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How has Japan become a major economic power, a world leader in the automotive and electronics industries? What is the secret of their success? The consensus has been that, though the Japanese are not particularly innovative, they are exceptionally skilful at imitation, at improving products that already exist. But now two leading Japanese business experts, Ikujiro Nonaka and Hiro Takeuchi, turn this conventional wisdom on its head: Japanese firms are successful, they contend, precisely because they are innovative, because they create new knowledge and use it to produce successful products and technologies. Examining case studies drawn from such firms as Honda, Canon, Matsushita, NEC, 3M, GE, and the U.S. Marines, this book reveals how Japanese companies translate tacit to explicit knowledge and use it to produce new processes, products, and services.

The knowledge-creating company : how Japanese companies create the dynamics of innovation

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)62631-8.pdf

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.

/pdf/patient-safety-satisfaction-and-quality-of-hospital-care-569u8f4bow.pdf

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

ContextBetter health care quality is a universal goal, yet measuring quality
has proven to be difficult and problematic. A central problem has been isolating
physician practices from other effects of the health care system.ObjectiveTo validate clinical vignettes as a method for measuring the competence
of physicians and the quality of their actual practice.DesignProspective trial conducted in 1997 comparing 3 methods for measuring
the quality of care for 4 common outpatient conditions: (1) structured reports
by standardized patients (SPs), trained actors who presented unannounced to
physicians' clinics (the gold standard); (2) abstraction of medical records
for those same visits; and (3) physicians' responses to clinical vignettes
that exactly corresponded to the SPs' presentations.SettingOutpatient primary care clinics at 2 Veterans Affairs medical centers.ParticipantsNinety-eight (97%) of 101 general internal medicine staff physicians,
faculty, and second- and third-year residents consented to be randomized for
the study. From this group, 10 physicians at each site were randomly selected
for inclusion.Main Outcome MeasuresA total of 160 quality scores (8 cases × 20 physicians) were generated
for each method using identical explicit criteria based on national guidelines
and local expert panels. Scores were defined as the percentage of process
criteria correctly met and were compared among the 3 methods.ResultsThe quality of care, as measured by all 3 methods, ranged from 76.2%
(SPs) to 71.0% (vignettes) to 65.6% (chart abstraction). Measuring quality
using vignettes consistently produced scores closer to the gold standard of
SP scores than using chart abstraction. This pattern was robust when the scores
were disaggregated by the 4 conditions (P<.001
to <.05), by case complexity (P<.001), by site
(P<.001), and by level of physician training (P values from <.001 to <.05). The pattern persisted,
although less dominantly, when we assessed the component domains of the clinical
encounter—history, physical examination, diagnosis, and treatment. Vignettes
were responsive to expected directions of variation in quality between sites
and levels of training. The vignette responses did not appear to be sensitive
to physicians' having seen an SP presenting with the same case.ConclusionsOur data indicate that quality of health care can be measured in an
outpatient setting by using clinical vignettes. Vignettes appear to be a valid
and comprehensive method that directly focuses on the process of care provided
in actual clinical practice. Vignettes show promise as an inexpensive case-mix
adjusted method for measuring the quality of care provided by a group of physicians.

https://jamanetwork.com/journals/jama/articlepdf/192552/joc91362.pdf

Comparison of vignettes, standardized patients, and chart abstraction: A Prospective validation study of 3 methods for measuring quality

The aim of this study was to find out whether elected politicians’ attitudes influence policy-making processes in terms of social and health-care resource allocation. A preliminary hypothesis was developed on the basis of previous empirical findings on the attitudes of politicians. If health-care costs decreased during the period 1993–1999, then secondary care costs should have increased and vice versa; if the total amount of resources increased, then secondary care must have been allocated fewer resources. However, the results of this study showed that the actual resource-allocation processes did not reflect the attitudes of local politicians. Expenditure on secondary health care increased during this period, while primary health-care services were allocated fewer resources. Analysing the actual decision-making processes rather than investigating attitudes to priority setting may prove more useful in gaining a better understanding of priority-setting processes and the mechanisms used in different contexts.

Social and health-care priorities of local politicians in Finland: do the attitudes of politicians reflect the actual processes in municipalities?

The aim of this study was to answer the question: How does organisational culture influence nurses' use of scientific knowledge in practice? The culture of the health care organisation was analysed mainly in terms of professionals (nurses, physicians and managers). All three professional subcultures, medical, nursing and managerial, seem to be very important from the patients' point of view. Nursing subculture has, for example, different philosophy, knowledge and values about the purpose and practices of the work. Despite this, many nurses hold medical norms, values and expectations to be more important than those of their own subculture. Consequently, when caring for patients such nurses act and behave according to medical knowledge and cultural assumptions. The influence of cultural factors on use of scientific knowledge in nursing practice can be classified as follows: (1) the nursing subculture is strong but old-fashioned and conservative, (2) the nursing subculture is weak and nurses are expected to act according to some of the competitive subcultures, (3) the content and construction of the process of work socialisation prevent the application of new scientific knowledge. These results must be confirmed in further empirical studies to determine their general validity for the primary health care system in Finland. The cultural analysis of health care system provides new information about why systematic scientific knowledge has not changed nursing practice as much as expected.

Juha Kinnunen

Papers

Social and health-care priorities of local politicians in Finland: do the attitudes of politicians reflect the actual processes in municipalities?

Impact of Organisational Culture on Use of Scientific Knowledge in Nursing Practice

The time series properties of accrual versus cash-based income variables : empirical evidence from listed finnish firms

The Prediction of International Accounting Standards Profits from Financial Statements of Finnish Firms

The Association of Stock Returns with International Accounting Standard Earnings