University managers or institutional leaders? An exploration of top-level leadership in Chinese universities.

In China, higher education institutions (HEIs) have a governance arrangement in which the university president and the party secretary occupy key roles. However, their legal roles as institutional leaders are vaguely specified in existing legal frameworks. Based on a four-dimensional theoretical model, this paper (i) clarifies the leadership roles in the dual governance structure, (ii) explores how HEI leaders (i.e. presidents and party secretaries) perceive their leadership, and (iii) applies the unique Chinese practices as a valuable test bed for critical reflections on how existing theoretical models of leadership are relevant in Chinese contexts. Through in-depth interviews with six top-level leaders from six Chinese public HEIs, our findings indicate that Chinese HEI leaders apply more structural than symbolic dimensions in their leadership practices. Whereas studies on institutional leadership conducted outside China tend to highlight the symbolic dimensions of leadership practices, our study suggests that top-level Chinese HEI leaders may assume the role of university managers rather than institutional leaders. We offer some reflections on the relevance of existing theoretical models of leadership and suggest the directions for further theoretical enhancement. Supplementary Information: The online version contains supplementary material available at 10.1007/s10734-023-01031-x.

Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals.

BACKGROUND: Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. OBJECTIVE: This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. METHODS: This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. RESULTS: From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system-1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). CONCLUSIONS: As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures.

Effect of governance structure on conservation land acquisition in California over the last 100 years.

The process of expanding a network of conservation areas includes identifying valuable areas for conservation, devising policies and implementing conservation actions on the ground. While the first two components are often analyzed in conservation science, the literature seldom focuses on the implementation process, particularly, how the governance structure acts as driver of conservation outcomes. In this paper, we analyze the process of development of the conservation network in California between 1910 and 2010 to test whether governance structure explains the variation in the attribution of land for conservation over time. We find that governance structure does play an important role in the development of the conservation network over the century. We find evidence that polycentric and diverse governance structures result in better conservation outcomes (i.e. more area of land acquired for conservation). Arrangements that included multiple levels of agencies (e.g. Federal, State, and County) better predict the area of conservation land per decade. Location of conservation action per county had an effect on conservation outcomes over the last decades, and we also find a strong negative effect of per capita income in the implementation of conservation actions. These results suggest that it is possible to leverage governance structure to meet future conservation challenges through the maintenance of a diverse and polycentric governance structure.

The Governance of Indigenous Natural Products in Namibia: A Policy Network Analysis.

At the end of the 20th century, optimism existed that non-timber forest products (NTFPs) can form an integral part in conservation and development strategies. However, there is limited knowledge on how the different stakeholders could relate to the state or to each other in promoting commercialization of NTFPs. Applying the policy network as an analytical framework, we investigated the structural patterns of actor relations in the governance structure of indigenous natural products (INPs) in Namibia, to understand the implications of such relations on INP policy process. The findings indicate that the INP policy network in Namibia is multi-dimensional, consisting of the Indigenous Plant Task Team (IPTT)-the key governance structure for resource mobilization and information sharing; and functional relations which serve specific roles in the INP value chain. The existing relations have facilitated policy development particularly for heavily regulated species, such as devil's claw; but for other species, only incremental changes are observed in terms of small-scale processing facilities for value addition and exclusive purchase agreements for sustainable sourcing of INPs. Participation of primary producers, private actors and quality standardization bodies is limited in INPs governance structures, which narrow the scope of information sharing. Consequently, despite that the IPTT has fostered publicly funded explorative pilot projects, ranging from production to marketing of INPs, there are no clear guidelines how these projects results can be transferred to private entities for possible commercialization. Further collaboration and information sharing is needed to guide public sector relations with the private entities and cooperatives.

Governance structure reform and antibiotics prescription in community health centres in Shenzhen, China.

BACKGROUND: It is unclear whether changing the governance structure of community health centres (CHCs) could affect antibiotic prescribing behaviour. OBJECTIVE: To explore how changes in governance structure affect antibiotic prescription for children younger than 5 years of age with acute upper respiratory tract infections (AURI) in CHCs in Shenzhen, China. METHODS: This study used an interrupted time series design with a comparison series. On 1 June 2009, the Health Bureau of Shenzhen's Baoan District transferred CHCs from a hospital-affiliated model to a self-managed independent model regarding finance, personnel and employee compensation. We collected 23481 electronic medical records of children younger than 5 years of age who were treated for AURI on an outpatient basis 1 year before and 1 year after governance structure reform. We used segmented regression analysis to evaluate the effect of reform on antibiotic prescription. RESULTS: After the reform, the proportion of patients receiving an antibiotic injection per month and the proportion of patients receiving two or more antibiotics conditional on receiving an antibiotic per month decreased 9.17% and 7.34%, respectively (P < 0.01 or P < 0.05). In the intervention series, the proportion of patients receiving an antibiotic injection per month and the monthly average cost of the antibiotics prescribed per patient continued to decrease over time compared with the control series (P < 0.001 or P < 0.05). CONCLUSION: This study suggests that governance structure reform can have positive effects on behaviour for antibiotic prescribing. Moreover, this short-term effect might have important implications for further community health reforms in China.

