitoring logistics, comparisons to sewering, co-benefits, risk/uncertainty, community culture, extent of public engagement, permitting/regulatory challenges, and siting considerations. The insights about these additional considerations are valuable for transferring to other coastal areas managing nutrient impairments that may have not yet factored in these considerations when making decisions about how to meet water quality goals.

Farm management and economic factors associated with bulk tank total bacterial count in Holstein dairy herds in Iran.

The objectives of this research were (1) to study different factors affecting milk total bacterial count (TBC) and (2) to estimate the economic value associated with TBC in Holstein dairy herds in Iran. The relationships between bulk tank TBC and farm management and economic factors were examined on 56 randomly selected intensive dairy farms. Herd management factors associated with bulk tank TBC were determined using mixed linear models. The median bulk tank TBC for the sample herds was 299 (range 81-1185) × 103 cfu/ml. The average economic premium opportunity from bulk tank TBC was US$ 1.32 per ton of milk ranging from US$ 0.02 per ton of milk for herds applying wet tissue procedures as teat cleaning material and washing the water troughs three times per day to US$ 5.20 per ton of milk for herds with dirty barns. Results showed that the following management factors were associated with low TBC and high economic value: frequency of cleaning water troughs, teat cleaning material, the frequency of milk delivery to the processor, bedding material, herd size, education level of workers, udder washing material, material of milking parlor wall, frequency of disinfection of the calving area, presence of veterinarian, water quality control, having a hospital pen and barn hygiene. In conclusion, our findings highlight the need to pay more attention to farm management issues, particularly farm hygiene practices to reduce milk TBC and so reduce the economic burden of TBC in dairy herds in Iran.

Identification of Contamination Sources and Assessment of Risk Factors Associated with the Occurrence of Escherichia coli O157:H7 on Small-scale Cow-calf Operations in Oklahoma and Louisiana.

Escherichia coli O157:H7 is a human pathogen that exists as part of the commensal microflora of cattle and is shed in animal feces. Little is known about the effect of management practices on its occurrence and transmission on small-scale cow-calf operations. Identification of risk factors associated with farm practices could help implement effective measures to control E. coli O157:H7. This study quantified the risk of E. coli O157:H7 occurrence associated with cow-calf farm practices using risk modeling. Management practices of small-scale cow-calf operations in OK and LA were assessed through survey-based research. Fecal, water, sediments and water-trough-swab samples were collected to determine the incidence of E. coli O157:H7, and potential on-farm contamination sources and risk factors identified. Association between the occurrence of pathogen and farm practices was determined using two risk assessment models (I and II). Model I determined the association of E. coli O157:H7 occurrence with water source, water container, feed, cattle breed, and herd density, while Model II determined its association with farm cleanliness. For both models, logistic regression was followed using a two-step approach, univariable and multivariable analysis. In OK and LA, E. coli O157:H7 was present in 5.8% and 8.8% fecal, 4.4% and 9.4% water, 10.3% and 9.6% sediments, and 1.5% and 10.6% water-trough-swab samples, respectively. In Model I, univariable analysis identified water container and feed, whereas multivariable analysis identified feed as a significant risk factor. In Model II, the univariable analysis found cleanliness of cattle-contact areas, such as, alleyways, water-trough, chute and equipment, to be a significant risk factor. In multivariable analysis, only the cleanliness of water-trough was identified to be a significant risk factor. Results from the study could aid in the development of on-farm best management practices for the reduction of E. coli O157:H7.

River Basin Export Reduction Optimization Support Tool; a tool to screen options for reducing nutrient loads while minimizing cost.

Excess loading of nitrogen and phosphorus to river networks causes environmental harm, but reducing loads from large river basins is difficult and expensive. We develop a new tool, the River Basin Export Reduction Optimization Support Tool (RBEROST) to identify least-cost combinations of management practices that will reduce nutrient loading to target levels in downstream and mid-network waterbodies. We demonstrate the utility of the tool in a case study in the Upper Connecticut River basin in New England, USA. The total project cost of optimized lowest-cost plans ranged from $18.0 million to $41.0 million per year over 15 years depending on user specifications. Plans include both point source and non-point source management practices, and most costs are associated with urban stormwater practices. Adding a 2% margin of safety to loading targets improved estimated probability of success from 37.5% to 99%. The large spatial scale of RBEROST, and the consideration of both point and non-point source contributions of nutrients, makes it well suited as an initial screening tool in watershed planning.

