Detecting organisational innovations leading to improved ICU outcomes: a protocol for a double-blinded national positive deviance study of critical care delivery

Technostress, Academic Self-Efficacy, and Resistance to Innovation: Buffering Roles of Knowledge Sharing Culture and Constructive Deviant Behavior

Aim

Scholarly works have primarily found a negative relation between technostress and individual performance outcomes. Nevertheless, there needs to be more empirical research that casts light on the underlying causal mechanism. The current study hypothesizes that technostress affects students' resistance to innovation through the mediating role of academic self-efficacy. Further, the study proposes innovation as a salient goal as a meta-level moderator. To capture this factor, the study investigates constructive deviant behavior and knowledge sharing culture as the buffering agents stimulating these links.

Methods

On a sample of 412 Chinese university students, the authors assess the structural model guided by the social cognitive theory to examine the predictive capability of the hypothesized relationships.

Results

The study found that technostress diminishes students' self-efficacy, which in turn augments resistance to innovation. Besides, constructive deviant behavior and knowledge sharing culture significantly moderate the direct association between technostress and self-efficacy and the indirect relationship between technostress and self-efficacy and then resistance to innovation.

Discussion

The study offers several meaningful theoretical and practical implications related to the critical role of technostress in deteriorating students' self-efficacy beliefs and enhancing resistance to innovation.

Rethinking How We Measure Costs in Implementation Research

BACKGROUND

Hospitals and other health care delivery organizations are sometimes resistant to implementing evidence-based programs, citing unknown budgetary implications.

OBJECTIVE

In this paper, I discuss challenges when estimating health care costs in implementation research.

DESIGN

A case study with intensive care units highlights how including fixed costs can cloud a short-term analysis.

PARTICIPANTS

None.

INTERVENTIONS

None.

MAIN MEASURES

Health care costs, charges and payments.

KEY RESULTS

Cost data should accurately reflect the opportunity costs for the organization(s) providing care. Opportunity costs are defined as the benefits foregone because the resources were not used in the next best alternative. Because there is no database of opportunity costs, cost studies rely on accounting data, charges, or payments as proxies. Unfortunately, these proxies may not reflect the organization's opportunity costs, especially if the goal is to understand the budgetary impact in the next few years.

CONCLUSIONS

Implementation researchers should exclude costs that are fixed in the time period of observation because these assets (e.g., space) cannot be used in the next best alternative. In addition, it is common to use costs from accounting databases where we implicitly assume health care providers are uniformly efficient. If providers are not operating efficiently, especially if there is variation in their efficiency, then this can create further problems. Implementation scientists should be judicious in their use of cost estimates from accounting data, otherwise research results can misguide decision makers.

Exchange variables, organizational culture and their relationship with constructive deviance

Purpose

Constructive deviance is a behavior that can contribute to the effectiveness of an organization despite its problematic nature. Too few studies have examined the correlates of this behavior. The purpose of this study is to examine variables that represent exchange and organizational culture and their relationship to supervisor-reported and self-reported constructive deviance.

Design/methodology/approach

The survey data were collected from 602 employees (a response rate of 67 per cent) in a large municipality in central Israel. Hierarchical linear modeling (HLM) analyses were performed for each of the dependent variables (three self-reported constructive deviances and three supervisor-reported constructive deviance) controlling for divisions and departments.

Findings

The findings showed that self-reported constructive deviance was explained much better by the independent variables than supervisor-reported deviance. Organizational justice and moral identity had a strong direct effect on constructive deviance (self-reported). The mediation effect showed that an organizational climate for innovation had the strongest mediation effect among the mediators. Psychological contract breach was found to have a limited effect on constructive deviance.

Practical implications

Organizations should encourage procedural justice to encourage their employees to act in support of the organization, whether openly (formal performance) or more secretly (constructive deviance). Also, organizations should support innovation climate if they want to increase constructive deviance of their employees.

Originality/value

In a time when innovation and creativity are gaining increasing importance as behaviors that contribute to organizational success, more research on constructive deviance is expected. This study increases our understanding of this important concept stimulates additional studies of it.

Temporal and Geographic Variation in the Incidence of Alzheimer's Disease Diagnosis in the US between 2007 and 2014

OBJECTIVES

Our aim was to describe the incidence of Alzheimer's disease (AD) in the United States, overall and by geographic region.

DESIGN

We conducted retrospective analyses of administrative claims data for a 5% random sample of US Medicare beneficiaries aged 65 years or older. AD incidence, defined as a diagnosis for AD (International Classification of Disease, Ninth Revision, Clinical Modification code 331.0×) in a given year, with no AD diagnosis in the beneficiary's entire medical history, was estimated for each calendar year between 2007 and 2014. Beneficiaries were required to be enrolled in Medicare for the calendar year of evaluation as well as the preceding 12 months. In addition, a cross-sectional assessment of geographic variation in AD incidence was conducted for 2014. For each population area (specifically, core-based statistical area, as defined by the US Census Bureau), AD incidence was estimated overall, as well as adjusted for differences in underlying patient demographics and metrics of access to care and quality of care. Changes in AD incidence from 2007 were also estimated.

SETTING

US fee-for-service Medicare.

PARTICIPANTS

US Medicare beneficiaries aged 65 years or older with no history of AD.

RESULTS

Overall, the diagnosed incidence of AD decreased over time, from 1.53% in 2007 to 1.09% in 2014; trends were similar for most population areas. In 2014, the rates of AD incidence ranged from 0% to more than 3% across population areas, with the highest observed incidence rates in areas of the Midwest and the South. Statistical models explain little of the geographic variation, although following adjustment, the incidence rates increased the most (in relative terms) in rural areas of western states.

CONCLUSION

Our findings are consistent with previously reported estimates of incidence of AD in the United States and its recent declining trend. Additionally, the study highlights the considerable geographic variation in the incidence of AD in the United States and suggests that further research is needed to better understand the determinants of this geographic variation. J Am Geriatr Soc 68:346-353, 2020.