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Promoting explicit instruction of strategies for self-regulated learning

Identification of promising strategies to sustain improvements in hospital practice

Background: A quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited “breakthrough” time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative. Methods: A qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006–2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes – max 51 minutes). Results: The current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme. Conclusions: Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.

Institutional entrepreneurship in constructing alternative paths

This paper investigates how firms adapt their innovation strategies to cope with constraints in national institutional environments. It is a comparative case study of Dutch and British dedicated biotechnology firms focusing on a particular type of strategy, the hybrid model. Patterns of skill accumulation and learning present in the Dutch hybrids are indications of how they use institutional advantages to focus on low-risk innovation and build deeper competences while also pursuing high-risk innovation strategies. The Dutch hybrid model offers insight into how firms comply with the dominant logic of the biotechnology field even when their institutional frameworks encourage the pursuit of low-risk innovation strategies.

Dutch Sport Federations Changing into Market Oriented Organizations: The Institutional Theory Applied on Three Case Studies

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.

Comparing MOOC adoption strategies in Europe

Much of the literature and the academic discussion about the impact of Massive Open Online Courses (MOOC) in institutional strategic planning has been centred on the US context. However, data shows that although the US are responsible for the largest MOOC platforms and the most successful course provision, it is the European region which accounts for the highest percentage of global MOOC participation. Differently from the US Higher Education system framework, however, in Europe public policy and in particular the European Commission is now driving MOOC institutional uptake. Given the very different institutional, political and cultural contexts, it is interesting to analyse how in these two different regions Higher Education institutions are responding to the challenges of the MOOC phenomena and are integrating it in their own strategic planning. The current research presents the first attempt to conduct a benchmarking study of institutional MOOC strategies in Europe and the US. It's based on a survey launched by the EU-funded project HOME and compares results with a similar survey launched in the US. Results show that are significant differences in how US and European institutions understand the impact of massive forms of open education and also how they perceive the efficiency of digital education and online learning.

Institutional MOOC strategies in Europe

Massive Open Online Courses (MOOCs) have continued to attract considerable media coverage as governments and universities respond to the open and online education movement. Three years after the MOOCs began its rise, it is clear that the HE institutions in the EU are gaining speed in this movement. This report on MOOCs intends to contribute to literature on MOOCs in Europe. Its specific aim is to present data on the perception and objectives of European higher education institutions on MOOCs and the main drivers behind the MOOC movement. In addition, the report makes a comparison with similar studies conducted in the United States in 2013 and 2014 and to data produced by the European University Association (EUA) between October and December 2013. The report made clear that involvement is still increasing, but also that arguments to get involved differ from those in the US. The main source is a survey conducted by the project HOME - Higher education Online: MOOCs the European way, partly funded by the European Commission’s Lifelong Learning Programme. The survey was conducted in October - December 2014. In total 67 institutions responded out of 22 European countries representing in total about 2.8 millions of students.