This article contributes to the growing scholarship on the topic of assurance services for sustainability reports. We first synthetically illustrate the main international standards for the implementation of assurance services regarding the subject documents. The second part of our article is an empirical analysis of reports drawn up on the basis of the current Global Reporting Initiative 2006 guidelines, and looks at how effectively these standards have been implemented, analyzing the different typologies of assurance statement.

A descriptive-exploratory analysis of assurance practices is presented in this paper, by analysing the patterns of sustainability assurance reporting in two national contexts with different levels of assurance activity over a period of 11 years. The study is based on theoretical insights drawn from institutional sociology and normativity production. It is framed both in the Italian situation, where assurance statements consistently include a narrow set of formal and procedural communications, and in an unsettled situation in the (...) U.S., where assurance activity is more incipient, but where experimentation in substantial assurance disclosure practices has more room to develop. Its main implication is that the diffusion of sustainability assurance and the creation of sustainability assurance disclosure norms are not without its cost: information quality does not increase with patterned practice. The results also point towards the noteworthy role of specific professionals in the earlier and later stages of assurance practice norms. They reveal a significant influence of non-Big4 firms in the diffusion of sustainability assurance disclosure norms. In contrast, the Big4 firms appear to be positively associated with the narrowing down of the assurance focus to a selected subset of this activity in later stages of the development of the assurance norm. In this regard, this study provides insight into the circumstantial—but relevant—carrier role of the Big4 firms in determining what “assurance” means. (shrink)

The original article was published without open access and with the copyright notice indicating © Springer Nature B.V. The article is now open access with the copyright residing with the authors.

Accountability and performance optimization are intended to improve the performance of homecare services (HS) but do not seem to have the desired effects. The lack of decision-making latitude of professionals and, consequently, their insufficient responsiveness would be at fault. This responsiveness is, however, part of their role as change agent, a role that is poorly invested. This article has three objectives : 1) To synthesize knowledge on the role of accountability and performance optimization in the practice of HS professionals (...) ; 2) To describe the role of change agent ; and 3) To explore its teaching. (shrink)

Research on sustainability assurance is still in its beginnings. One of the key questions in this field that also is of the highest practical relevance is concerned with the quality of the assurance process. However, a common understanding of assurance quality and how it should be measured is still missing. We try to close this gap by building on the financial audit literature. We introduce a definition of assurance quality that comprises two key aspects: the depth (...) of the assurance process and the breadth of the assurance statement. Based on prior research, we hypothesize that a firm’s sustainability performance is related to the depth of the assurance process, while the type of the assurance provider, more precisely the affiliation to the accounting profession, is related to the breadth of the assurance statement. Results for a sample of 122 European firms reveal a negative relationship between sustainability performance and assurance process depth as well as between the affiliation to the accounting profession and assurance statement breadth. Thus, we find evidence that poor sustainability performers ask for in-depth assurance services, most likely as a means to enhance their internal sustainability-related processes and systems. Assurance providers that do not belong to the accounting profession in turn are associated with broader assurance statements. (shrink)

The prior research on different forms of what can be referred to as corporate social responsibility reporting is vast. As CSR reporting becomes more commonplace, the theoretical and empirical analysis of this type of reporting has matured and both academics and practitioners have begun to explore the possibility of having CSR disclosures assured. This paper makes an important contribution by synthesising the findings on emerging forms of CSR assurance practice. It summarises the ground covered to date and provides a (...) comprehensive review of the literature on the characterises, use and limitations of CSR assurance services. It develops a conceptual model which distinguishes between determinants of CSR assurance at the national- and firm-level and shows how the nature of assurance services, a company’s reporting infrastructure and current technologies of assurance enable or constrain the benefits of having CSR disclosures assured. Areas for future research, based on identified weaknesses in the current CSR assurance environment, are also identified. (shrink)

The objective of this paper is to investigate, through a qualitative study based on 38 semi-structured interviews with agents who provide assurance of sustainability reports, how they perceive and manage ethical issues underlying the verification of sustainability reports. Most of the ethical issues observed involve four interconnected aspects: the commercialism underlying sustainability assurance, the symbolic nature of the verification process, interdependency between auditing and consulting activities, and familiarity with the audited companies. The findings shed light on the reflexivity (...) of assurance providers on these issues and the legitimation strategies used to explain how they reconcile the independence and impartiality required for auditing activities with commercial aspects related to client–provider relationships. The study also shows the role of contextual variables in the ethics of assurance services. The paper contributes to the literature on the legitimacy of sustainability assurance and commercialism of the audit function. Practical implications and avenues for future research are also developed. (shrink)