Digital transformation: fresh insights to implement green supply chain management, eco-technological innovation, and collaborative capability in manufacturing sector of an emerging economy.

The increasing significance of green supply chain management in developing countries' manufacturing sector is primarily driven by the deteriorating environment, signified by decreasing raw material resources, a surplus of waste sites, and rising pollution levels. Green supply chain management can provide competitiveness while boosting a company's environmental sustainability if implemented effectively. Therefore, it is necessary to determine the effect of green supply chain management practices on the firm performance of the manufacturing sector. This research aims to determine the moderating effect of collaborative capability and the mediating influence of eco-technological innovation and environmental strategy on the relationship between green supply chain management and firm performance. Five hundred fifty survey questionnaires are gathered from manufacturing firms of China. Utilizing structural equation modeling (SEM), the proposed hypotheses have been analyzed and investigated. The results show that green supply chain management indirectly affects the firm performance. Moreover, green supply chain management is positively related to environmental strategy and eco-technological innovation, which effectively enhance firm performance. The findings further indicate that environmental strategy and eco-technological innovation significantly mediate the association between green supply chain management and firm performance. Furthermore, collaborative capability significantly and positively moderates the relationship between green supply chain management and firm performance. As a result, the adoption of these factors influences firm performance positively and will assist the manufacturing sector in meeting diverse yet radically changing requirements and overcoming obstacles originating from a dynamic global business environment. Consequently, it is of the utmost importance that businesses must utilize green practices with relatively low environmental impacts. Companies can considerably maintain and improve their firm performance by reducing the environmental impact if they have effective collaborative capabilities, eco-technological innovation, and environmental strategies.

Teachers and school administrators' experiences with professional development feedback: The classroom strategies assessment system implementation.

To support teachers' evaluation and professional development valid assessments that measure teachers' classroom practices and capture teachers' strengths and areas in need of improvement are needed. The current study examined school administrators' and teachers' experiences of Professional Development (PD), with the use of the Classroom Strategies Assessment System (CSAS), a classroom observational assessment that measures universal classroom instructional and behavioral practices, and their perceptions of the usability of CSAS for supporting PD. The study also examined school administrators' ratings of elementary school teachers' use of evidence-based instructional and behavior management practices, as an illustrative example of how performance feedback was implemented. Three school administrators observed 31 elementary school teachers three times each using the CSAS Greek version. Following each observation, teachers received brief performance feedback based on CSAS scores from their school administrator. School administrators and teachers completed the System Usability Scale to assess the usability of the CSAS administration. Semi-structured interviews with 19 of the participating teachers were conducted to further explore teachers' professional development experiences. Overall, teacher interviews expressed their need for professional development in the areas of instructional and behavior management practices and perceived CSAS feedback helpful for instructional improvement. Findings also suggest some improvements in the frequency and quality of teacher instructional and behavior management practices as measured by the CSAS. Implications for practices and research are discussed.

Field-scale nutrient loss assessment following cover crop and manure rate change.

Eutrophication due to elevated nitrogen (N) and phosphorus (P) loss from croplands remains one of the most pressing water quality issues throughout the world. Understanding the effect of implementing conservation management practices is critical for meeting nutrient reduction goals as well as informing conservation programs and policies. A before-after-control-impact (BACI) analysis was used to evaluate the individual and combined effect of cover crops and manure application rate on discharge and nutrient loss using six water years (WY2014-WY2019) of measured data across four distinct drainage zones (1X-NCC; 1X-CC; 2X-NCC; 2X-CC) within an Ohio, USA, crop production field. White mustard significantly reduced mean monthly nitrate (NO3--N) concentration regardless of manure application rate (i.e., 65 m3 ha-1 and 130 m3 ha-1). However, neither the use of white mustard, doubling manure rate, or the combination of the two had a significant impact on mean monthly drainage discharge, dissolved-reactive P (DRP), or total P (TP) loss. Seasonal analysis confirmed that NO3--N concentration in the cover crop zones was signficantly less in fall, winter, and spring. However, significant increases in spring discharge, NO3--N, DRP, and TP loads as well as TP concentration were noted with cover crop and greater manure rate treatments. These findings confirm that cover crops have a reducing effect on NO3--N concentration but may not have any effect on addressing P concerns. Further research is warranted; however, this study highlights that the resource concern (e.g., N or P) should be considered prior to implementing cover crops as a conservation management practice.

