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Rapidly rising healthcare costs, partially due to preventable medical errors, have led hospitals to redouble their process improvement (PI) efforts. The purpose of this paper is to examine how PI initiatives mediate the effect of medical error sources to enhance three hospital outcomes (patient safety, operational effectiveness, and competitiveness).

Drawing from Dynamic Capabilities Theory, the authors develop a framework to explore three PI initiatives: Continuous Quality Improvement (CQI), Six Sigma Initiatives (SSI), and Lean Management Initiatives (LMI). Hierarchical regression analysis is employed to test the proposed model, using data from a nationwide survey of 210 US hospitals.

For enhancing patient safety outcomes, it was found that CQI and LMI were significant in mediating hospital error sources; however, SSI was not significant after accounting for the other two PI types. For improving organizational effectiveness, CQI and SSI were significant; whereas LMI was not significant over and above the other two PI types. Finally, only SSI was significant for superior sustainable competitive advantage.

The paper provides insight into which PI initiatives were most effective for various hospital outcomes. The findings can benefit healthcare practitioners as they select among different PI programs for enhancing healthcare results. Limitations of the study include the use of perceptual measures, relatively small sample size, and potential alternate relationships relevant to the outcome variables.

This is the first study to explore the mediating effects of three PI programs for the impact of medical errors on each of three hospital outcomes.

Healthcare organizations have addressed current error issues by adopting quality programs, which usually include strategic human resource management (HRM). However, little research has focused on the determinants of successful quality programs at healthcare organizations. The purpose of this paper is to examine the centrality of strategic HRM for addressing healthcare errors, error reduction barriers, quality management processes and practices, quality program results, and competitive advantage.

The methodology of this study involves the analysis of questionnaire data from the quality and/or risk directors of 587 US hospitals by factor analysis and regression analysis.

The findings focus on highly statistically significant relationships of strategic HRM with antecedent healthcare error sources, error reduction barriers, and quality management processes and practices, as well as the strategic HRM consequences of perceived quality program results and sustainable competitive advantage.

The limitations of perceptual data and common method variance are checked. Future research could investigate international effects.

The practical implications are that hospital errors can be successfully addressed with effective strategic HRM, quality management processes, and quality management practices.

The original contribution of this paper is the centrality of strategic HRM as a determinant of successful quality programs at healthcare organizations.

The purpose of this study is to explore the use of patient safety initiatives (PSIs) at the US hospitals. These PSIs include such approaches as open discussion of errors, education and training, and system redesign. In particular, the paper seeks to examine factors that influence the implementation of PSIs as well as the benefits realized from their implementation.

The paper draws on the TQM and medical safety literatures to develop a conceptual framework for improving patient safety. Extensive survey data were gathered from 252 hospitals throughout the US to test McFadden et al.'s model of the factors influencing successful implementation of PSIs.

Certain barriers (lack of top management support, lack of resources, lack of incentives and lack of knowledge) significantly impeded implementation while other factors (perceived importance of PSIs) facilitated implementation. It was also found that implementation of PSIs was associated with benefits to the hospital in areas such as medical error reduction, cost reduction, and patient satisfaction.

The use of a single respondent represents a possible limitation. Future research will explore organizational culture and its relationship to patient safety.

The findings provide direction for implementing more effective PSIs at hospitals.

The paper contributes to the literature on patient safety and medical errors by testing specific mechanisms that are associated with successful implementation of PSIs.

This study examines the critical impact of human resource factors on the competitive advantage of supply chain management (SCM) practices. The human resource management (HRM) literature suggests that there are effects of HRM factors on SCM success, but neglects the relative importance among various factors regarding organizational performance. Survey responses from executives in 358 of the largest US manufacturing and service corporations are analyzed to test the relationships among selected HRM factors and SCM practice success. The results suggest an interactive role of managerial and employee support to enhance the effectiveness of employee training and to mitigate the adverse effect of implementation barriers on the success of SCM practices. The corresponding implications for managerial practice are also discussed in terms of the use of HRM program implementation to create a sustainable competitive advantage even when competitors adopt similar SCM “best practices”.

