This paper analyzes the institutional context of maintenance purchasing in higher education. It aims to provide insights into the institutional complexities of smart maintenance purchasing in higher education institutes. In a case study, six external institutional fields and two internal institutional logics are identified. They create two types of institutional complexities that impede innovation if not treated correctly. Three ways are discussed to deal with those institutional complexities, 1) negotiating institutional field boundaries, 2) creating new institutional logics and practices, and 3) implementing institutional changes.
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Research suggests that construction clients, as building owner-occupier, are struggling to implement smart maintenance. This thesis assumes that this is due to a failure to fully understand the institutional complexities of smart maintenance. Hence, the aim of this thesis was to improve our understanding of these complexities and to develop theoretical and practical knowledge on the professionalization of construction clients in commissioning smart maintenance through stewardship. Stewardship theory portrays managers and employees as collectivists, pro-organizational and trustworthy, and can be used for designing collaborations based on intrinsic motivation and trust. A first insight from this thesis relates to how institutional complexity in smart maintenance management (SMM) can be understood (study 1). Institutional complexity is defined as the combined effect of 15 interorganizational and intraorganizational tensions that are active simultaneously. A second insight from this thesis relates to the capabilities that construction clients need to address the institutional complexities of SMM and connect various institutional fields (study 2). Using data collected from four cases involving two construction clients, a framework with eight maturity dimensions, involving 23 sub-dimensions, has been developed and validated. The third insight from this thesis relates to the role of the purchasing function in commissioning smart maintenance and emerged from considering the service triad concept (study 3). The findings indicate that the service triad concept fails to provide sufficient detail to adequately describe the construction client’s role in SMM. Hence, the service triad is extended to a service hexad. Our fourth insight relates to intrapreneurial stewardship (study 4). A process model for change implementation through stewardship interventions has been developed and then evaluated in a case study. The process model combines constructs from stewardship theory with intrapreneurship concepts and describes how employees can be coached by leaders during periods of organizational change. Together, the insights from the four studies are synthesized in a framework for client-led innovation in SMM and describe how construction clients can increase SMM maturity in institutionally complex environments through stewardship.
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BACKGROUND: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language.METHODS: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero.RESULTS: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found.CONCLUSIONS: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.
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