A quantitative approach on environment-food nexus: integrated modeling and indices for cumulative impact assessment of farm management practices.

Background: Best management practices (BMPs) are promising solutions that can partially control pollution discharged from farmlands. These strategies, like fertilizer reduction and using filter strips, mainly control nutrient (N and P) pollution loads in basins. However, they have secondary impacts on nutrition production and ecosystem. This study develops a method to evaluate the cumulative environmental impacts of BMPs. It also introduces and calculates food's environmental footprint (FEF) for accounting the total environmental damages per nutrition production. Methods: This study combines the soil and water assessment tool (SWAT) for basin simulation with the indices of ReCiPe, a life cycle impact assessment (LCIA) method. By these means, the effectiveness of BMPs on pollution loads, production yields, and water footprints (WFs) are evaluated and converted as equivalent environmental damages. This method was verified in Zrebar Lake, western Iran. Here, water consumption, as WFs, and eutrophication are the main indices that are converted into equivalent health and ecological impairments. Two methods, entropy and environmental performance index (EPI), are used for weighting normalized endpoints in last step. Results: Results showed that using 25-50% less fertilizer and water for irrigation combined with vegetated filter strips reduce N and P pollution about 34-60% and 8-21%, respectively. These can decrease ecosystem damages by 5-9% and health risks by 7-14%. Here, freshwater eutrophication is a more critical damage in ecosystem. However, using less fertilizer adversely reduces total nutrition production by 1.7-3.7%. It means that BMPs can decline total ecological damages and health risks, which threatens nutrition production. FEF presents a tool to solve this dilemma about the sustainability of BMPs. In the study area, a 4-9% decrease in FEF means that BMPs are more environmental friendly than nutrition menacing. Finally, this study concludes that SWAT-ReCiPe with FEF provides a quantitative framework for environment-food nexus assessment. However, due to the uncertainties, this method is recommended as a tool for comparing management strategies instead of reporting certain values.

Amending woodchip bioreactors with corncobs reduces nitrogen removal cost.

Woodchip denitrification bioreactors are an effective agricultural practice to reduce nitrogen (N) export from subsurface drainage via the conversion of nitrate (NO3-) to nitrogen gas (N2), but there are challenges associated with limited woodchip supplies and increasing prices. Previous lab studies indicate that corncobs could be a promising woodchip alternative from the perspectives of N removal rate and cost. This field study aimed to provide early performance and cost assessment of denitrification bioreactors with two woodchip-corncob treatments. The objectives were to i) compare N removal rates of bioreactors with different carbon and hydraulic retention time (HRT) treatments, ii) compare bioreactor N removal costs, and iii) conduct sensitivity analysis on full-scale bioreactors (FBR) N removal costs with varying corncob lifespans and prices. Nine replicated field pilot-scale bioreactors (PBRs) using three carbon treatments and three HRTs were assessed for N removal efficiency. The carbon treatments were woodchip-only (WC100), 25% (by vol.) corncobs + 75% woodchips media (CC25) in series, and 75% corncobs + 25% woodchips (CC75) in series set at HRTs of 2, 8, and 16 h. N concentrations were monitored at each PBR inlet and outlet, and the PBR N removal efficiencies were used to estimate FBR N removal rates and costs. At respective HRTs, the estimated N removal rates of CC75 were 1.6- to 10.1-fold higher than WC100, but CC25 exhibited 0.9-fold lower (at 8-hr HRT) to 2.8-fold higher than WC100. A 15-yr cost assessment indicated CC75 ($10.56 to $13.89 kg-1 N) was the most cost-efficient treatment, followed by WC100 ($13.30 to $88.11 kg-1 N) and CC25 ($22.41 to $60.13 kg-1 N). This assessment showed CC75 as a promising alternative to WC100 in terms of N removal rate and cost, but CC25 did not provide sufficient N removal rate increase for it to be a cost-efficient option. Nonetheless, using corncobs as a bioreactor medium is a relatively new approach, and we encourage more field studies to explore the long-term opportunities and challenges.