This research focuses on examining the relationship between some attributes of assurance providers and the level of sustainability assurance. By using the propensity to issue negative conclusions in the assurance statement as an indicator of the level of assurance, we examine whether the brand name and industry specialisation of the practitioners have an impact on the assurance opinion issued. Using an international sample of 1233 firm-year observations over the period 2007–2014, the findings document the impact (...) of the brand reputation and industry specialisation of assurance providers on the level of assurance. The probability of detecting material errors and omissions in a sustainability report is higher if it is verified by a Big 4 auditing firm and by an industry expert as an assurance practitioner. The greater experience in providing audit services and the relevant skills and training provided by Big 4 firms, as well as the greater knowledge and experience of industry experts, increase the propensity to report more accurate opinions about a sustainability report. The findings are robust for alternative measures for the level of assurance and the industry specialisation. (shrink)

For hospitality establishments like the House of Lechon to remain profitable and draw in new clients, maintaining high standards of service quality is essential. Despite this, satisfying and surpassing client expectations is a constant struggle given the dynamic nature of consumer preferences. To evaluate customer satisfaction at the House of Lechon, this study draws on previous research on service quality and examines customers' expectations and experiences in several areas, including responsiveness, tangibility, reliability, assurance, and empathy. This study, which involved (...) a purposive sample of 100 participants, used a descriptive-quantitative technique to identify areas for improvement and suggest strategic actions to improve service quality and close the gap between customer experiences and expectations. The results emphasize how crucial it is to give service quality factors top priority to increase client happiness and loyalty in the cutthroat hotel sector. (shrink)

Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance use screening (...) would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (shrink)

The aim of this research is to examine the impact of service quality on customer satisfaction in the post pandemic world in auto care industry. The car care vendor in the study made effective use of social media to provide responsive updates to the customers in the post pandemic world; such use of social media provides bases for service quality and customer satisfaction. The study examined the relationship between service quality and customer satisfaction using the SERVQUAL framework. According to the (...) findings, empathy, reliability, assurance, responsiveness, and tangibles have a significant positive relationship with customer satisfaction. Our findings suggest that it is critical for workshops to recognize the service quality factors that contribute to customer satisfaction. Findings also suggest that empathy, assurance, reliability, responsiveness, and tangibles contribute to customer satisfaction. Auto repair industry must regularly provide personal attention, greet customers in a friendly manner, deliver cars after services, notify customers when additional repairs are required, and take the time to clarify problems to customers. Furthermore, workshops must screen and hire courteous staff who can clearly communicate the services required to customers both in-person and online and effectively communicate the risks associated with repairs. Service quality seems to be aided by prompt services. (shrink)

This research focuses on the employee loyalty aspect of private hospitals in Pakistan during the COVID-19 pandemic, seriously impacted by strict work demand and work-family conflict. To manage this issue, social rewards and psychological rewards played a role as a mediator. The study uses a causal research design with a correlational study design in a non-contrived environment. Minimal researcher interference has been assured. AMOS 24 has been used to deal with the mediation in study design with bootstrap methodology. The study (...) was conducted on 250 nurses of different private hospitals across Punjab province using a proportionate stratified sampling technique. A finding of this study suggests that nurses remain loyal to their organizations despite having uncompromising work demands and facing work-family conflict when they are provided with social and psychological rewards on their job by their organizations. (shrink)

Background: Nurses’ service behaviors have critical implications for hospitals. However, few studies had adequate ethical considerations of service behaviors and accounted for how organizational or individual antecedents can induce nurses to engage in service behaviors. In addition, they mainly focused on the one side of role-prescribed or extra-role service behavior. Objective: This study aims to explore the chained mediation effect of ethical climate and moral sensitivity on the relationship between organizational ethical leadership and nurses’ service behaviors and to examine the (...) relationship, from a comparative view, of the role-prescribed service behavior and extra-role service behavior. Methods: In all, 476 nurses from three tertiary hospitals were investigated with the Ethical Leadership Scale, Ethical Climate Scale, Moral Sensitivity Questionnaire and Service Behavior Questionnaire. Structural equation modeling was adopted to analyze the data. SPSS and Mplus statistical software was used in the data analysis. Ethical considerations: Approval was obtained from the Ethics Committee at School of Nursing, Hebei Medical University. Data privacy and confidentiality were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Results: The effects of ethical leadership on nurses’ service behaviors are mediated by two variables in turn: ethical climate and nurses’ moral sensitivity. Ethical climate and moral sensitivity partially mediated the relationship between ethical leadership and nurses’ role-prescribed service behavior and fully mediated the relationship between ethical leadership and nurses’ extra-role service behavior. Conclusion: Organizational ethical leadership positively affected ethical climate, which positively affected nurses’ moral sensitivity and affected both their role-prescribed service behavior and extra-role service behavior. (shrink)

