The literature on how organizations respond to institutional pressure has shown that the individual decision-makers’ interpretation of institutional pressure played an important role in developing organizational responses. However, it has paid less attention to how this interpretation ultimately contributes to their range of organizational decisions when responding to the same institutional pressure. We address this gap by interviewing board members of U.S. and Dutch hospitals involved in adopting best practices regarding board evaluation. We found four qualitatively different cognitive frames that board members relied on to interpret institutional pressure, and which shaped their organizational response. We contribute to the literature on organizational response to institutional pressure by empirically investigating how decision-makers interpret institutional pressure, by suggesting prior experience and role definition as moderating factors of multidimensional cognitive frames, and by showing how these cognitive frames influence board members’ response to the same institutional pressure.
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Research conducted by the Research Group Study Success indicates that many students experience performance pressure. In addition, we’ve noticed an increase in performance pressure in recent years. A little bit of performance pressure can be a good thing: it can facilitate concentration or hitting your deadlines. Are you feeling pressured over extensive periods of time, or are you experiencing stress, lack of sleep, or decreased concentration due to concerns about delivering on performance? Then it is probably a good plan to spring into action. With this info sheet we will explain what performance pressure entails, what causes it, and we will offer suggestions on how to handle performance pressure.
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In 2005 and 2006, almost sixty Dutch National Sport Federations (NSFs) participated in a special program for creating a marketing strategy for the next four years. This program was initiated and organized by NOC*NSF (the Dutch Olympic Umbrella Sports Organization). The NSFs had to joint the project to receive funds. For most of them it was the first time they seriously analyzed the market with the aim of developing new programs. The purpose of this paper is to explore to what extent Dutch NSFs are capable to change their structures to become more market oriented and more market responsive in order to write strategic plans. The changed structures are investigated using the "institutional theory" (Tolbert & Zucker, 1996) and are explained by exogenous (market context and institutional context) and endogenous (interests, values, power dependencies, and capacity for action) dynamics from the neo-institutionalist framework (Greenwood & Hinings, 1996). In 2005 NSFs were expected to be in a pre-institutionalized stage, i.e. they were supposed to develop new organizational structures in response to specific problems (Kikulis, 2000). Now, approximately 1½ years after finishing their strategies, the question arises whether they have reached the semi-institutional stage, i.e. whether the new structures or actions are diffused across organizations, yet still subject to change and whether old structures are yet eroding (Kikulis, 2000). Methods Studying the intended structural change of NSFs requires an in-depth study of their social reality and the reactions and interpretations of involved actors, including their applied meanings to certain situations. Greenwood & Hinings (1996) plead for detailed comparative case-studies when studying institutional changes. Therefore three NSFs has been selected: The Royal Dutch Korfball Federation (KorfFed); The Royal Dutch Billiards Federation (BillFed); and the Dutch Jeu de Boules Federation (JeuFed). These three federations differ on size, amount of housed sports, number of associated clubs, sorts of intermediary decision making bodies, employed FTE's, and more. Therefore it is expected that the tempo of institutionalization of the new, market oriented, structures, will differ among them. Sugden & Tomlinson (2002) developed a multi-method style of qualitative research for making sense of the deep, inside information below the surface of everyday life. They call it the "Brighton method. Applying the Brighton method for this research implies that the three cases will be studied with respect to their history, their present marketing actions, their results and the changes in their organization. In-depth interviews, document analysis (policy plans, marketing plans and more), and where possible observations and participations are used to create a critical and investigative view of the organizations in change. Results The KorfFed used the marketing program to further develop existing programs. Although the outcomes of these programs were not new, the program has opened the eyes of the president, director and staff members. They are now conscious of the urgency of a market orientation, and a marketing orientation (a marketing position has already been introduced), and they see opportunities in attracting non-competition playing korfball players. They have, however, not yet reached the phase of semi-institutionalization of the market oriented structures. This can be concluded from the following: - The organization still has an ad-hoc character; - Some board members still make decisions based on their own insights rather than on information from the professional part of the organization; - Decisions to start programs are still grounded on subsidy possibilities rather than on market possibilities. Interest dissatisfaction and power dependencies are the main dynamics that form barriers in the planned organizational change. The BillFed is a federation that covers four disciplines, i.e. pool, snooker, carom, and billiard 3 cushions. The federation used to act upon these four disciplines. The marketing program has made clear that the BillFed should act upon target groups instead of on these disciplines. Therefore, the federation created a vision to reach youth, young adults, as also elderly people. Carrying out this new vision requires a market orientated structure (focus on target groups) instead of an