Literature reviews are a pervasive aspect in research. An ever mounting field such as Lean Six Sigma requires a perpetual touch on the subject to accentuate insights that can be researched about. The purpose of this paper is to address the published literatures in the field of Lean Six Sigma through multiple criterion for an enhanced understanding of the subject matter through summarizing its current trends, uncovering existing literature gaps and revealing opportunities for future research in the field.

The literature review on Lean Six Sigma field spans around 17 years that includes peer-reviewed journals from management, business, engineering, healthcare, manufacturing, military among the many disciplines. The study uses a content analysis approach in which several dimensions of the literature were analysed: purpose or focus of study, years of publication, journal name or publications, methodologies, theories used, country of study, industry sub-sectors, active authors in the field, critical success factors, barriers and challenges and the most contribution of Lean Six Sigma papers by universities.

Eleven important findings from the analysis were summarized among them; the field of Lean Six Sigma had begun to grow significantly since the new millennium particularly after the 2004-2007 or 2008 period; standalone concepts of Lean and Six Sigma are highly researched compared to the integrated concepts; large proportion of perspective, conceptual and descriptive based studies; lack of empirical validity on the fusion between Lean and Six Sigma; lack of theoretical based studies, etc.

The study is limited to 102 journals in commonly searched databases in the subject matter which produced 261 journal papers. This study seeks to broaden the summary of studies done under the keyword “Lean Six Sigma”.

The review analysis uses a content analysis approach in search of valuable gaps in existing research. The study found 261 papers from 102 journals that were published over the past seventeen years (2000-2016). This paper provides scholars, practitioners and managers with insights on the present trends and focus of Lean Six Sigma in addition to what else are lacking in the subject matter, which could pave the way for future research and practical endeavours.

Currently, most research about the autism spectrum has examined Caucasian autistics. Consequently, African American autistics have not received much attention from scholars. This chapter begins with an overview of statistics from the Centres for Disease Control and Prevention (CDC) about the population of Black and Latino autistics in the United States from 2000 to 2016. Plausible reasons for why there is a lack of research about African American autistics are then presented along with a section about the underrepresentation of ethnic minorities in autism spectrum research. Four strategies that can improve the production of research about African American autistics are then presented. The purpose of presenting these strategies is to help stimulate the production of research about African American autistics.

The original contribution that this chapter makes to the field of autism spectrum research is to inform the reader about the lack of research about African American autistics in comparison to other ethnicities.