Fragile states and developing countries increasingly contract out health services to non-state providers (NSPs) (such as non-governmental organisations, voluntary sector and private sector). The paper identifies ethical issues when contracts involve devolution of health services to NSPs and proposes procedures to prevent or resolve these ethical dilemmas. Ethical issues were identified by examining processes of contracting out. Health needs could be used to select areas to be contracted out and to identify service needs. Health needs comprise “disease-burden-related needs”, (...) “health-service needs”, and “urgency of health-service needs”. The mix of services should include an analysis of cost-effectiveness. NSPs should be selected fairly, without bias, and conflicts of interest during their work must be avoided. The population’s views must be respected and accountability structures established. Devolved health services should ensure equity of access to healthcare. The services ought to be sustainable and evaluated objectively. Of these issues, conflicts of interest among NSPs and sustainability of health services have not attracted attention in the literature on ethics of health policy. Fair procedures could address these ethical issues—for example, public consultation on issues; decisions based on the public consultation and made on evidence; principles of decisions stated and reasonable; decisions given adequate publicity; a mechanism established to challenge decisions; assurance that mechanisms meet the above conditions; and regular review of the policies. These procedures are complemented by improving self-governance of NSPs, countries’ development of guidelines for devolving health services, and measures to educate the public of the client countries on these issues. (shrink)

The Patient Protection and Affordable Care Act of 2010 purportedly assures almost all Americans of the right to health insurance coverage. The long-term success of this legislation in improving the public’s health in the United States will likely hinge in no small part on the degree to which statutorily establishing a right to health insurance coverage translates into actual timely, meaningful access to health services, particularly physician services, for specific individuals.

This study sought to examine the effect of the quality of chatbot services on customer satisfaction, repurchase intention, and positive word-of-mouth by comparing two groups, namely chatbots with and without emotion words. An online survey was conducted for 2 weeks in May 2021. A total of 380 responses were collected and analyzed using structural equation modeling to test the hypothesis. The theoretical basis of the study was the SERVQUAL theory, which is widely used in measuring and managing service quality (...) in various industries. The results showed that the assurance and reliability of chatbots positively impact customer satisfaction for both groups. However, empathy and interactivity positively affect customer satisfaction only for chatbots with emotion words. Responsiveness did not have an impact on customer satisfaction for both groups. Customer satisfaction positively impacts repurchase intention and positive word-of-mouth for both groups. The findings of this study can serve as a priori research to empirically prove the effectiveness of chatbots with emotion words. (shrink)

La prise de rendez-vous dans un service de consultation conjugale est un aspect spécifique du travail de la secrétaire-réceptionniste. Les différentes tâches qui s’y associent sont le tri des appels et l’évaluation des demandes, l’écoute, l’information et l’orientation. Le rôle de la secrétaire est d’assurer le premier contact, de recueillir les éléments de la demande et de présenter le cadre de travail du conseiller conjugal. Les rendez-vous sont pris selon des règles et des consignes définies dans un cadre institutionnel.

Reducing the global treatment gap for mental health conditions in low- and middle-income countries requires not only an expansion of clinical psychology training but also assuring that graduates of these programs have the competency to effectively and safely deliver psychological interventions. Clinical psychology training programs in LMICs require standardized tools and guidance to evaluate competency. The World Health Organization and UNICEF developed the “Ensuring Quality in Psychological Support” platform to facilitate competency-based training in psychosocial support, psychological treatments, and foundational helping (...) skills, with an initial focus on in-service training for non-specialists. Our goal was to design the first application of EQUIP to implement competency-based training into pre-service education for clinical psychology trainees. With Makerere University in Uganda as a case study, we outline an approach to develop, implement, and evaluate a competency-based curriculum that includes seven steps: Identify core clinical psychology competencies; Identify evaluation methods appropriate to each competency; Determine when competency evaluations will be integrated in the curriculum, who will evaluate competency, and how results will be used; Train faculty in competency-based education including conducting competency assessments and giving competency-based feedback; Pilot test and evaluate the competency-based education strategy with faculty and students; Modify and implement the competency-based education strategy based on pilot results; and Implement ongoing evaluation of the competency-based curriculum with continuous quality improvement. This approach will be formally evaluated and established as a foundation for pre-service training in other low-resource settings. (shrink)

