Decision Challenges for Managing Acute Paediatric Infections: Implications for Antimicrobial Resistance.

Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific challenge being the prominent role of parents and carers who act as intermediaries between prescribers and paediatric patients. In this Perspective article concentrating on healthcare of the United Kingdom, we describe this complicated interplay of different decision stakeholders (patients, parents and prescribers), outline four dimensions of decision challenges (social, psychological, systemic and specific diagnostic and treatment challenges) and provide a number of theory-based strategies for supporting different stakeholders during the decision process, ultimately with the aim of improving antimicrobial stewardship. Key decision challenges for patients and carers include limited knowledge and experience of managing infections, which were exacerbated during the COVID-19 pandemic and frequently result in health anxiety and inappropriate health-seeking behaviours. Challenges for medical prescribers span societal pressures from prominent patient litigation cases, cognitive biases, and system pressures to specific diagnostic problems (e.g., age limitations of current clinical scoring systems). Strategies for mitigating decision challenges in paediatric infection management will need to include a range of context- and stakeholder-specific actions, including improvements of integrated care and public health education as well as better clinical decision tools and access to evidence-based guidelines.

Production Capacity Reserve Strategy of Emergency Medical Supplies: Incentive Model for Nonprofit Organizations

In 2020, COVID-19 swept across the globe. To reduce the social harms caused by this public health event, nonprofit organizations (NPOs) cooperated with medical enterprises to produce reserves of emergency medical supplies. In practice, this cooperation was challenged by the different goals of NPOs and medical enterprises and the asymmetry of information between these parties. Enterprises are prone to irregularities or speculative behaviors that can result in insufficient production capacity during public health events, which increase disaster risks. Based on the principal–agent relationship of NPOs and enterprises, this study analyzed a game model between NPOs and enterprises under information asymmetry;constructed an incentive model for reserve emergency medical supply production capacity;and solved the optimal reward and punishment coefficients of NPOs, optimal effort level of enterprises, and benefits of disaster reduction. The study also verified the validity of the model using numerical examples and a sensitivity analysis. In taking up the findings of the study, this paper discusses the effects of several important exogenous variables on the optimal decision strategies of NPOs and enterprises and offers management-related insights for NPOs. © 2022 by the authors.

Listed public–private enterprises: stock market information, agency costs and productive efficiency outcomes

Purpose>This paper addresses the social value of commercial enterprises that are jointly owned by a government and private sector investors and where the shares are listed on a stock exchange: thus, “listed public–private enterprises” (LPPEs). The theoretical part of the paper addresses how differences in ownership patterns influence the behavior and performance of LPPEs.Design/methodology/approach>We develop a conceptual taxonomy, drawing on the empirical evidence on the behavior and performance of public–private hybrid enterprises and on the application of agency theory to that evidence. The taxonomy discussion predicts how different ownership patterns affect enterprise productive efficiency and the ability of governments to achieve social goals through LPPEs. We review the empirical literature on government enterprise ownership and on the concentration of private share ownership to deduce how these matter for owner and managerial behavior and productive efficiency. We review the literature that considers the informational content that listing of an enterprise's shares on a stock exchange can provide to enterprise owners, managers and other domestic audiences with a policy interest. We employ a social welfare perspective to derive policy implications as to when the LPPE governance structure is most appropriate.Findings>We show how the monitoring and performance weaknesses of state ownership are offset by some private ownership, particularly when combined with listing on a stock exchange. We demonstrate the effects of different governance structures on enterprise productive efficiency. We find that the LPPE structure is particularly appropriate as an alternative to nationalization or to full privatization and regulation of natural monopoly public utilities, and as an alternative to full private ownership and taxation of non-renewable natural resource extractive enterprises.Originality/value>This paper explicitly addresses the question of why and how the combination of government ownership, private investor ownership and listing on an exchange is socially valuable in providing information on productive efficiency to governments.

Partnering with Agents: How the Covid-19 Pandemic changed Relations between the UK Government and Public Service Contractors.

The contracting out of public goods and services has become a central feature of the UK's state machinery, with more than £350 billion spent annually on services ranging from rubbish collection to building submarines. In response to the Covid-19 pandemic, the UK government took the unprecedented step of incorporating private providers at a national scale to deliver emergency services which were previously the purview of the state. To achieve this, the government used emergency legislation temporarily to remove competitive tenders and reduced reporting processes. In doing so, it substantially re-orientated its relationship with private providers, moving from a position of a principal granting its authority to deliver services to something more akin to a partner organisation leveraging private resources. This shift in power dynamics, coupled with an ongoing government ambition to expand the UK's public service markets, risks a permanent change in government-provider relations, to the detriment of the UK's contracting out framework.

Intraorganization conflicts of interest in hospitals adapting to a changing ecosystem.

PURPOSE: Health systems function in an ecosystem that is turbulent and competitive because of demographic, economic, political, technological and lifestyle changes and sociopolitical influences, requiring hospitals to adopt comprehensive business strategies. Failure to do so may result in duplication, waste and deficits. This original article uses the prism of agency theory to examine differences in approach at two levels of hospital management and the consequent problems in the incorporation of necessary changes. Agency theory posits an inherent conflict of interest in organizations, including health organizations: the managers (agents) always aim to maximize their profit or personal interest instead of that of the owner or organization (principal), potentially causing difficulty in managing the organization. The aim is to generate recommendations for policymakers. DESIGN/METHODOLOGY/APPROACH: The study is based on 30 semi-structured, in-depth interviews with key figures in the health system and on two levels of hospital management: senior managers and heads of selected departments. The analysis used a categorical qualitative methodology. FINDINGS: The main findings are five key themes: views of business behavior, asymmetry of interests, asymmetry of information, transparency and cooperation between various levels of management and ambivalence toward business in hospitals. The two levels of management are clearly divided in terms of interests, information and activity, leading to difficulty in cooperation, efficiency and achievement of organizational goals. ORIGINALITY/VALUE: Using agency theory, this study provides a systemic and organizational view of hospitals' management and environmental adaptation. Understanding the processes and increasing cooperation at various managerial levels can help make the system more efficient and ensure its survival in a dynamic market.

Healthy conflict?: Healthcare operations in light of inter-organizational conflict

PurposeThis paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies.Design/methodology/approachThis briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context.FindingsHealthcare systems around the globe have been hit hard by COVID-19. In Israel this is no different, and yet their system was already under considerable pressure due to the internal conflicts between practitioners and administrators.Originality/valueThe briefing saves busy executives, strategists and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format.

Healthy conflict?

Purpose: This paper aims to review the latest management developments across the globe and pinpoint practical implications from cutting-edge research and case studies. Design/methodology/approach: This briefing is prepared by an independent writer who adds their own impartial comments and places the articles in context. Findings: Healthcare systems around the globe have been hit hard by COVID-19. In Israel this is no different, and yet their system was already under considerable pressure due to the internal conflicts between practitioners and administrators. Originality/value: The briefing saves busy executives, strategists and researchers hours of reading time by selecting only the very best, most pertinent information and presenting it in a condensed and easy-to-digest format. © 2021, Emerald Publishing Limited.