Washington.—The Government of the United States at the Copenhagen Conference of the Food and Agricultural Organisation last September firmly supported the twin objectives of Sir John Orr's World Food Hoard proposals of raising the diets of all nations to a health standard and of stabilising agricultural prices at levels fair alike to both producers and consumers. Sir John's specific proposal for a World Food Board was not considered at Copenhagen. Instead, the U.S., the United Kingdom and all other nations represented at Copenhagen unanimously agreed to refer the whole question to a 17‐nation Preparatory Commission which met in Washington from October 28th to January 24th. The Commission was specifically instructed by the terms of reference to consider Sir John's proposal and any other alternative proposals which might be offered. The preparatory commission in its recommendations followed the instructions in the terms of reference and its final recommendations as made public on January 24th containing little of the specific machinery of the original proposals of Sir John's. But the twin objectives of Sir John's proposals were retained in the final recommendations. Had a show down come to Sir John's proposals at Copenhagen, the U.S. would have opposed it. Of this there can be no doubt. As early as August 9th, a month before the Copenhagen Conference, the U.S. Department of State issued a public statement on the Orr proposals. Any doubt as to the U.S. position was dispelled by Under Secretary of Agriculture Norris E. Dodd, who was chief American delegate at both Copenhagen and Washington. In his opening speech before the preparatory commission in Washington on October 28th, Mr. Dodd gave four reasons why the U.S. opposed the Orr proposal. He said: “First, we consider it doubtful whether a World Food Board or any similar device would, by itself, be adequate to deal with the effect that widespread government intervention threatens to have upon the agricultural demand and supply situation over the world once the present emergency has come to an end. Second, we consider it doubtful whether any combination of buffer‐stock and surplus‐disposal operations which contemplates the establishment of a two‐price system can be operated successfully without quantitative controls of supply. In our view such controls are not adequately provided for. Third, there is the fact that price, production and distribution problems differ greatly between different commodities and at different times. An over‐all body such as the proposed World Food Board would not suffice for dealing effectively with these so different and rapidly changing problems, which ought to be dealt with by special negotiations, commodity by commodity. Fourth, Governments are not likely to place the large funds needed for financing such a plan in the hands of an international agency over whose operations and price policy they would have little or no control. In view of these considerations, we believe that it is fortunate that the Copenhagen Conference has given this Commission a free hand to consider alternative machinery for achieving the basic objectives which we all support.” The original Orr proposals called for an internationally‐managed and internationally‐financed World Food Board. It would have bought and sold exportable surpluses at agreed minimum and maximum prices, thus providing a buffer‐stock against fluctuation in price and supply. Excess supplies under the Orr plan were to be sold cheaply to feed chronically malnourished people. FAO would work with such nations and with other international argencics to build producing and buying power so as to remove the underlying causes of poor diets. A statement by Under Secretary of Agriculture Mr. Norris E. Dodd, made on January 24th in connection with the report of the FAO Preparatory Commission on the food proposals, said, in part: “The principal ideas which the U.S. has advanced in the Commission are: (1) That the problems of better diets and price stabilisation mustbe approached in connection with the general expansion of production, employment, trade and consumption, as envisaged in the proposals for an International Trade Organisation, which we consider as complementary to the FAO programme. (2) That particular problems of price stabilisation can best be met through separate but co‐ordinated international agreements covering the specific commodities affected, within the general framework of principles for such agreements provided in the proposed ITO. (3) That under such commodity agreements the participating nations should consider methods of using excess supplies to support special food programmes to improve the diets of the most needy groups in connection with long‐term development plans designed to overcome the causes of malnutrition. (4) That the co‐ordination of national agricultural and nutritional programmes is so important the FAO should bring about annual consultation upon such programmes among the responsible national officials.” The principal U.S. proposals incorporated in the final report and recommendations of the FAO Preparatory Commission published on January 24th may be summarised as follows: The international commodity agreement approach to the stabilisation problem. The use of excess supplies under commodity agreements to support supplemental food programmes for vulnerable groups. Annual consultation of national agricultural and nutritional officials for the purpose of bringing about co‐ordination and integration of national programmes. Appointment of an interim co‐ordinating committee on international commodity agreements to bridge the gap between FAO and the projected International Trade Organisation. Acceptance in the final report of the American proposal for international commodity agreements may be construed as not merely an American victory since the commodity agreements would be negotiated within the framework of the proposed International Trade Organisation. Governments of 18 nations are represented on the ITO Preparatory Committee which met in London simultaneously with the FAO Preparatory Commission sessions in Washington. Here is the basic difference between the Orr World Food Hoard proposals and the final recommendation. Under a commodity agreement, such as provided for in the final report, each nation holds its own reserves, and finances its own operations. It provides for a co‐ordinated system of nationally managed and nationally financed buffer stocks of individual commodities. The Orr proposal envisaged an internationally managed and internationally financed World Food Board operating in many commodities. The U.S. position with reference to tieing in ITO with FAO was set out fully by Mr. Dodd in his October 28th speech before the FAO Preparatory Commission. Mr. Dodd said: “In putting forward its suggestions for an International Trade Organisation, the Government of the United States has had in mind the importance of securing— with the help of a reduction in trade barriers and other measures—a world‐wide expansion in employment, production, trade and consumption. We consider that action toward this end is of fundamental importance to the achievement of the objectives which this (Prepara‐tary) Commission is considering… It is the considered view of the United States Government that the ITO proposals provide a useful starling point for the deliberations of this Commission.” Previous U.S. experience in attempting to solve the riddle of farm surplus in the midst of hunger has been uneven and spotty. Perhaps the worst failure in this regard was the ill‐fated Federal Farm Board created in 1929 to arrest the drastic decline in farm prices. The Board advanced large sums to farmers' co‐operatives which extended loans to its member co‐operatives to induce farmers to withhold wheat and cotton from the market, without, however, controlling production. The Farm Board finally concluded that no such scheme could succeed without control over production, and production control therefore became a salient feature of the Agricultural Adjustment Act of 1933. This Act was amended in 1936 to meet the objections of the U.S. Supreme Court, which held it unconstitutional, but the essential requirement of control over production was retained and remains in effect to‐day. The Commodity Credit Corporation, a Government buying and selling agency created in 1933, has succeeded where the Farm Board failed, because the Government has exercised a degree of control over production. At Copenhagen last September, Mr. Dodd referred to the success of the Commodity Credit Corporation in these words: “Some people have expressed fear that stabilisation of farm prices would keep food prices above the reach of many consumers, but in the United States we have used the Commodity Credit Corporation effectively to protect farm prices, and food consumption, meantime, has increased. Furthermore, Commodity Credit stocks have served as reserves against years of bad weather and poor crops—reserves that were welcome indeed during the last war.” The Biblical idea of Joseph—of an ever‐normal granary—wherein surplus farm supplies are carried over from years of good harvest as a reserve against lean years of crop failure and hunger war and popularised in the United States by Mr. Henry A. Wallace during his service as Secretary of Agriculture, 1933–40. Sir John's World Food Board proposal also envisaged this evernormal granary concept, but failed of adoption because of the heavy expense involved, together with lack of adequate controls over production. It was this absence of production control in the Orr plan that led the U.S. to oppose the Orr plan, even though the country was in sympathy with its humanitarian objectives of raising living standards through expansion of consumption.