Evaluation of the costs of agricultural diffuse water pollution abatement in the context of Lithuania's water protection goals and climate change.

This study aimed at evaluating the scale and costs of an environmentally and economically optimal set of Best Management Practices (BMPs) for agricultural pollution abatement in Lithuania in order to reach water protection goals in both inland and marine waters by distributing BMPs optimally in space, while taking climate change impacts into consideration. The assessment of BMPs impact involved the use of the SWAT model by applying two climate change representative concentration pathways (RCP4.5 and RCP8.5) and two time horizons (mid-century and end-century), as well as five BMPs (arable land conversion to grasslands, reduced fertilization, no-till farming, catch-crops, and stubble fields throughout winter). The optimization of the set of BMPs employed a genetic algorithm. The results suggest that the need for BMPs application will increase from 52% of agricultural areas in the historical period up to 65% by the end of century in the RCP8.5 scenario. This means less arable land could actually be used for crop production in the future if water protection targets are met. The high costs for reaching water targets would rise even more, i.e. by 173% for RCP4.5, and by 220% for the RCP8.5 scenario, reaching approximately 200 million euros/year. In such a context, the BMP optimization approach is essential for significant reduction of the costs. Winter cover crops and reduced fertilization show the best effectiveness and cost balance, and will therefore be essential in pursuing water protection targets.

Data on prevalence and management practices of malaria-typhoid co-infection in Unwana South East Nigeria.

Using a descriptive survey design, the prevalence and management practices of malaria and malaria- typhoid co-infection in Unwana South East Nigeria was determined. Two hundred and thirty-six (236) febrile volunteers comprising 104 males and 132 females attending the Medical Centre of Akanu Ibiam Federal polytechnic Unwana, Afikpo Ebonyi state Nigeria participated in this study. Using thick film microscopy and Widal antigen-based agglutination test, one hundred and thirty-seven participants were diagnosed with malaria mono infection while ninety-nine were diagnosed with malaria-typhoid co-infection. Structured questionnaire was used to obtain data on the management practices and attitudes that constitute risk factors to increased incidence of treatment failure of malaria and malaria- typhoid co-infection. The dataset [1] is relevant as a baseline and reference for further research related to factors associated with increased risk of treatment failure and emergence of drug resistance of malaria and malaria-typhoid co-infection in resource poor setting.

Role of corporate social responsibility, management practices, organizational behavior in social equity with mediating role of women empowerment: A study of the Islamic banking sector of South Punjab.

The objective of this study was to identify the relationship between corporate social responsibility (CSR), management practices (MPs), and organizational behavior (OB) in social equity (SE) with the mediating role of women empowerment in the Islamic banking sector of South Punjab. It is a fact that, in the Islamic banking sector, South Punjab is facing a crisis in terms of SE for its employees and customers. This study is based on the quantitative data collected with a five-point Likert scale to identify the relationship between the variables of the framework. Smart PLS 3 software was used in this study to measure the primary data collected by 355 questionnaires. The study concluded that there is an important role of CSR, MPs, and OB in the management of SE in the Islamic banking sector of South Punjab. The theoretical framework of this study is a significant contribution to knowledge as it is based on the significant variables for SE. The study is significant because it provides theoretical as well as practical implications quite useful for the Islamic banking sector of South Punjab to cope with the problem of SE.

Levers of change: using mathematical models to compare gender equity interventions in universities.

Women are under-represented in academic staff in universities worldwide. Our work builds on other studies of 'demographic inertia'. We find that time will not bridge the gender representation gap in academia, and echo others in saying bold actions are required to reach parity. Our work then uses New Zealand's unique system of scoring individual research performance to test empirically which levers universities should pull, and in which combinations. We combine individual research performance scores with 20 years of data from one university to parametrize a rank-structured mathematical model using Leslie matrices. Our model compares three key levers of change at universities' disposal-hiring, promotion and attrition. We apply the model to a bifurcated population of university staff-those with high research activity, and those who are moderately active-based on their national research quality score. We then test levers in various combinations that management could pull to improve gender representation. We find that the solutions are different for the high versus moderate research performers. For individuals with high research activity, universities should concentrate on equitable hiring practices. For those with more moderate research activity, more equitable promotion practices hold the key.

