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BACKGROUND: It is essential to identify the necessary competencies of hospital CEOs in order to improve the quality and efficiency of services they provide. Expert leadership skills and competencies can have a significant impact on the success of an organization, benefiting both patients and staff. This study aimed to assess the competencies and training needs of hospital CEOs in Iran public hospitals. METHODS: We conducted this cross-sectional analytical study through a self-assessment questionnaire, which was a web-based platform developed by the WHO country office in Iran, between July 2018 and September 2018. The questionnaire was completed by 180 hospital CEOs and included a core set of 81 items based on Assessing the Competency of Hospital CEO. These items were categorized into five superordinate categories: leadership, personality and quality of individual behavior, knowledge and business skills, social responsibility, and healthcare environment. In addition, we conducted focus groups with 30 hospital CEOs, supervisor assessments with 10 hospital managers, and interviews with 10 supervisors. RESULTS: Of the 180 questionnaires distributed, 78% were returned, and most respondents were medical specialists. The need for leadership competencies such as individual behavior skills and change management received the highest priority. Most respondents required training in management skills, including financial management, governance, strategic thinking, quality improvement, and disaster management. CONCLUSION: Providing needs-based education is crucial, especially in developing countries. In this study, leadership and strategic thinking were found to be the most needed competencies among hospital CEOs in Iran. These findings serve as reference points for developing countries with similar backgrounds and healthcare environments as Iran.

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Firm internationalization is a great challenge that needs a strong leader because of the uncertainty involved. Previous research has examined the antecedents of firm internationalization from the perspective of upper echelons theory, including chief executive officer (CEO) or top management team (TMT) characteristics, yet little research has examined the role of CEO early-life adversity experiences. Based on the imprinting theory and upper echelons theory, this study explores the relationship between CEO early-life adversity experience and firm internationalization. Using data from Chinese listed companies during the period 2007-2017, we demonstrate that CEO early-life adversity experiences have a significantly positive effect on firm internationalization; the effect is stronger when the CEO with early-life adversity has a higher level of organization discretion and institutional discretion. The findings are robust to a battery of alternative variable definitions and estimation methods. We contribute to upper echelons theory and the research on internationalization antecedents by showing that CEO early-life adversity has a positive effect on firm internationalization. The findings suggest boards aspiring to expand internationally place weight on candidates' early-life experiences while selecting and hiring CEOs and confer them managerial discretion to better play their strength after CEO's appointment decision is made.

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OBJECTIVE: Breaches of Te Tiriti o Waitangi (Te Tiriti) and evidence of institutional racism have been consistently documented within the public sector for decades. Chief executives across the sector have a critical responsibility to lead the implementation of the Crown's Te Tiriti o Waitangi responsibilities. This paper examines the recruitment and performance review processes of public sector chief executives from 2000 to 2020 to ascertain Te Tiriti compliance. METHODS: Recruitment and performance review templates were obtained via official information requests to Te Kawa Mataaho Public Service Commission. The data were analysed using a five-stage Critical Tiriti Analysis to determine compliance based on indicators developed around the five elements of Te Tiriti. RESULTS: Our study found no explicit evidence of engagement with te Tiriti in any aspect of the recruitment and or performance review processes in the documents released. CONCLUSIONS: This appears to be another contemporary breach of Te Tiriti that urgently needs to be addressed prior to the new round of appointments in the health sector. Implications for public health: With significant senior appointments about to be made within the health sector, this paper is a timely contribution to the wider debate about the implications of the WAI 2575 Waitangi Tribunal report on the health sector.

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This study explores the implications of CEO entrepreneurial orientation for firm performance through corporate dynamic capabilities. It explores the moderating effects of firm industry type on the above indirect effect. Based on 188 matched sample data collected from vice chief executive officers (CEOs) of Chinese firms, this study found that CEO entrepreneurial orientation was positively related to corporate dynamic capabilities and firm performance and that corporate dynamic capabilities mediated the positive relationship between CEO entrepreneurial orientation and firm performance. Firm industry type moderated the direct effect of CEO entrepreneurial orientation on corporate dynamic capability, and the indirect effect of CEO entrepreneurial orientation on firm performance through corporate dynamic capability. Both direct and indirect effects were stronger in manufacturing enterprises. The findings enrich the CEO entrepreneurial orientation literature by extending the existing knowledge on its underlying mechanism and its impact on firm performance, as well as its boundary conditions.

