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Sustaining sustainability: What institutional investors should do next on ESG

What may popular cultural depictions of socio-political institutions tell us of the institutions they portray? More particularly, how are institutionalized bodies configured, discursively and materially, in filmic representations of bodily institutionalization? In order to offer possible answers to these questions, Norholm and Kirkegaard analyse war on screen and bodies at war. They begin from a material-discursive ontology that emphasizes the co-constitutive character of each, and offer the notion of plasticity as an intermediary concept. Material-discursive configurations are plastic in three respects as the involved elements both give form to and take form from the relationships into which they enter, but as the elements may also become explosive and blow up form Malabou, Plasticity at the dusk of writing.

Columbia University Press, New York, Blackwell Publishers, Malden, concepts of encoding and decoding. Further, the film shapes public perceptions of war at its moment of reception as reviewers and commentators alike were influenced by its depiction of war. Here, they encounter explosive plasticity; as the soldiers are, literally and figuratively, blown to pieces, they become other to themselves and to society. In and through the analysis, they offer illustrations of their methodological and theoretical contributions. Methodologically, analysis of popular cultural artefacts may help expose public perceptions of institutional arrangements.

Theoretically, plasticity may provide a conceptual key to theorizing the relationships between institutions, discourse and materiality. Legitimation is rarely described as an embodied experience constituting a legitimate space and time for those involved in it. Spatialization i. If the former is partly coherent with most institutional analysis about the process of social judgement involved in legitimation as ultimately discursive , the latter requires some new ontological explorations. The case of a an artistic makerspace in Paris MS is used to illustrate the key tenets of the ontology of bubbles.

The chapters in this book have illuminated four building blocks of debates about materiality in institutions: objects and artifacts, digitality and information, space and time, bodies and embodiment. Each block has been an opportunity to stress the relationships between theoretical, epistemological, methodological and ontological debates on institutional dynamics. Defining what an institution is or becomes, how it is performed and embodied, has also strong implications about the way it can be theorized and analyzed.

This article examines the relationship between materiality and institutional theory in two parts. The first part examines the chapters of the current volume and how these chapters enlighten our understanding of the relationships between materiality and institutional logics, institutional work and legitimation. I focus on empirical chapters because the relationships among materiality and aspects of institutional theory are clearer and more elaborated.

The second part explores the material basis of institutions and offers a few thoughts on the gaps in and directions for future research in materiality and institutional theory. Titel Materiality in Institutions. A previous article discusses the questionnaire in detail Hopmans et al. The questionnaire consisted of the following themes: opinion of competency-based training, support and application of clinical assessment tools, feasibility of training objectives and subspecialty training during residency, impact of DHRs on surgical residency training and health care delivery, and the altered structure and organization of the training program.

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Statistical analyses were performed with SPSS version We defined agreement with questionnaire items as a response of four or five on the 5-point Likert scale. In both the methodological approach and the analysis stage, the quantitative and qualitative findings were used iteratively to inform each other. The semi-structured interviews and thick descriptions were used to inform the questionnaire.

The statistical analyses of the questionnaire laid the basis for the second round of analyzing the interview and observation data. Subsequently, we presented the analytical results of both quantitative and qualitative data at a meeting of the expert group. Observations of the following discussions e.

In so doing, we deepened our understanding of how surgeons and surgical residents give shape to contemporary changes in surgical training and how this impacts on surgical practice. In the next section, we discuss the results of our analysis by attending to both the quantitative and qualitative data.


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The results are presented in two sections. In the first section, we describe how the traditional way of residency training has changed due to contemporary transitions in surgical training programs as well as the hospital organization, and how surgeons and surgical residents make sense of them. We will show how the reform has induced a disembedded training practice.

In the second section, we examine how surgeons and surgical residents respond do this by conducting repair work to re-embed surgical training, yet at the same time embrace the new training methods to come to a modern surgical training program. First, our analysis reveals how the organization of residency training has changed. Due to the reforms, the traditional master-apprenticeship training model has been replaced by a more a structured training program with formal arrangements: We used to choose our own role model, someone you wanted to be like.

You watched everything he or she — well, usually he — did. You joined him, watched his activities. You wanted to see as much as you could. That meant you came in at seven in the morning and stayed until eight or nine in the evening ….

Assembling Health Care Organizations : Kajsa Lindberg :

Nowadays residents are only in for a short time. You need formal training requirements and assessment of competencies to know how someone is doing. During the interviews and observations, both residents and attending surgeons underscored the changing nature of surgical training. Surgical training used to be characterized by lengthy periods of formal and informal on-the-job training, of making long hours and frequent and intensive contact between attending surgeons and residents Bolton, Muzio and Boyd-Quinn Yet, this surgeon argues, the sharp reduction of the number of hours residents spend in the hospital encroaches on the traditional training model.