This paper proposes a roadmap for how privacy leakages from outsourced managed security services using intrusion detection systems can be controlled. The paper first analyses the risk of leaking private or confidential information from signature-based intrusion detection systems. It then discusses how the situation can be improved by developing adequate privacy enforcement methods and privacy leakage metrics in order to control and reduce the leakage of private and confidential information over time. Such metrics should allow for quantifying how much (...) information that is leaking, where these information leakages are, as well as showing what these leakages mean. This includes adding enforcement mechanisms ensuring that operation on sensitive information is transparent and auditable. The data controller or external quality assurance organisations can then verify or certify that the security operation operates in a privacy friendly manner. The roadmap furthermore outlines how privacy-enhanced intrusion detection systems should be implemented by initially providing privacy-enhanced alarm handling and then gradually extending support for privacy enhancing operation to other areas like digital forensics, exchange of threat information and big data analytics based attack detection. (shrink)

Ce document présente les expériences des personnes handicapées physiques dans l’accès aux prêts de microfinance. La microfinance est apparue comme un outil pour éradiquer la pauvreté et autonomiser les pauvres; cependant, y accéder est difficile pour de nombreuses personnes ayant un handicap physique. Cette étude qualitative a été menée par le biais d’entretiens approfondis semi-structurés avec vingt personnes handicapées physiques au Bangladesh pour explorer leurs points de vue sur les problèmes auxquels elles sont confrontées pour accéder à la microfinance. Les (...) données ont été collectées à la fois dans des zones urbaines et rurales et auprès de participants masculins et féminins. S’appuyant sur le modèle social du handicap, cette étude constate que les personnes handicapées physiques subissent une exclusion, une stigmatisation et des obstacles importants dans l’accès à la microfinance. Dans de nombreux cas, malgré les efforts des institutions de microfinance, le crédit n’est pas disponible pour de nombreuses personnes handicapées physiques, car elles subissent un comportement négatif et hostile de la part du personnel de la microfinance et des conditions de crédit inaccessibles. De plus, les personnes handicapées physiques ont moins de possibilités d’accéder à des services autres que le crédit, tels que l’épargne, l’assurance, la formation et les mécanismes de plainte. Pour relever ces défis, les institutions de microfinance doivent élaborer des réformes institutionnelles solides et adaptées aux personnes handicapées. Les personnes handicapées devraient être activement impliquées dans le processus d’élaboration des politiques. Cette étude partagera non seulement les expériences des personnes handicapées physiques dans le contexte des pays du Sud, mais fournira également des informations qui pourraient être utiles pour comprendre les défis auxquels d’autres personnes handicapées dans différents pays sont confrontées en termes d’inclusion financière. (shrink)

Customers are skeptical about shopping online because e-commerce environments are typically considered impersonal. To assure product quality and to enhance customer proclivity in such environments, post-sale services may be considered to alleviate customers’ skepticism. Therefore, this study’s objective is to investigate the role of an online retailer’s post-sale services on customers’ attitudinal and behavioral aspects. Structural equation modeling is applied to data collected through an online survey answered by 409 online customers of jd.com. Research findings show that product (...) return, exchange, and maintenance services are strongly predictive of online customer satisfaction, and satisfaction significantly impacts customer trust. Both customer satisfaction and trust, as indicators of relationship quality, further mediate the links between product return, exchange, and maintenance services and online customer repurchase intention. In addition, differences between male and female customers were found in various aspects of online retailers’ product return, exchange, and maintenance services. This is the first empirical study that not only examines the influence of all three dimensions of online retailers’ post-sale services on customers’ online shopping perceptions and decisions, but also considers differences between male and female customers. Finally, this research provides theoretical and managerial implications based on conceptual and empirical evidence. (shrink)

Over the past three decades, two separate federal regulatory structures have emerged, each seeking to assure separate aspects of the integrity and ethics of research conducted using federal funding. One set of regulations is described in the Public Health Service Policies on Research Misconduct and relates to research misconduct, defined as consisting of fabrication of data or results, falsification of data and results, or plagiarism, in accordance with the federal‐wide definition adopted by the Office of Science and Technology Policy. The (...) second set of regulations, set forth in the Department of Health and Human Services regulations on the protection of human subjects (known as the “Common Rule”), prescribes a set of ethical and procedural protections for research involving human subjects.These two sets of research regulations are distinguished from each other by having different foci of enforcement, priorities of protection, oversight officials, oversight procedures, seizure of evidence, standards of proof, expectations of privacy, and appeal procedures for researchers who are subject to adverse findings and penalties. These differences are significant and fundamental. They complicate the process of compliance for institutions and researchers, who are expected to adhere to both sets of standards for the same federally funded research activities in research with human subjects. Compliance is especially complicated when suspected violations of both sets of standards must be investigated and resolved concurrently. This document represents an effort to provide institutions and individuals with practical suggestions as they try to comply with both sets of regulations. (shrink)