internal orientated structure (focus on discipline groups). This new vision is created on an upper level (general board together with professional staff) in the organization. This federation also introduced a professional marketing position. Unfortunately, the underlying layers remain slightly passive and are not willing to work along the new structures, which mean that the new structures have not been diffused across the whole organization. Interest dissatisfaction, value commitments and power dependencies are the problematic dynamics. The JeuFed used to have a strong competition and tournament (internal) orientation, while many jeu-de-boules players play the game just for fun. The marketing program has created the insight that the just-for-fun players are also an important target group. Hence, 3 projects are developed to make club membership more attractive for all jeu-de-boules players. Since the federation never worked with projects before, they just found out that implementing projects such as these requires new structures. The JeuFed has just arrived in the pre-institutionalized phase, still far away from the semi-institutionalized chapter. Power dependencies and a lack of capacity for change are influencing dynamics in this case. Discussion Although it is already 1½ years ago that Dutch NSFs finished their marketing program, in none of the described cases the new structures have reached the semi-institutional stage. These new structures or actions are not yet diffused across the organizations, and the old structures are not eroding. In all three cases another combination of endogenous dynamics are influencing the process of organizational change. Continuing research is needed to find out whether these federations will ever reach the next stage of institutionalization and which dynamics will play an important role.
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Musicians often play under circumstances in which pressure may lead to anxiety and performance deterioration. Theories suggest that a drop in performance is due to a shift in focus of attention towards task-irrelevant information. In this study, we asked music students to report what they think and where they focus attention in three situations: when they play under pressure (Study 1; n = 81), the moment just before choking under pressure and when they try to recover after a mistake (Study 2; n = 25). Focus of attention was examined using retrospective verbal reports and point-spread distributions. Besides a notable focus on music-related information (36.9%), music students reported a considerable number of worries and disturbing thoughts (26.1%) during playing under pressure (Study 1). Just before choking, they showed even more worries and disturbing thoughts (46.4%) at the cost of music-related focus (21.1%) (Study 2), as also confirmed by the point-spread distributions. During recovery after a mistake, attention was mainly focused on music-related information (53.0%) and less on thoughts that give confidence (18.5%) and physical aspects (16.6%). It is advisable to help music students with improving their performance, for example, by attentional control training or providing training with elevated levels of anxiety.
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The Co-Design Pressure Cooker was set up to gather knowledge on co-design in product development activities of Small-to-Medium Enterprises(SMEs). This booklet gives an impression of ten projects conducted in the Province of Utrecht, the Netherlands. In these ten projects, a total of 22 companies were involved. 5000 booklets have already been printed in Dutch and handed out to SMEs for knowledge dissemination. We have received ample requests from the international community, which leads us to believe that there is an international audience for the cases conducted and knowledge gathered. This is why we decided to publish an English version of this booklet. The booklet will be followed by a scientific publication on the knowledge gathered for the academic community. Feel free to contact us for more information on this project
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Background: The emphasis on impact factors and the quantity of publications intensifies competition between researchers. This competition was traditionally considered an incentive to produce high-quality work, but there are unwanted side-effects of this competition like publication pressure. To measure the effect of publication pressure on researchers, the Publication Pressure Questionnaire (PPQ) was developed. Upon using the PPQ, some issues came to light that motivated a revision.Method: We constructed two new subscales based on work stress models using the facet method. We administered the revised PPQ (PPQr) to a convenience sample together with the Maslach Burnout Inventory (MBI) and the Work Design Questionnaire (WDQ). To assess which items best measured publication pressure, we carried out a principal component analysis (PCA). Reliability was sufficient when Cronbach's alpha > 0.7. Finally, we administered the PPQr in a larger, independent sample of researchers to check the reliability of the revised version.Results: Three components were identified as 'stress', 'attitude', and 'resources'. We selected 3 × 6 = 18 items with high loadings in the three-component solution. Based on the convenience sample, Cronbach's alphas were 0.83 for stress, 0.80 for attitude, and 0.76 for resources. We checked the validity of the PPQr by inspecting the correlations with the MBI and the WDQ. Stress correlated 0.62 with MBI's emotional exhaustion. Resources correlated 0.50 with relevant WDQ subscales. To assess the internal structure of the PPQr in the independent reliability sample, we conducted the principal component analysis. The three-component solution explains 50% of the variance. Cronbach's alphas were 0.80, 0.78, and 0.75 for stress, attitude, and resources, respectively.Conclusion: We conclude that the PPQr is a valid and reliable instrument to measure publication pressure in academic researchers from all disciplinary fields. The PPQr strongly relates to burnout and could also be beneficial for policy makers and research institutions to assess the degree of publication pressure in their institute.