Like other respondents see Table 1 , he recognizes the need of a more structured and formalized training model. At the same time, however, the old training model was still highly valued, as reflected by the quantitative data showing that both attending surgeons and residents highly appreciated the traditional master-apprenticeship model. A second major transition was the shortening of the surgical training trajectory, due to both the reduction of working hours and the shift to early subspecialization.

After 4 years of training in general surgery, residents must choose a subspecialization for the last 2 years of their training. Consequently, residents are no longer trained as general surgeons, being able to take care off all emerging surgical needs, but are specialized in the areas of gastrointestinal surgery, surgical oncology, trauma surgery or vascular surgery. A majority of the respondents recognized the need for subspecialty training during general surgery education.

Few respondents believed that just-qualified surgeons could act as fully qualified subspecialized surgeons after 6 years of training. During the interviews another concern was revealed, which had to do with the shift to tailor made subspecialty training programs. As not all surgical procedures are carried out in one particular hospital—especially not the more complicated procedures such as liver and lung surgery or particular kinds of cancer operations—residents now must compose an individual, tailored made program in which they attend different hospital sites to meet all aspects and targets belonging to their chosen subspecialty.

Of particular concern was the breach of the building of personal relationships between attending surgeons and residents. Through their stay at a particular hospitals site, residents become part of the clinical staff and are able to participate in the clinical process. Moving in and out of the hospital, due to working in shifts as a consequence of the DHR or following the logic of a tailored made training schedule, induces social distance between attending surgeons and residents: In the past [a resident] saw everything.

Now the day is divided into shifts. Residents lack continuity. Attending surgeons work more hours than residents. For educational purposes, residents would benefit if they were the ones solving clinical problems instead of the surgeons. Residents are part of a local surgical community for only a short period of time. Hence, residents lack the informal connections which attending surgeons do have. Attending surgeons, for instance, are brought up to date on patients admitted to their wards after a day off or a holiday. Residents are not automatically informed. Hence, it is more difficult for them to be closely involved in daily patient matters—and thus to be able to fully participate in surgical care delivery as the surgeon quoted above explained.

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Moreover, moving between hospital sites is in contrast with the tradition of gradual integration and embedded learning. Before they let you operate on your own, the year has passed. Imagine, you come here wanting to learn a specific form of lung surgery, and after a couple of months you leave and visit another couple of hospitals for short periods.


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Our analysis thus reveals a mixed image of both support for the new training program and hanging on to the traditional training model. This was also visible in discussions about the implementation of the DHR Table 3 and the perception of the clinical assessment tools Table 4 , for more detailed discussion on this topic see the second empirical section below.

On the one hand, surgeons and residents expressed their support, stressing the need for change and welcoming the added value of the new training methods to traditional training practice like an increasing quality of care and enhanced patient safety due to subspecialty training Table 2 and a better work-life balance for residents Table 3. On the other, they were highly critical and underscored the importance of long-lasting personal relationships, the building of trust among surgeons and residents, and clinical exposure.

Changes in clinical exposure were not only due to the reform of surgical training, but also a result of an increasing emphasis on efficiency in hospital organizations, particularly in the use of the operation theater. The operating theater is a costly part of the hospital organization due to the use of high-tech medical equipment, safety requirements and the presence of a large amount of highly educated staff.

To save time and money, operations are tightly scheduled and time is managed strictly.

Time management policies have ensured a discussion on the enrollment of residents in operations as residents need guidance and instruction and hence work in a far less efficient way than routinized surgeons. Attending AS12 : Occasionally, yes. In short, surgical training programs are going through a number of transitions that pursue a more disembedded way of training; surgical training no longer is something that goes naturally as residents work fewer hours, move between hospital sites and training is increasingly subjected to hospital policies.

In the next section, we examine how surgeons and surgical residents have responded to these changes by conducting repair work. From the data analysis three repertoires of repair work emerged: 1 organizing for the reform, 2 bending rules, and 3 negotiating procedures. As indicated above, the reform entailed a shift of the old, rather implicit and lengthy training model of learning-by-doing and role modeling to a time-capped and structured training trajectory.

Some senior residents are still looking for a training post in the subspecialty of their choice, and there are some missing spots; some hospitals do not have enough residents to fulfill their capacity needs. One of the program directors complains that he is losing senior residents to the neighboring hospital, while his group has made a large investment in training them. The chair program director answers that they all face this problem, but that the training schedule of the residents is leading now. He points at Tom [fictional name], a resident who has signed up for a position in vascular surgery.

He glances at one of the other program directors: can you have him?