Island ecological restoration and management practices based on nature: Conference report.

As a result of climate change as well as the increasing need for island ecological protection, nature-based solutions have attracted increasing international attention. The impact of climate change and COVID-19 has presented island countries and regions with practical challenges such as rising sea levels, stunted economic development and difficult survival situations. Therefore, finding ways to realize the sustainable development of islands from a nature-based perspective has become a key concern. The Island Research Center of the Ministry of Natural Resources of China etc. organized the International Forum on Island Ecological Protection 2021 on November 19, 2021 with the theme, 'Nature-based Island Ecological Restoration and Management Practice.' The conference, which was held online and face-to-face, brought together front-line staff from government agencies, academic institutions and experts from major countries around the world to discuss emerging issues of sustainable island development.

Hydro-conditioning: Advanced approaches for cost-effective water quality management in agricultural watersheds.

Accurate simulation of landscape hydrological connectivity is pivotal for planning practices required for treating agricultural farm pollution. This study assesses the role of an advanced geospatial approach, namely, 'hydro-conditioning' employed for modifying Digital Elevation Models, termed hDEMs to replicate landscape hydrology by simulating continuous downslope flow through drainage structures such as bridges and culverts. The capabilities of manual and automated hDEMs in delineating optimal locations and water treatment potential of Best Management Practices (BMPs) in a typical agricultural watershed were evaluated. Parallel processing of both hDEMs revealed that 'ground truthing' plays a critical role in the accurate placement of breach lines for allowing water movement through digitally elevated surfaces. Outcomes guide the practitioners in selecting appropriate hDEM (manual or automated) depending on the complexity of modeled hydrological pathways, which is essential for planning BMPs in a cost-effective manner at different spatial scales. Modeling results show that hDEMs greatly influence hydrological connectivity, catchment boundaries, BMP locations, treatment capacities, and related costs. The accuracy of hDEMs was verified using a robust sub-basin scale validation approach. The study recommends a hybrid approach for utilizing the strengths of both, automated and manual hDEMs for efficient agricultural farm pollution in an economical manner.

Systematic Literature Review on Indicators Use in Safety Management Practices among Utility Industries.

BACKGROUND: Workers in utility industries are exposed to occupational accidents due to inadequate safety management systems. Accordingly, it is necessary to characterize and compare the available literature on indicators used in safety management practices in the utility industries. METHODS: The systematic literature review was based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. This study considered 25 related studies from Web of Science and Scopus databases. RESULTS: Further review of these articles resulted in three mains performance indicators; namely, driven leading indicators, observant leading indicators, and lagging indicators consisting of 15 sub-indicators. CONCLUSIONS: Future studies should consider researching a more comprehensive range of utility industries, measuring subjective and objective indicators, integrating risk management into safety management practices, and validating the influence of leading indicators on safety outcomes. Further, researchers recommend including accidents, fatalities, lost time injuries, and near misses in safety outcomes.

The impact of management practices on relative patient mortality: Evidence from public hospitals.

A small, but growing, body of empirical evidence shows that the material and persistent variation in many aspects of the performance of healthcare organisations can be related to variation in their management practices. This study uses public data on hospital patient mortality outcomes, the Summary Hospital-level Mortality Indicator (SHMI) to extend this programme of research. We assemble a five-year dataset combining SHMI with potential confounding variables for all English NHS non-specialist acute hospital trusts. The large number of providers working within a common system provides a powerful environment for such investigations. We find considerable variation in SHMI between trusts and a high degree of persistence of high- or low performance. This variation is associated with a composite metric for management practices based on the NHS National Staff Survey. We then use a machine learning technique to suggest potential clusters of individual management practices related to patient mortality performance and test some of these using traditional multivariate regression. The results support the hypothesis that such clusters do matter for patient mortality, and so we conclude that any systematic effort at improving patient mortality should consider adopting an optimal cluster of management practices.