The Impact of Sanming Healthcare Reform on Antibiotic Appropriate Use in County Hospitals in China.

Background: The excessive use of resources and poor quality of care are great concerns worldwide, particularly in China. In 2013, a model of systematic reforms was developed in Sanming to address the inefficiency and waste in public hospitals. However, limited empirical studies have evaluated the effect of Sanming healthcare reform on antibiotic appropriate use. This study aims to evaluate the impact of the healthcare reform on the appropriate use of antibiotics in county-level public hospitals in Sanming, China. Methods: We conducted a retrospective observational study exploring trends in antibiotic use with an interrupted time series design. We selected three county-level hospitals in Sanming and extracted outpatient prescriptions of the Departments of Internal Medicine and the Department of Pediatrics between January 2011 and December 2017. Acute Upper Respiratory Tract Infection (AURI), Acute Bronchitis (AB) and Community Acquired Pneumonia (CAP) were selected as the sample diseases for our analysis. The primary outcome was the percentage of prescriptions conformed with standard treatment guidelines (STGs). Results: A total of 142,180 prescriptions were included in the analysis. During the study period, the percentage of antibiotics prescriptions conformed with STGs boosted from 32.4% in 2011 to 82.3% in 2017. Moreover, after the reform, the rate of prescriptions that conformed with STGs showed significant increasing trends in children with AURI (ß = 1.624, p < 0.001), children with AB (ß = 3.123, p < 0.001), adult with AB (ß = 1.665, p < 0.001), children with CAP (ß = 3.123, p < 0.001), adult with CAP (ß = 4.385, p < 0.001), but not in adult patients with AURI (ß = -0.360, p = 0.022). Conclusion: Our study confirmed that the Sanming healthcare reform helped to promote the appropriate use of antibiotics in county-level hospitals. This systematic approach to healthcare reform, characterized by an effective governance structure, dynamic financial compensation mechanisms, and specialized drug stewardship, is promising for future public hospital reforms.

Implementing Enhanced Recovery After Surgery Across a United States Health System.

Enhanced recovery after surgery (ERAS) is a series of evidence-based perioperative care protocols designed to improve outcomes following surgery. The concept was founded on the principle of producing a predictable quality outcome by reducing morbidity and shortening hospital stay. The key objective of ERAS is to incorporate optimized multimodal perioperative care in a variety of different surgical specialties to reduce injury and stress during the perioperative period and promote a return to normal function rapidly.

Corrigendum: The Impact of Global Dynamic Capabilities on Governance Structure Choice of Partnership: The Moderating Effect of Ambidexterity.

[This corrects the article DOI: 10.3389/fpsyg.2021.619334.].

The Impact of Global Dynamic Capabilities on Governance Structure Choice of Partnership: The Moderating Effect of Ambidexterity.

Research on multinational inter-organizational relationships has demonstrated that the capabilities of small and medium sized enterprises (SMEs) can be developed via partnerships, but at present, we lack studies that relate the development of such capabilities to the management of business governance structure. This study provides a new perspective on internationalized SME marketing strategies in the global context. Using a dynamic capability view of firms, the study develops hierarchical regression models linking global dynamic capabilities and governance structure. This study empirically verifies the research framework from 206 internationalized SME Taiwanese firms. The results confirm previous studies that indicate positive correlations between market orientation, learning orientation, and global dynamic capabilities. The results also indicate that the development of global dynamic capabilities impacts the choice of governance structure in firms. Our study suggests that internationalized SMEs strategically manage their autonomy and strategic options by choosing combinations of different relationship types while they decide to develop global marketing capabilities and global design capability, or both. The study also found that market orientation and learning orientation act as enabling mechanisms for building global dynamic capabilities.

Effective Coordination and Governance of PGRFA Conservation and Use at the National Level-The Example of Germany.

