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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

Background: It has earlier been suggested that one-third of violent offenders are recorded in psychiatric case registers. Our aim was to study whether violent and non-violent offenders differ with respect to admissions to any health care inpatient service due to psychiatric disorders. Methods: We used a genetically homogeneous, general population database from the Northern Finland 1966 Birth Cohort, together with the Finnish Hospital Discharge Register and national crime registers. Results: We found that one-third of violent and one-fourth of non-violent male offenders had at least one hospital admission due to a psychiatric disorder before the age of 32. Sixty-five violent criminals – 1.2% of all cohort males (n=5636) – accounted for 14.4% of all psychiatric treatment days. The admission rates among both violent and non-violent male offenders were significantly higher when compared with males with no criminal history. Among violent males, only half (55.5%) of the inpatient hospital days due to psychiatric disorders occurred in psychiatric hospitals. The corresponding percentages for non-violent criminals and non-criminals were 64.9% and 74.1%, respectively. Among the violent offenders, one-third of hospital inpatient days occurred in university hospitals or central hospitals, and only 1.9% of them occurred in a comprehensive community care system. Conclusions: Violent offenders' admission rates due to a psychiatric diagnosis are high, and they are frequently treated at an inappropriate health care level.

Psychiatric admissions at different levels of the national health care services and male criminality: the Northern Finland 1966 Birth Cohort study.

The aim of this article is to examine, by means of an empirical study, the: a) relationship between formal and cultural structures; b) similarities and differences between professional subcultures (medical, nursing and managerial); and, c) the effects of the social assumptions of the work teams on development activities in one large primary health care organization. The results show that different professional groups have created quite different sets of social values, norms and assumptions, which have significant consequences, both for patients care and organizational performance.

The importance of organizational culture on development activities in a primary health care organization

Somatic morbidity and criminality: the Northern Finland 1966 Birth Cohort Study

Using data for a sample of listed Finnish firms for 1995–97 this paper examines the coincidence of reported cash flows with corresponding cash flows estimated from income statement and balance sheet data. The issue is important in light of prior empirical studies that have analysed the properties and usefulness of cash flow information derived from income statements and balance sheets. In addition, financial analyses of firms not disclosing cash flow statements are implicitly based on the assumption that income statements and balance sheets are useful in producing unbiased and efficient estimates of cash flows. The overall findings indicate that reported cash flows do not always articulate with income statements and balance sheets and that non-articulation can be observed in cash flows from operating, investing and financing activities. The differences between reported and estimated cash flows prove to be mostly random. The findings on cash flows from operating activities indicate that differences attribu...

Do cash flows reported by firms articulate with their income statements and balance sheets? Descriptive evidence from Finland

We establish a local boundedness estimate for weak subsolutions to a doubly nonlinear parabolic fractional $p$-Laplace equation. Our argument relies on energy estimates and a parabolic nonlocal version of De Giorgi's method. Furthermore, by means of a new algebraic inequality, we show that positive weak supersolutions satisfy a reverse Holder inequality. Finally, we also prove a logarithmic decay estimate for positive supersolutions.

Juha Kinnunen

Papers

Psychiatric admissions at different levels of the national health care services and male criminality: the Northern Finland 1966 Birth Cohort study.

The importance of organizational culture on development activities in a primary health care organization

Somatic morbidity and criminality: the Northern Finland 1966 Birth Cohort Study

Do cash flows reported by firms articulate with their income statements and balance sheets? Descriptive evidence from Finland

Some local properties of subsolutons and supersolutions for a doubly nonlinear nonlocal parabolic $p$-Laplace equation