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Objetivo: Descrever situações geradoras e elementos envolvidos no processo de sofrimento moral na experiência de enfermeiros gerentes de um hospital público do sul do Brasil. Método: Estudo descritivo e exploratório de abordagem qualitativa, realizado durante o período de março a setembro de 2014 cujas informações foram coletadas mediante entrevista semiestruturada. Participaram da pesquisa 17 enfermeiros gerentes. Os dados foram organizados no software Atlas.Ti© e analisados segundo a técnica de análise textual discursiva. Resultados: Emergiram três categorias: Organização e Condições de trabalho, Gestão de Pessoas e O Ser Gerente. Conclusão: Constatou-se que os gerentes vivenciam o sofrimento moral decorrente de situações conflituosas relacionadas às condições de trabalho, profissionais insubordinados, falta de autonomia, assédio moral e as múltiplas faces da função gerencial. Assim, buscou-se contribuir para área da saúde, nos aspectos de sensibilizar moralmente os profissionais para as atividades que desempenham e no tocante ao sofrimento moral

Objective: Describe generating situations and elements involved in moral distress process in nurse managers experience of a public hospital in southern Brazil. Method: Descriptive and exploratory study, nature of qualitative approach, conducted from march 2014 to september 2014 and whose information was collected through semi-structured interview. There was a participation of 17 nurses managers. Data were organized in the software Atlas. Ti© and analyzed according to the technique of discursive and textual analysis. Results: Three categories emerged: Organization and working conditions, People management, and Being the Manager. Conclusions: It was found that the managers experience moral distress arise from conflicting situations related to working conditions, insubordinate professionals, lacking of autonomy, psychological harassment and the multiple faces of the managerial function. Accordingly, it was sought to contribute to the health area, in the aspects of morally sensing the professionals for the activities they perform and regarding moral distress

Objetivo: Describir la generación de situaciones y elementos relacionados con el proceso de sufrimiento moral en enfermeros gerentes de un hospital público en el sur de Brasil. Método: Estudio descriptivo y exploratorio de enfoque cualitativo, realizado durante el período de marzo a septiembre de 2014 y cuyas informaciones fueron obtenidas por medio de entrevista semiestructurada. Participaron de la investigación 17 enfermeros gerentes. Los datos fueron organizados en el software Atlas.Ti© y analizados de acuerdo con el método de análisis textual discursiva. Resultados: Se desarrollarán tres categorías: Organización y Condiciones de trabajo, Gestión de personas, y el Ser Gerente. Conclusión: Se concluyó que los gerentes experimentan el sufrimiento moral resultante de situaciones conflictivas relacionadas con las condiciones de trabajo, profesionales insubordinados, falta de autonomía, acoso moral y las múltiples facetas de la función gerencial. Así, se buscó contribuir al área de la salud, en los aspectos de sensibilizar moralmente a los profesionales para las actividades que desempeñan y en lo tocante al sufrimiento moral

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Nutrition support teams (NSTs) in the United States have had to justify their existence since their inception in the 1970s. Concomitant with those efforts, changes in healthcare financing have challenged hospital administrators to adapt their reimbursement strategies and methods. NSTs, if they are to survive and/or thrive, must be aware of the convulsive currents of change faced by those who determine which programs move downstream and which find their demise on the banks of the stream. This review provides a historical perspective of both the US healthcare financing system and the NST experiences of nutrition clinicians over the past 4 decades. Focused discussions of 5 teams are provided from individual members of those varied NSTs. Additional recommendations from the administrative side of the equation are presented by 3 administrators. Whether NSTs will "rise or demise" depends on many factors. Understanding what those who control the purse strings are seeking in terms of salutary cost and quality outcomes in the current value-based system will facilitate the NST's communication with them. The demonstration of the NST's value is more likely to succeed when bolstered by current evidence-based data as applied to the specific institution. These efforts can be carried out by a formal NST in larger or academic institutions or a "virtual" team with a single individual coordinating the services in a transdisciplinary fashion, employing the acronym ACT (accountability, communication, [transdisciplinary] teamwork).

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Aim: to identify the attributes and competencies of nursing managers in the teaching hospitals in the state of Paraná, in relation to their teaching, research, care and management. Method: a descriptive, exploratory, qualitative approach, carried out in 12 teaching hospitals in Paraná, through semi-structured interviews with 13 nurses who occupy the top position in nursing. The interviews included identification data of the participants, their positions and their attributes and competencies. Results: the attributes were; institutional representation, nursing care management, human resources management and teaching. The skills that stood out after content analysis were; conflict management, leadership, decision making and policy. Conclusions: although the research was carried out in teaching hospitals, the most frequent assignments and competencies of managers relate to the managerial dimension to the detriment of the teaching and research dimensions.(AU)