Recognition of the importance of plant genetic resources started in Germany at the end of the 19th century. Plant research and breeding began to develop in the 1920s. Formal structures of public institutions were founded, long-term conservation facilities were established, private breeding initiatives developed. In 1990, the German reunification required an assessment of the existing research and breeding landscape. This milestone allowed a comprehensive overview of the great number of stakeholders, active in the entire range of tasks related to plant genetic resources. The Federal Ministry of Agriculture then developed a conceptual approach for an efficient governance structure and published its concept of a national programme for the conservation and sustainable use of genetic resources for food and agriculture in 2000. It recognized the sharing of decentral responsibilities among the respective public and private actors and governmental levels with dis-tributed mandates and funding. It also led to the establishment of a central information and coordination center for genetic resources, which facilitates the data sharing, communication, and co-operation among stakeholders, supports public awareness and advises the Federal Ministry on national policies and efficient European and global cooperation. It also supports efficient contributions of German stakeholders into European structures and international bodies. An equivalent conceptual approach and governance structure is recommended to be established at European level.

Combining Resource, Structure and Institutional Environment: A Configurational Approach to the Mode Selection of the Integrated Healthcare in County.

Integrated healthcare has received considerable attention and has developed into the highly important health policy known as Integrated Healthcare in County (IHC) against the background of the Grading Diagnosis and Treatment System (GDTS) in rural China. However, the causal conditions under which different integrated health-care modes might be selected are poorly understood, particularly in the context of China's authoritarian regime. This study aims to identify these causal conditions, and how they shape the mode selection mechanism for Integrated Healthcare in County (IHC). A theoretical framework consisting of resource heterogeneity, governance structure, and institutional normalization was proposed, and a sample of fifteen IHCs was selected, with data for each IHC being collected from news reports, work reports, government documents and field research for Fuzzy-sets Qualitative Comparative Analysis (fsQCA). This study firstly pointed out that strong governmental control and centralization are necessary conditions for the administration-oriented organization mode (MOA). Additionally, this research found three critical configured paths in the selection of organizational modes. Specifically, we found that the combination of low resource heterogeneity, weak governmental control, centralization, and normalization was sufficient to explain the selection path of the insurance-driven organization mode (MOI); the combination of low resource heterogeneity, strong governmental control, centralization, and normalization was sufficient for selecting MOA; and the combination of weak governmental control, weak centralization, and weak normalization was sufficient for selecting the contractual organization mode (MOC). Our study highlighted the necessity and feasibility of constructing different IHC modes separately and promoting their development gradually, as a result of the complex relationships among the causal conditions described above, thus helping to optimize the distribution of health resources and integrate the healthcare system.

Practice of Huzhou in promoting the reform of countywide medical and health governance system / 中华医院管理杂志

The construction of a countywide community for medical and health services is designed to upgrade the service capacity of primary medical and health institutions, to promote resource sharing and collaborative services, and promote the hierarchical medical system. Huzhou of Zhejiang province has launched its initiative in building a countywide community for medical services since 2018. The authors summarized its main practices in promoting the integration of the management system and optimizing operating mechanism of countywide medical and health institutions, promoting the reform of the county medical and health governance system, as well as the achievements and shortcomings, with a view to providing reference for promoting the high-quality development of the countywide medical and health service system.

An evaluation of systemic reforms of public hospitals: the Sanming model in China.

Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians' incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value < 0.001), respectively. It is largely accomplished through a decrease in drug expenditures per outpatient visit and per inpatient admission of about 29% (P-value < 0.001) and 53% (P-value < 0.001). These results show that the Sanming model has achieved at least a short-term success in improving the performance of the public hospitals. These findings suggest that such a systemic transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs.

Contractual arrangements in the cattle beef chain: an analysis of trust / Arranjos contratuais na cadeia da carne bovina: uma análise da confiança

ABSTRACT: In Brazil, the conflict between cattlemen and the slaughterhouse industry is evident and historic in the beef cattle Agribusiness System, in which opportunistic behavior is commonplace. Accordingly, the role of trust is significant in trade decisions, which makes the analysis of trust in the construction process of governance structure an important factor. The present article aimed to identify the influence of trust in selecting the contractual arrangement in transactions between cattle ranchers and abattoirs. This qualitative and descriptive study used semi-structured interviews, done in loco, along with 30 beef cattle ranchers and five abattoirs in the west of São Paulo State. It was observed that transactions involve opportunistic behavior, and that trust is critical in selecting the contractual arrangement.

RESUMO: O conflito entre pecuarista e indústria frigorifica é evidente e histórico no Sistema Agroindustrial da carne bovina no Brasil, sendo comum a presença de comportamento oportunista. Nesse sentido, o papel da confiança se apresenta como significativo na decisão de troca, o que torna a análise da confiança no processo de construção da estrutura de governança um fator importante. O presente artigo teve como objetivo identificar a influência da confiança na escolha do arranjo contratual nas transações entre pecuaristas e frigoríficos. O estudo qualitativo e descritivo empregou entrevistas semi-estruturadas, realizadas in loco, junto a 30 pecuaristas de gado de corte e cinco frigoríficos localizados no Oeste Paulista. Observou-se que as transações envolvem comportamento oportunista, e que a confiança exerce fator significativo na escolha pelo arranjo contratual.

