Eitan Naveh

Standardization and Discretion: Does the Environmental Standard ISO 14001 Lead to Performance Benefits?

This study sought to determine if the environmental management standard ISO 14001 helps organizations reduce the negative impact their business activities may have on the environment, and as a result, also improves their business performance. Forty organizations participated in the study and described how they implement ISO 14001 requirements. They also reported how the standard impacts on their environmental and business performance. The results show that if ISO 14001 requirements become part of the organizations daily practices, then standardization of the organizations handling of environmental issues follows-leading, consequently, to better organizational environmental performance. In addition, standardization augments its effect on organizational environmental performance through its positive impact on employee discretion. Allowing employees discretion further improves environmental performance. We saw that discretion partially mediates the effect of standardization on environmental performance. Analysis of survey and financial data did not reveal any support for the hypothesis that achieving improvement in environmental performance as result of ISO 14001 implementation leads to better business performance; on the other hand, we saw that business performance was not harmed

Innovation and Attention to Detail in the Quality Improvement Paradigm

This study asserted that quality improvement (QI) requires the coexistence of two cultural values of innovation and attention to detail and proposed that their coexistence depends on the implementation of multiple QI practices. A longitudinal QI intervention, with five phases, consisting of multiple QI practices--ISO 9000, QI teams, quality goals, and coaching and communication by top management--was implemented.Participants were 425 employees working in 18 departments of four manufacturing plants. The QI practices were implemented in a different order in each one of the plants. Measures were assessed five times, at the end of each implementation phase. We used hierarchical linear models (HLM) to account for the nested structure of departments within the plants and the five repeated measures.Findings demonstrated that the above-mentioned QI practices had differential effects on innovation and attention to detail: ISO 9000 positively affected attention to detail but negatively affected innovation. Both QI teams and quality goals positively affected innovation. Thus, the multiple QI initiative enabled the coexistence of the two aforementioned cultural values. Both cultural values had a positive impact on performance quality and productivity and partially mediated the effects of ISO 9000 on productivity.

When does the ISO 9000 quality assurance standard lead to performance improvement? Assimilation and going beyond

ISO 9000 is a management standard that provides customers with assurance that their registered suppliers have a consistent quality system to which they adhere. This paper draws on four sources to show how ISO 9000 can lead to performance improvement: 1) theories of induced innovation and improvisation; 2) the literature on ISO 9000; 3) a case study of a telecom company; and 4) a survey of 1,150 North American companies. We find that the extent to which ISO 9000 is associated with performance improvement depends on the level of its assimilation, and the degree to which an organization goes beyond the minimal requirements of the standard.

Readiness to report medical treatment errors: the effects of safety procedures, safety information, and priority of safety.

Background:Medical error reporting is an essential component of patient safety enhancement. However, increasingly, the literature points to a problem of underreporting of treatment errors, mainly as a result of the fear of malpractice lawsuits and limited formal data collection systems. Few studies, if any, have examined the influence of informal aspects of the organization, such as safety climate, on employees’ willingness to report errors. Objectives:This study investigated the relationship between safety climate aspects and personnel readiness to report treatment errors in different hospital departments. Method:The model was tested in 3 hospitals (n = 632 in 44 medical departments of 3 types; internal medicine, surgery, and intensive care). Three safety climate aspects were measured using questionnaires: the way employees perceive the safety procedures, the safety information flow within their department, and the relative priorities given to safety in the department. Readiness to report was measured by tallying each departments annual number of treatment errors reported to the hospitals’ risk management systems. Results:Negative binomial regression analysis indicated that the more personnel perceive procedures as suitable and safety information as available, the higher was their willingness to report treatment errors. These relationships significantly differed depending on the department type. Conclusions:Hospitals should take into account the perceptions of personnel regarding safety procedures and information and understand that these perceptions operate differently in different department types in their effect on the staffs willingness to report treatment errors.

Implementing ISO 9000: performance improvement by first or second movers

When an organization implements a new managerial practice how should timing affect its decision? Should it be among the organizations that implement the new management practices early, i.e. first movers, or wait for others to implement and implement it a later time, i.e. second movers. The literatures findings with regard to many management practices, especially those that deal with quality, such as total quality management, suggest that while first movers implement a new management practice because of real needs and a high fit between what the practice suggests and their needs (technical efficiency), second movers implement the new management practice because of customer pressure and the fear of falling behind the competition (external pressure). Second movers just mimic first movers, and the new practice does not really fit with their operations. Thus, the new management practice achieves more for the first movers than the second movers. In this paper we ask whether this premise holds for the ISO 9000 quality standard, one which was specified in considerable detail by outside forces but was implemented in many different ways by organizations. Our results are based on a survey of 1150 quality managers who implemented ISO 9000. We find that learning is a more important factor than timing in explaining ISO 9000 performance. First movers achieve a high level of performance because they learn from their own experience, and second movers achieve a high level of performance because they learn from the experience of others. Whether an organization is a first mover or second, the ones that benefit from ISO 9000 are those who learn.