Se realizó una propuesta metodológica en el Hospital Militar Clínico Quirúrgico Docente Doctor Octavio de la Concepción y la Pedraja de Camagüey durante el año 2014 con el objetivo de argumentar el valor ético que tiene para el estudiante de Medicina ser insertado al sistema de garantía de la calidad hospitalaria. Se emplearon métodos de nivel teórico como análisis y síntesis, histórico-lógico, inducción-deducción. La vinculación del estudiante universitario al sistema de garantía de calidad en un centro asistencial docente permite elevar (...) la utilización correcta del método clínico y provee al discente de conocimiento para que al egresar desempeñe un servicio de excelencia y alcance a reducir los errores e insatisfacciones de la población y con ello los costos innecesarios. In order to increase the ethical value integrating medical students into a hospital quality guarantee system has, a methodological proposal was put forward in the Doctor Octavio de la Concepcion y la Pedraja Teaching Clinical-Surgical Military Hospital of Camaguey during 2014. Theoretical methods such as analysis and synthesis, historical-logical methods and induction-deduction were used. Linking college students to the quality guarantee system allows increasing the proper use of the clinician and it provides the learner with the knowledge he needs to carry out an excellent service and to reduce errors making and people dissatisfactions, therefore cutting on unnecessary costs. (shrink)

As an excellent management tool, service guarantee can improve the competitive advantage of enterprises and allow consumers to obtain high-quality products and services. However, in the current Chinese context, this tool has not played its proper function. One important reason is the perception deviation of Chinese consumers. This research analyzes the main reasons for this deviation, puts forward related hypotheses and research models, and discusses the influence of disposition to trust of contract, perceived structural assurance, and subjective norm (...) on service guarantee perception. Also, this study discusses SGP of customers through perceived risk and quality. Through the verification of 574 sample data, the main conclusions are as follows: Disposition to trust of contract, subjective norms, and PSA significantly affect SGP positively; SGP positively affects customer value ; and SGP s are obviously different between people of different ages, education levels, and income levels. Hopefully, these conclusions can have the following enlightenment to enterprises serving Chinese consumers: in the designing stage of service guarantee, perception of customers of this guarantee should be a consideration; CUV can be a proper direction if an enterprise wish to lead the guarantee perception of the customer; Not all products need the same level of service guarantee; and The proper service guarantee level depends on various statistical characteristics of target customers of the service. (shrink)

Dans le cadre de la Convention internationale des droits de l’enfance, à la fin des années 1980, les Nations unies ont encouragé de nombreux pays à créer des lieux de rencontres médiatisées pour assurer la continuité des liens parentaux lorsque les mineurs sont physiquement éloignés d’un ou de deux parents. En Italie, un service appelé « Spazio neutro » (espace neutre) a ainsi vu le jour. Il représente un espace à la fois physique et psychique voué au soutien, au maintien (...) ou à la refondation des liens parentaux en souffrance. À l’aide d’un suivi familial issu de l’expérience clinique d’un des auteurs de l’article dans une commune de l’Italie centrale, les caractéristiques et les spécificités d’un tel service seront illustrées ici. (shrink)

Production methods for food from U.K. livestock industries (milk, dairy products, meat, eggs, fibre) are undergoing substantial change as a result of the need to respond to environmental and animal welfare awareness of purchasing customers, and to espouse the principles of environmental protection. There appears to be a strong will on the part of livestock farmers to satisfy the environmental imperative, led by the need to maintain market share and by existing and impending legislation. There has been support forthcoming in (...) the form of Government-sponsored scientific research and technological development to provide the necessary framework for new environmentally sensitive practices. The agricultural community has itself made substantial responses to market demand through the inception of Farm Assured Quality Assurance Schemes. These appear to have a more sustainable future than the extremes of organic farming and free-range practices. Pollution of agricultural land with nitrate and phosphate by intensive livestock industries is a greater problem in some parts of continental Europe than it is in the U.K. The distribution of livestock out of intensive units and into mixed farming systems, would require substantial restructuring of the industry. Many of the animal welfare requirements which have been forwarded as a part of the environmental agenda for agriculture have been voluntarily accepted by livestock producers. However, some major aspects, such as alternative housing systems for pigs and poultry, remain unresolved. Analysis of the science and technology support for the environmental imperative, especially from Government sources, would suggest that, although dramatically increased in recent years, environmentally orientated research remains a relatively small proportion of the whole. Whilst a movement away from governmental funding of volume production appears to be justifiable, there has not been an equivalent balancing of effort toward funding for product quality, sustainability, environmental protection and animal welfare. Nevertheless, the university education system is producing a generation of more environmentally aware agricultural science graduates who are opting to pursue Government-sponsored environmentally orientated postgraduate research programs. (shrink)