Objetivo: identificar as atribuições e competências dos gerentes de enfermagem de hospitais de ensino do estado do Paraná, nas dimensões do ensino, pesquisa, assistência e gerenciamento. Método: pesquisa descritiva exploratória, de abordagem qualitativa, realizada em 12 hospitais de ensino do Paraná, por meio de entrevistas semiestruturadas, que contemplam dados de identificação do participante e do cargo e as suas atribuições e competências, com 13 enfermeiros que exerciam o cargo máximo na área da enfermagem. Resultados: as atribuições foram: representação institucional, gerenciamento da assistência de enfermagem, gerenciamento de recursos humanos e ensino. As competências que se sobressaíram após a análise de conteúdo foram: gestão de conflitos, liderança, tomada de decisão e política. Conclusões: apesar de a pesquisa ter sido realizada em hospitais de ensino, as atribuições e competências mais frequentemente evidenciadas dos gerentes dizem respeito à dimensão gerencial em detrimento das dimensões de ensino e pesquisa.(AU)

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Este trabalho tem como objetivo caracterizar os enfermeiros que exercem o cargo de gerente de enfermagem nos hospitais de ensino do Paraná; caracterizar o cargo de gerente de enfermagem nas instituições; descrever as atribuições relativas ao cargo; apreender as competências necessárias para o cargo e, como elas foram adquiridas. Trata-se de uma pesquisa descritiva exploratória de abordagem qualitativa. Tem como cenário de estudo os hospitais de ensino do estado do Paraná. Foram entrevistados 13 enfermeiros de doze hospitais de ensino. As falas dos participantes foram pré-categorizadas nas dimensões de ensino, pesquisa, gerenciamento e assistência e, para a sua análise, utilizou-se a análise de conteúdo proposta por Bardin. Durante a realização da pesquisa os aspectos éticos foram respeitados conforme os preceitos da Resolução 466/2012. Entre os resultados verificou-se que a maioria dos enfermeiros é do sexo feminino, formados há mais de 9 anos e poucos tem experiência anterior na função. A escolha para o cargo de gerente de enfermagem variou entre indicação, promoção, eleição, processo seletivo e transferência. O quantitativo de recursos humanos que o enfermeiro gerente é responsável variou entre 27% a 60% do total de recursos humanos dos hospitais. Suas atribuições são referentes à dimensão de gerenciamento, sendo que o gerente desenvolve atividades de gerenciamento da assistência de enfermagem, de recursos humanos, custos e educação permanente e continuada. Além destas, há a participação na direção do hospital na qual o enfermeiro gerente representa a enfermagem perante a direção geral e representa a direção para os trabalhadores de enfermagem concomitantemente. Para o desenvolvimento destas atividades observou-se que são necessárias a competência política e as competências gerenciais como a liderança, gestão de conflitos e tomada de decisão. Ademais o conhecimento, a habilidade em se comunicar, o ser ético, ter senso de justiça e ser comprometido foram ressaltadas nas falas dos participantes. Não foram evidenciadas atividades e competências referentes à dimensão de pesquisa neste estudo. As competências foram adquiridas por meio da prática profissional, estudo, troca de experiências e com o apoio da instituição. Entende-se que este estudo aumenta a visibilidade e a importância do enfermeiro nas organizações de saúde além de contribuir para que os profissionais da prática se atentem para a função dos hospitais de ensino e, que as escolas formadoras se tornem mais visíveis nestes espaços.

This work aims to characterize nurses who pursue the position of nurse manager in the Paraná teaching hospitals; characterize the position of nursing manager in the institutions; describe the duties related to the position; learn the skills required for the position and how they were acquired. This is an exploratory descriptive study of qualitative approach. Its study scenario of Paraná state teaching hospitals. We interviewed 13 nurses twelve teaching hospitals. By the participants were pre-categorized into the dimensions of teaching, research, management and support, and for its analysis, we used the content analysis proposed by Bardin. During the research the ethical aspects were respected as the precepts of Resolution 466/2012. Among the results found that the majority of nursing women is formed for more than 9 years and has little prior experience in function. The choice for the position of nurse manager ranged from display, promotion, election, selection process and transfer. The quantity of human resources that the nurse manager is responsible ranged from 27% to 60% of total human resources of hospitals. Its responsibilities are related to the size of management, and the manager develops management activities of nursing care, human resources, costs and permanent and continuing education. Besides these, there is participation in the management of the hospital in which the nurse manager is the nurse before the general direction and represents the direction for nursing workers concomitantly. For the development of these activities was observed that are necessary to political competence and managerial skills such as leadership, conflict management and decision making. Besides the knowledge, ability to communicate, being ethical, sense of justice and be committed were highlighted in the speeches of the participants. No activities and skills were observed for the size of research in this study. The skills were acquired through professional practice, study, exchange of experience and with the support of the institution. It is understood that this study increases the visibility and importance of nurses in health organizations and contribute to the professional practice they pay attention to the function of teaching hospitals, and that the educational schools become more visible in these spaces.