A Survey of Pain, Pressure, and Discomfort Induced by Commonly Used Oral Local Anesthesia Injections

Intraoral local anesthesia is essential for delivering dental care. However, it is often perceived by some patients as the most painful and in some instances as the only painful part of the treatment, leading in extreme cases to avoidance of dental care. The present study measured the variables of pain, pressure, and discomfort caused by 4 commonly used local anesthesia injections: local infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament injections. Patients were asked to grade pain, discomfort, and pressure on a visual analog scale as associated with needle insertion, operator finger position in the mouth, and pressure at injection. The inferior alveolar injection was graded to be the most painful followed by periodontal ligament and then mental nerve block injections. The periodontal ligament injections yielded the highest pressure scores. The inferior alveolar block injection yielded significantly more discomfort than local infiltration and mental nerve block injections when comparing finger and needle position. Local infiltration in the anterior maxillary region yielded the highest needle insertion and finger position discomfort scores. The present study suggests that the dental operator should be aware of local anesthesia injection pain, pressure, and discomfort together with efficacy of technique.

How quality improvement programs can affect general hospital performance

PURPOSE Given the enormous size of the health care industry, the problem of developing high-quality, cost-effective health care delivery systems is growing in importance. There is general consensus that health care systems require a continuous process of quality improvement (QI). Less agreement, however, surrounds the mechanisms to be implemented so that such a process is effective. This study aims to bring empirical evidence to support the hypothesis that a QI program in a general hospital - a special context of the health care delivery system - does not necessarily lead to better overall organizational performance results. DESIGN/METHODOLOGY/APPROACH The study was done at the hospital level, and included all acute care hospitals in Israel. Data was collected in 16 of the countrys 23 hospitals, a 70 percent response rate. The study compared hospital performance before and after the QI program implementation. FINDINGS The study shows that QI creates meaningful improvement events. In addition, the research supports the hypothesis that increasing the number of QI activities (items) included in the QI program brings about more improvement events. The results do not support the hypothesis that high, rather than low, intensive implementation of QI activities leads to more improvement events. ORIGINALITY/VALUE The special context of general hospitals decreases the effects of a QI program on overall hospital performance, whereas QI activities function as triggers in initiating improvement events.

The cardiovascular effect of local anesthesia with articaine plus 1:200,000 adrenalin versus lidocaine plus 1:100,000 adrenalin in medically compromised cardiac patients: a prospective, randomized, double blinded study

OBJECTIVES This study compared cardiovascular safety profiles of 2 local anesthetics (LA): articaine (Ubistesine) versus standard lidocaine solution in cardiovascular patients. STUDY DESIGN Fifty cardiovascular patients were randomly assigned to dental treatment using 1.8 mL of one of two LA injections: articaine 4% and adrenalin 1:200,000 or lidocaine 2% and adrenalin 1:100,000. A computerized system enabled continuous longitudinal data collection: electrocardiography (ECG), O(2)-saturation, blood pressure (BP), and heart rate (HR). Patients scored pain level at the end of the LA injection (on a 0 to 10 scale). RESULTS There were no clinical severe adverse effects. One transient local parasthesia occurred (lidocaine group), which lasted 4 weeks. There were no statistically significant differences between the 2 groups in HR, systolic or diastolic-BP, and O(2) saturation. Age, gender, jaw treated, treatment duration, and the pain level did not influence the results of the comparison. In 3 patients asymptomatic ischemic changes were noted on ECG (1 in the lidocaine group and 2 in the articaine group). CONCLUSIONS LA with articaine 4% with adrenalin 1:200,000 was comparably as safe as LA with standard concentrations of lidocaine and adrenalin in cardiovascular patients. Cardiac ischemic changes on ECG did not appear to be related to the LA.

Active Learning: When Is More Better? The Case of Resident Physicians' Medical Errors

An active learning climate facilitates new knowledge acquisition by encouraging employees to ask questions, seek feedback, reflect on potential results, explore, and experiment. These activities, however, also increase a learners chances of erring. In high-reliability organizations, any error is unacceptable and may well be life threatening. The authors use the example of resident physicians to suggest that by adjusting the conditions of priority of safety and managerial safety practices, organizations can balance these potentially conflicting activities. Participants in the study were 123 residents from 25 medical wards. Results demonstrated that the positive linear relationship between priority of safety and safety performance, demonstrated in earlier studies, existed only when the active learning climate was low. When the active learning climate was high, results demonstrated a U-shaped curvilinear relationship between priority of safety and number of errors. In addition, high managerial safety practices mitigated the number of errors as a result of the active learning climate.

The effects of administrative innovation implementation on performance: an organizational learning approach

This study defines organizational learning as greater cognizance of action-outcome relationships and the effects that environmental events have on these relationships. It shows that two learning mechanisms, adaptation-in-use and change catalysis, are key factors inrealizing gains from the implementation of administrative innovations. Adaptation-in-use denotes ongoing adjustment of the innovation to the organizational context. Change catalysis means that implementation is an occasion for rethinking the way the organization does business and an opportunity to introduce additional new practices and to innovate. A total of 1150 facilities belonging to 885 companies that implemented the worldwide quality standard ISO 9000 participated in this study. Results demonstrate that the effects of implementation of this administrative innovation on performance are curvilinear; both too little and too much implementation have a negative effect on performance. The two learning mechanisms moderate the relationship between implementation of the administrative innovation and subsequent performance, such that implementation is associated with higher performance when adaptation-in-use and change catalysis are high rather than low.