This paper examines the success of corporate communication in voluntary sustainability reporting. Existing studies have focused on the perspective of the communicators but lack an understanding of the perspective of information recipients to clearly evaluate this interactive communication process. This paper looks at the issue of a credibility gap perceived by external stakeholders when they doubt the authenticity of communicated information due to the reporting company’s governance structure. The paper uses family businesses to exemplify the emergence of such a gap (...) when outsiders become concerned about the potential agency problem of the integrated ownership and management controlled by a few members of the same family. Following source credibility theory, these concerns raise a credibility gap associated with a family firm’s trustworthiness and goodwill, even if the family has the expertise to carry out sustainability reporting. The findings of two experimental studies indicate that family businesses suffer a greater credibility gap than non-family businesses. An external and independent assurance service can mitigate such gaps, especially when the service is comprehensive and targets family businesses. The paper provides a complete view evaluating corporate communication by looking at the interaction between the communicating company and the information recipients. (shrink)

This study examines the roles of environmental strategy and accounting in corporate carbon performance, as measured by the Greenhouse Gas (GHG) Protocol. A novel interaction model is developed based on legitimacy theory and natural-resource dependence theory to capture the interaction between environmental strategy and accounting. An international sample of 3322 firms from 73 countries is used in the analysis, based on a panel data design for 17 years (2005–2022). The empirical findings reveal an overall reactive role of these environmental initiatives (...) in relation to carbon performance. The marginal effect analysis shows that environmental accounting favourably moderates the effect of environmental strategic functions on carbon performance, indicating that the former facilitates the translation of the latter into practice. Similarly, environmental strategic initiatives improve the impact of environmental accounting information on carbon performance. The main contribution of this study stems from methodologically demonstrating how the synergy between environmental strategic initiatives and environmental information mechanisms can translate into improved carbon performance. This finding has multiple societal, practical and research implications. The interaction effect evidence can be viewed as consistent with recent trends of integrated approaches to thinking and reporting, where interrelated phenomena are integrated into operational and reporting contexts to improve efficiency. This can be of interest to policymakers, investors, corporate managers and providers of assurance services related to carbon performance. (shrink)

Traditionally, certified public accountants (CPAs) have served a unique role in the world of commerce and the profession of accounting. They perform an attest function and thereby serve as the chief providers of relevant, high quality accounting information to the decision making public. CPAs are licensed practitioners, who as expert independent accountants express opinions about an entity'sfinancial statements. Their license provides them with the exclusive right to perform this attest function. This monoploy relies on the concept of independence that is (...) the normative standard of accountancy. It is this perceived independence of auditors which provides credibility, reliability and trust in the financial accounting information upon which stakeholders depend to make informed decisions. Now, however, we see the environment in which CPAs operate undergoing rapid change. Both the globalization of business operations and technological advances have radically changed how and where accountants work and the speed at which things happen. The very nature of accounting information services is evolving; moving from a concentration on audits to an increasing reliance on consulting and assurance services. New ethical issues have been raised by this confluence of changes in the accounting environment. Noteworthy is that the application of the principle of independence by CPAs has been called into question by no other than the SEC. Are those stakeholders who depend upon the independence of CPAs at risk? The influence of insiders has significantly increased as accounting firms perform multiple tasks for the same clients. This paper discusses the different groups who can potentially impair the independence of auditors and the steps that are being taken to enhance the "independence" of the auditors. (shrink)

Dans le cadre de leur démarche permanente d’innovation, les équipes de la protection juridique du groupe Covéa ont expérimenté les nouveaux outils dits « prédictifs » à l’appui des conseils qu’elles donnent au titre des litiges dont elles ont la gestion. Parmi les objectifs, mesurer leurs apports dans la perception par nos assurés de leurs chances de succès et risques de condamnation, afin de faciliter leur prise de décision sur les suites à donner à leur dossier, et bien sûr, préparer (...) de nouveaux services à leur attention. (shrink)