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Its focus on snow-dependent activities makes Alpine winter tourism especially sensitive to climate change. Stakeholder risk perceptions are a key factor in adaptation to climate change because they fundamentally drive or constrain stakeholder action. This paper examines climate change perceptions of winter tourism stakeholders in Tyrol (Austria). Using a qualitative approach, expert interviews were conducted. Four opinion categories reflecting different attitudes toward climate change issues were identified: convinced planners, annoyed deniers, ambivalent optimists, convinced wait-and-seers. Although the findings generally indicate a growing awareness of climate change, this awareness is mainly limited to perceiving the issue as a global phenomenon. Awareness of regional and branch-specific consequences of climate change that lead to a demand for action could not be identified. Current technical strategies, like snowmaking, are not primarily climate-induced. At present, coping with climate change is not a priority for risk management. The findings point out the importance of gaining and transferring knowledge of regional and branch-specific consequences of climate change in order to induce action at the destination level.

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El artículo está dividido en dos partes. En la primera, llamada “las Empresas Sociales del Estado (ESE)”, se trata el marco en que está inscrito este tipo de hospital público descentralizado en Colombia, hasta llegar a la figura del gerente hospitalario, que es el tema del artículo. Se explica como, de acuerdo con lo sugerido por la jurisprudencia de la Corte Constitucional, el mecanismo para elegir gerentes en las ESE a futuro sería exclusivamente el concurso de méritos, lo cual hace que este proceso de selección se haga especialmente relevante y de allí la necesidad de evaluar las experiencias institucionales que se tienen al respecto para refinar los procedimientos a futuro. Partiendo de ésto, en la segunda parte del artículo sobre “Selección de ternas para gerente de ESE en la universidad CES” se hace una reseña histórica del proceso, se explica la metodología que ha venido siendo empleada y se hace un sucinto análisis de lo hecho hasta ahora por la universidad CES en este campo.

The article is divided into two parts. The first one is named “the State Social Enterprises (ESE by the acronym in Spanish)”, and refers on the framework in which is inscribed this kind of public decentralized hospitals in Colombia to finally arrive to the figure of managers of the ESE [hospital chief executive officers], which is the central issue of the article. This part is divided in: decentralization of public hospitals, public funding of ESE, structure and organization of ESE, Directive Boards of ESE, managers of the ESE, evaluation of managers of the ESE, and selection of managers of the ESE. It is explained that, in according what is suggested by the jurisprudente of the Constitutional Court, the mechanism for choosing would be based in future on merit, exclusively, and it could convert the selection process in a particularly relevant step and it justifies to evaluate the institutional experiences to refine the procedures in the future. Since this, the second part of the article, about “selection of triples for manager of ESE in the CES University”, makes a historical review of the processes and explains the methodology that has been used, to finally make a brief analysis about the know-how of the CES University in that field.

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Este artigo apresenta o resultado de uma pesquisa sobre a prática gerencial em hospitais públicos - hospitais gerais com emergência do Município do Rio de Janeiro, Brasil -, desenvolvida mediante a perspectiva psicossociológica de análise das organizações. Em um universo de 12 hospitais, 8 foram incluídos no estudo, realizado entre julho de 2003 e abril de 2004. A investigação, desenvolvida pela narrativa dos diretores de hospitais, identificou três modalidades de prática gerencial. Em uma primeira, vislumbram-se processos de mudança, ganhando destaque elementos simbólicos e imaginários envolvidos na construção de uma visão de futuro dos hospitais. Uma segunda modalidade de prática pauta-se por projetos específicos que se tornam objeto de investimento da gestão. Um terceiro modelo, dominante na investigação, estaria marcado pela luta para fazer funcionar o hospital, tendo como motor o imaginário da urgência. A ação contínua se impõe, não havendo brechas para a reflexão. A crise dos hospitais públicos no Rio de Janeiro foi levando a um contexto de "guerra" e de generalização do modelo da urgência.

This article discusses management practices in public hospitals (general hospitals with emergency services) in the city of Rio de Janeiro, Brazil, based on a psychosociological approach to organizational analysis. Of the 12 existing hospitals, 8 were included in the current study, conducted from July 2003 to April 2004. The research, drawing on hospital directors' narratives, identified three management models. The first focuses on processes of change, highlighting symbolic and imaginative elements for building a vision of the future for the hospitals. The second concentrates on specific projects, which absorbs all the management efforts. A third pattern (predominant in the study) is marked by the struggle to keep the hospital working, with the image of urgency as the driving force. The imposition of continuous action leaves no room for reflection. The crisis in Rio de Janeiro's public hospitals has led to a "wartime" environment and thus the dissemination of the urgency-based model.

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