Alerts as Coordination Mechanisms

In this study, we explore how clinical decision support features can be designed to aid teams in caring for patients during time-critical medical emergencies. We interviewed 12 clinicians with experience in leading pediatric trauma resuscitations to elicit design requirements for decision support alerts and how these alerts should be designed for teams with shared leadership. Based on the interview data, we identified three types of decision support alerts: reminders to perform tasks, alerts to changes in patient status, and suggestions for interventions. We also found that clinicians perceived alerts in this setting as coordination mechanisms and that some alert preferences were associated with leader experience levels. From these findings, we contribute three perspectives on how alerts can aid coordination and discuss implications for designing decision support alerts for shared leadership in time-critical medical processes.

Faith in localisation? The experiences of local faith actors engaging with the international humanitarian system in South Sudan

Localisation, as it aims to shift power in the humanitarian system, will involve the increased inclusion of local faith actors, those national and local faith-affiliated groups and organisations that are often first, and last, responders in crises and have been responding in humanitarian contexts for many years, but often in parallel to humanitarian coordination mechanisms. In primary research in South Sudan with local faith actors and international humanitarian actors, this article aims to examine the inroads and barriers to local faith actor involvement in the humanitarian system and the realisation of localisation with local actors such as these. The research is based on an ethnographic study in which researchers were imbedded in a humanitarian project that aimed to help bridge divides between local faith actors and the international humanitarian system. The findings are based on one-on-one and group interviews with 89 participants from a range of international and local, and faith and secular, organisations. Findings indicate that local faith actors are active in responding to crises and want to be linked to the humanitarian system, but they feel distanced from it and pigeonholed as local faith actors. Formalisation through the appropriate registration systems and then training and networking with the humanitarian system helped them build legitimacy and feel confident to participate in humanitarian coordination. International humanitarian actors can help bridge barriers by understanding and connecting with the local faith actors and challenging their own assumptions about who local faith actors are.

Persistent Developmental Limits to Devising Policy Innovation for Innovation Policies in Emerging Economies

Promising industrial profiles of Southeast Asian emerging economies have met their developmental limits in the face of the Asian Financial Crisis in the late 1990s. However, following the crisis, they have not been successful in upscaling the technological competitiveness of their industries. By applying the national innovation system approach originally developed in advanced western economies as an institutional mechanism of policy innovation in light of developmentalism, I seek to explain these persistent developmental limits in Malaysia and Indonesia. My qualitative research examines literature discussing policy coordination mechanisms in innovation policies and policy documents containing coordination mechanisms involving firms, universities, and government agencies; then, how these issues implicate innovation policies in the two countries. I employ a comparative institutional analysis between them focusing on institutional characteristics of the national innovation systems, specifically their institutional obstacles occurring within development paths amidst prevailing political environments. I suggest that persistent developmental limits in Malaysia and Indonesia result from systemic failures of achieving developmental aims regardless of their politico-administrative regimes. Existing institutional frameworks of the national innovation systems, entrenched in the socio-economic prevalence of the two countries, have not fit the nations’ developmental aims pursued upon innovation upgrading.

Innovation and Competitiveness in the Copper Mining Global Value Chain: Developing Local Suppliers in Peru

Peru is the second largest producer and exporter of copper in the world. However, the countrys sector has weak background linkages and the emergence of innovative suppliers able to provide high-value products and services is still incipient. This article explores the opportunities to leverage Perus international positioning in the mining industry to foster the development and innovation capacities of local suppliers. Based on data analysis and interviews with local industry stakeholders, this research--which uses the global value chain framework--finds that the incorporation of a larger number of high-value local suppliers into the copper value chain is limited by weaknesses in the national innovation system. In addition to this, it notes that the national copper policy places little emphasis in the need to innovate and add value. In order to generate a critical mass of strong and innovative suppliers, Peru must create solid institutions and coordination mechanisms to develop the sector. At the same time, it should favor the insertion of domestic suppliers into the value chain and incentivize these to innovate and scale. The article presents recommendations in these areas, as well as best practices from other mining countries that have successfully overcome these challenges.

Bottom-Up Approach to Establish Coordination Mechanisms for Disaster Preparedness Among Largely Private Health-Care Providers in Central Tokyo

In Japan, despite its private-dominant and disjointed health-care system, national initiatives to coordinate various types of health-care facilities are lacking. Municipal governments manage this task with limited resources. This study describes a successful example of a bottom-up approach to create city-wide collaboration for disaster preparedness. In Minato City, located in central Tokyo, a group of physicians created a project involving a city-wide disaster medical care drill. The city Public Health Center, in charge of health-care systems including disaster medicine, helped the group to increase proponents of the project. The city-wide disaster drill started in November 2017; thereafter, the drills were held every year. Participation in drills by various health-care personnel helped establish a city-wide system for disaster medical care, coordination mechanisms among stakeholders, increased motivation among health-care personnel, and development of in-hospital systems. This approach is flexible and applicable to various forms of health-care systems in other areas.

Aligning policymaking in decentralized health systems: Evaluation of strategies to prevent and control non-communicable diseases in Nigeria

Noncommunicable diseases (NCDs) are leading causes of death globally and in Nigeria they account for 29% of total deaths. Nigeria’s health system is decentralized. Fragmentation in governance in federalised countries with decentralised health systems is a well-recognised challenge to coherent national health policymaking. The policy response to the rising NCD burden therefore requires strategic intent by national and sub-national governments. This study aimed to understand the implementation of NCD policies in Nigeria, the role of decentralisation of those policies, and to consider the implications for achieving national NCD targets. We conducted a policy analysis combined with key informant interviews to determine to what extent NCD policies and strategies align with Nigeria’s decentralised health system; and the structure and process within which implementation occurs across the various tiers of government. Four inter-related findings emerged: NCD national policies are ‘top down’ in focus and lack attention to decentralisation to subnational and frontline care delivery levels of the health system; there are defective coordination mechanisms for NCD programmes which are underpinned by weak regional organisational structures; financing for NCDs are administratively burdensome and fragmented; and frontline NCD service delivery for NCDs are not effectively being integrated with other essential PHC services. Despite considerable progress being made with development of national NCD policies, greater attention on their implementation at subnational levels is needed to achieve more effective service delivery and progress against national NCD targets. We recommend strengthening subnational coordination mechanisms, greater accountability frameworks, increased and more efficient funding, and greater attention to integrated PHC service delivery models. The use of an effective bottom-up approach, with consideration for decentralization, should also be engaged at all stages of policy formulation.