Background: Emergency care providers are frequently faces with situations in which they have to make decisions quickly in stressful situations. They face barriers to ethical decision-making and recognizing and finding solutions to these barriers helps them to make ethical decision. Objectives: The purpose of this study was to identify barriers of ethical decision-making in Iranian Emergency Medical Service personnel. Methods: In this qualitative research, the participants (n = 15) were selected using the purposive sampling method, and the data were collected (...) by deep and semi-structured interviews. Finally, the data are analyzed using the content analysis approach. Ethical considerations: Permission to conduct the study was obtained from the Ethics Committee of the Shahid Beheshti University of Medical Sciences. The objectives of the study were explained to the participants and written consent was received from them. Also, participants were assured that necessary measures were taken to protect their anonymity and confidentiality. Findings: The results of the analysis are classified in five main categories. It encompasses the following areas: perception of situation, patient-related factors, input and output imbalance, uncoordinated health system, and paradoxes. Conclusion: Emergency Medical Service personnel make ethical decisions every day. It is important that prehospital personnel know how to manage those decisions properly so that clients’ moral rights are respected. Hence, by identifying the dimensions and obstacles of ethical decision-making in Emergency Medical Service personnel, it is possible to enhance the moral judgment and ethical accountability of the personnel and develop the strategies necessary for ethical decision-making in them. (shrink)

Client-provider relationships have significant effects on how individuals comprehend their life situation during chronic disease and illness. Yet, little is known about how frontline health care providers (HCPs) influence client’s identity formation through meaning-making with clients such as HIV-positive women living in poverty. This requires ethical consideration of the meanings made between clients and providers about client’s health and well-being, both individually and in the larger society. Health care providers (N = 15) and married women living with HIV (N = (...) 33) in north-central India engaged in separate intensive interviews providing narrative data which were analysed using a conceptual framework crossing Lipsky’s street-level bureaucracy theory (Lipsky 2010) with meaning-making processes. HCPs and women construct meanings of women’s role as caregivers that impact women’s sense of identity, health, and well-being. Findings indicate that despite being well-intentioned, HCPs inadvertently reinforce rigid gender norms and convey that women’s worth is tied to their familial caregiving role. HCPs’ discretionary advocacy may also reinforce societal images of women as incapable and needy, thereby harming them more generally. Attention to the gender-sensitive training of HIV health care providers may assure that discretion is ethically interrogated to promote gender equity and enhance women’s access to social welfare services. (shrink)

Is selling sex a service like any other? Philosophers have given a range of answers to this question: (a) sex has a specific value that is debased by commercial markets in sex; (b) sex work is a service like any other; (c) markets in sex perpetuate structural systems of inequality. This article takes seriously the suggestion that there is something special about sex itself which raises a specific set of concerns when traded for money. The challenge is to explain this (...) without drawing on contentious essentialist claims about the value of sex. It proceeds by analysing a parallel between sexual promises and selling sexual consent. On an expectational theory of promising, commercial agreements to sex generate obligations in a way that is normatively analogous to sexual promises. Understanding the normative release conditions for such assurance‐providing agreements provides a way of analysing the justifiability of various ways of enforcing such agreements. I argue that the release conditions for agreements involving sex are not conducive to being codified under typical forms of service contract. As such, regulation aimed at legitimising sex work must provide adequate protections to workers without codifying it under typical forms of service contract. (shrink)

The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...) and Genomics England.3 A recent review commissioned by the UK’s Department of Health and Social Care (hereafter referred to as the ‘Goldacre Review’) places TREs at the heart of its recommendations around the future of National Health Service (NHS) health data sharing for research, describing them as the ‘clear path forward’ to a health data system in which trust is ‘earned’ through ‘provable, credible steps to protect patient privacy, and by being transparent with everyone about everything that is done with their deepest medical secrets’.4 We argue that rather than building public trust, the TRE model actually reduces the need for trust in the use and sharing of patient health data. This is because trust is importantly connected to vulnerability and uncertainty; an essential part of trusting someone is accepting that one’s trust could be disappointed or betrayed. In attempting to provide assurances or guarantees of data privacy and security, TREs strive to remove this vulnerability, and so remove the need for trust. We do not see this as a problem and are broadly supportive of this kind of data sharing model because of the increased security and oversight it provides. However, having argued that TREs are not actually concerned with trust, we consider the importance of being precise about the words that we use …. (shrink)

Ce commentaire analyse les enjeux éthiques soulevés par la circulaire 03-01-42-07 qui prescrit l’application d’une majoration tarifaire de 200 % à toute personne non affiliée à la RAMQ (assurance maladie publique) pour des soins délivrés dans un établissement du réseau de la santé et des services sociaux. Cette règle tarifaire s’applique aussi bien aux personnes qui ne résident pas au Québec (touristes) qu’à celles qui y habitent sans couverture d’assurance santé. En ayant pour hypothèse qu’elle vise à (...) protéger le réseau de santé du phénomène de tourisme médical, ce commentaire en démontre l’aspect inéquitable et injuste lorsqu’elle s’applique à des personnes qui résident au Québec. (shrink)

Abstract“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day (...) if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field. (shrink)

This paper reports an initiative from the National Research Ethics Service (UK) and research ethics committees in the UK to develop a shared ethical debate between committees and to promote standards of ethical review, exploring the problems and practicalities of such an approach.