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Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device-related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device-related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January–December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28⋅3% (n = 72/254 patients). The incidence of device-related PUs was 20⋅1% (n = 51), and 13% (n = 33) developed solely device-related PUs. We observed 145 PUs in total of which 60⋅7% were related to devices (88/145). Device-related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device-related PUs is very high in trauma patients
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Music performance anxiety (MPA) is one of the most reported psychological problems among musicians, posing a significant threat to the optimal performance, health, and psychological wellbeing of musicians. Most research on MPA treatment has focused on reducing symptoms of performance anxiety, but complete “cures” are uncommon. A promising addition or alternative that may help musicians enhance their performance under pressure, despite their anxiety, is pressure training (PT). In other high-pressure domains, such as sports and police work, pressure training has been proven effective in reducing choking and enhancing performance quality under pressure. Therefore, the aim of this narrative review is to explore the potential of pressure training in music settings. Specifically, we first provide a theoretical overview of current models explaining performance declines due to anxiety. Second, we discuss the current state of research on the effectiveness and application of pressure training in sports and police work as well as recent developments in pressure training interventions for music settings. While there is a limited number of studies investigating the effectiveness of pressure training on musicians' performance quality, research focusing on musicians' experiences has shown that pressure training can be particularly beneficial for enhancing performance skills, preparing for performances, and managing performance anxiety. Based on the reviewed literature, the final section points out suggestions for future research as well as recommendations for musicians, teachers, and music institutions for practical applications.
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IntroductionThe driving pressure (ΔP) has an independent association with outcome in patients with acute respiratory distress syndrome (ARDS). INTELLiVENT-Adaptive Support Ventilation (ASV) is a closed-loop mode of ventilation that targets the lowest work and force of breathing.AimTo compare transpulmonary and respiratory system ΔP between closed-loop ventilation and conventional pressure controlled ventilation in patients with moderate-to-severe ARDS.MethodsSingle-center randomized cross-over clinical trial in patients in the early phase of ARDS. Patients were randomly assigned to start with a 4-h period of closed-loop ventilation or conventional ventilation, after which the alternate ventilation mode was selected. The primary outcome was the transpulmonary ΔP; secondary outcomes included respiratory system ΔP, and other key parameters of ventilation.ResultsThirteen patients were included, and all had fully analyzable data sets. Compared to conventional ventilation, with closed-loop ventilation the median transpulmonary ΔP with was lower (7.0 [5.0–10.0] vs. 10.0 [8.0–11.0] cmH2O, mean difference − 2.5 [95% CI − 2.6 to − 2.1] cmH2O; P = 0.0001). Inspiratory transpulmonary pressure and the respiratory rate were also lower. Tidal volume, however, was higher with closed-loop ventilation, but stayed below generally accepted safety cutoffs in the majority of patients.ConclusionsIn this small physiological study, when compared to conventional pressure controlled ventilation INTELLiVENT-ASV reduced the transpulmonary ΔP in patients in the early phase of moderate-to-severe ARDS. This closed-loop ventilation mode also led to a lower inspiratory transpulmonary pressure and a lower respiratory rate, thereby reducing the intensity of ventilation.Trial registration Clinicaltrials.gov, NCT03211494, July 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03211494?term=airdrop&draw=2&rank=1.
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BACKGROUND: The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).METHODS: PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.FINDINGS: We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I 2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. INTERPRETATION: In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.FUNDING: Dutch Association for Quality Funds Medical Specialists.
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