Viabilidade econômica da produção de frangos de corte sob diferentes estruturas de governança / Economic viability of broiler production under different governance structures

Objetivou-se verificar a viabilidade econômica da produção de frangos de corte sob mecanismos de governança híbrida e hierárquica. Estudos de caso foram escolhidos para avaliação da atividade em núcleos de empresas integradoras e de produtores rurais integrados. Realizou-se pesquisa de campo para coleta de dados em 36 unidades de produção em Minas Gerais. Informações provenientes de 216 lotes produzidos entre agosto de 2015 e agosto de 2016 foram utilizadas nas análises econômicas. O cálculo dos custos baseou-se na metodologia proposta pela Embrapa - CNPSA e IEA - SP. As análises econômicas se realizaram conforme proposto pelo DAE - Ufla e pela Conab. Constatou-se que o custo com mão de obra causou maior impacto sobre o desempenho econômico de núcleos com estruturas de governança distintas. No modelo de produção via governança hierárquica, mesmo se considerando receitas secundárias ao processo de produção de aves, verificou-se prejuízo financeiro na atividade. Concluiu-se que a estrutura de governança híbrida representou melhor alternativa econômica que a internalização do processo de criação de frangos pelas empresas integradoras. Assim, sugere-se que empresas integradoras esgotem as possibilidades de produção via contrato de integração antes de investirem recursos em instalações próprias de criação.(AU)

The objective was to verify the economic feasibility in the production of broilers under hybrid and hierarchical governance mechanisms. Case studies were used to evaluate the activity of the integrating company and the integrated rural producers. The primary data about costs, income, and zootechnical indicators were collected in 36 poultry production units belonging to an integrated company and five rural producers, in state of Minas Gerais. Data from 216 batches of broilers produced between August 2015 and August 2016 were used in the economic analysis. Costs calculation was based on the methodology proposed by EMBRAPA - CNPSA and IEA - SP. The economic analyzes were carried out as proposed by DAE UFLA and CONAB. It was verified that the cost of labor caused the greatest impact on the economic performance of cores with different governance structures. In all breeding sites via hierarchical governance, even considering secondary revenues, there was a financial loss in the activity. It was concluded that the hybrid governance represented a better economic alternative than the internalization of the broiler production by integrating companies. Thus, it is suggested that integrating companies deplete the production possibilities through an integration contract before investing resources in their own breeding facilities.(AU)

Explorations of the healthcare group reform: Edong Healthcare Group / 中华医院管理杂志

Edong Healthcare Group is cited as an example to introduce the founding background, and summarize its successful practices and outcomes in corporate governance, internal operation management mechanism, and optimized resources deployment within the group.Win-win mechanism is proposed as the key to a successful grouping reform, and further experiment with the hierarchical medical system is recommended for deeper reform in building groups of public hospitals.

Empirical study on the relationship between hospital governance structure and social responsibility / 中华医院管理杂志

This paper sampled 79 TCM hospitals above county level in Jiangsu Province for research.With hospital ownership,board governance and hospital directors as three dimension of internal governance structure,the multiple regression model was used to investigate the impact of such structure on its social responsibility performance.Education level,number of hospital directors,and their values are found to be significant factors on their social responsibility performance.

Practice and insight of corporate governance structure at Jiangsu Kangfu Medical Group / 中华医院管理杂志

Establishing a corporate governance structure is an important goal in this round of public hospital reform.The “group plus corporate governance” model in Zhenjiang is highly typical and significant for building such a structure.This paper introduced the main measures of the group,analyzed the main problems found and proposed policies correspondingly.

Research and practice on corporate governance of public hospitals / 中华医院管理杂志

The paper reviewed basic concepts of corporate governance.Based on these concepts,the authors proposed the general strategy and practices for introducing corporate governance structure at the hospital,and stated key characteristics of such a structural reform,thus making worthwhile attempts to this direction.

Theoretical thoughts on corporate governance structure in public hospitals / 中华医院管理杂志

The paper systematically elaborated the concept of corporate governance structure of public hospitals and theories in relation. In addition, it analyzed the status quo and problems existing in corporate governance structure of public hospitals in China, proposing the basic principles and the council model of corporate governance structure. The authors emphasized the following responsibilities and rights of the council, the president, and the board of supervisors in such a framework: 1) As the hospital's highest decision-maker, the council exercises the rights of ownership, playing a decisive role in hospital management; 2) the president is appointed and dismissed by the council, and authorized to run the hospital; 3) the supervisors are responsible for overseeing the council and senior management. In the end, this paper summarized the external environment required for building corporate governance structure of public hospitals.