We have from time to time suggested that librarians should pool experiences in regard to annual estimates, but there seems to be no enthusiasm for the suggestion. If library work is to develop it must be by gently progressive finance, and nothing helps one librarian more than to be able to point to another who is progressing. We all tend to wait upon one another. In such a matter as salaries, a librarian circulates his colleagues to learn what they are getting; and library authorities almost invariably ask, “What is paid at So and So ?” This is a vicious circle which cannot be broken unless librarians in consultation can reach a Standard. Perhaps the active London and Home Counties Branch of the L.A. will give a lead since the L.A. itself is too busy to do so.

One explanation for why people wear masks to prevent the spread of COVID-19 focuses on political party affiliation. This study explores the role of values in attempts by five South Dakota cities to pass local mask mandates.

A nonrandom convenience sample used search engines to find documents on mask mandates in South Dakota. The working hypotheses are: (1) the debate over mask mandates is a form of value conflict over freedom of choice and the role of government that reflect those held by Emerson, Thoreau, and Spencer and (2) the mandates themselves prescribe Value-Rational rather than Instrumental-Rational action to control the pandemic.

Antimaskers valued freedom of choice, and were willing to defy authority while promasker health professionals valued science and were willing to sacrifice themselves for the health of their patients. South Dakota cities encouraged mask wearing but did not include penalties for noncompliance. The vociferous opposition to the mask mandates resembles the opposition cities encountered when deciding to fluoridate drinking water in the 1950s and 1960s.

A case study cannot be generalized and may reflect sampling and researcher bias. Future research could include a content analysis of documents and videos presenting both sides of the debate.

This case study may provide the first in-depth analysis of values in the masking debate.

WE offer our readers again our best wishes for the joy that appropriately belongs to Christmas. The happy festival comes at the close of one of the most fruitful and useful years in library history: a year which has seen wide developments—not, indeed, in the establishment of new libraries, though these have not been wanting (the last month of the year, for example, has seen Lord Elgin open the new library at Hendon), but in a drawing together of existing organizations, the creation of a really new Library Association, and a degree of co‐operation which thirty years ago would have seemed difficult.