Background: Empathy and moral courage are important virtues in nursing and nursing ethics. Hence, it is of great importance that nursing students and nurses develop their ability to empathize and their willingness to demonstrate moral courage. Research aim: The aim of this article is to explore third-year undergraduate nursing students’ perceptions and experiences in developing empathy and moral courage. Research design: This study employed a longitudinal qualitative design based on individual interviews. Participants and research context: Seven undergraduate nursing students were (...) interviewed during or immediately following their final clinical placement. Ethical considerations: The Norwegian Social Science Data Services (NSD) approved the study. Participants were informed that their participation was voluntary and were assured confidentiality. They were informed that they could withdraw from the study at any time, without providing reasons. Findings: Affective empathy seemed to be strong among third-year undergraduate nursing students. However, they tried to handle the situations in a ‘professional’ way, and to balance their emotions. At the same time, they expressed how difficult it can be to show moral courage when confronted with poor patient care. In addition, they spoke about a lack of role models during clinical practice and supervision. Conclusions: Undergraduate nursing students are in a vulnerable position throughout their journey to become professional and to develop empathy and moral courage. The professional socialisation and forming of professional empathy and moral courage among nursing students, may be seen as a complex interaction of formal and hidden curriculum, where role models play an important role. We argue that the main theme ‘Vulnerable students – a journey towards professional empathy and moral courage’ may cover the longitudinal project as a whole. This vulnerability is something both teachers and supervisors should be aware of when following up with students in their clinical placements. (shrink)

The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.

COVID-19 pandemic has claimed thousands of lives around the world. Among the casualties are doctors, nurses, and other health care professionals. Those who defy the danger of death and continue to render their services have to deal with psychological and mental stress due to the lack of protective measures and equipment, the overwhelming number of patients, and the experience of discrimination. In fact, some left their job. In this paper, I will argue that the motivation of health care professionals (...) and the outcome of their sacrifices, as against assuring personal safety, can be explained by the principle of the common good. First, they are faithful to their oath as health care professionals since it is their commitment as part of an institution that assumes the responsibility of providing health care to people in need. Second, restoring the patients’ condition goes beyond health issues since the recovery of each COVID-19 patient diminishes the spread of the virus, which, if not for the care of HCPs, could worsen the situation with snowballing consequences to society as a whole. While it is expected for any health care professional as a frontliner in times of pandemic, their motivation to serve exemplifies the greater value for the common good. (shrink)

The role of government in assuring population access to affordable and appropriate health care represents a central question for any nation. Of particular concern is access to prescription drug coverage, not only because of the vital role played by drugs in modern medicine, but also because of their high costs. This article examines the sharply contrasting prescription drug coverage and payment policies found in Australia and the U.S. – strong political allies and international trading partners – and describes how key (...) U.S. interests have sought, through an aggressive trade agenda, to expand markets for U.S. goods and services, even when market expansions clash with other nations’ contrasting emphasis on social equity and fairness. Indeed, the nation’s bilateral free trade negotiations have brought the contours of this policy schism into sharp relief. (shrink)

In response to the Covid‐19 pandemic, health care systems worldwide canceled or delayed elective surgeries, outpatient procedures, and clinic appointments. Although such measures may have been necessary to preserve medical resources and to prevent potential exposures early in the pandemic, moving forward, the indirect effects of such an extensive medical shutdown must not outweigh the direct harms of Covid‐19. In this essay, we argue for the reopening of evidence‐based health care with assurance provided to patients about the safety and (...) necessity of high‐value vaccinations, screenings, therapeutics, and procedures. To ensure that virtually all non‐Covid‐related services do not come to a halt again, health care systems and physician practices must preemptively increase their capacity, secure adequate personal protective equipment to safeguard health care personnel, and develop a measured approach to reclosing such routine health care, should it become necessary in the future. (shrink)

IntroductionElements mark the reality of reading the female body in symbolic constructions and social symbols in the exercise of their reproductive health. The study aims to identify elements that characterize the female condition while analyzing the reproductive health of Brazilian and French women.Materials and MethodsA qualitative, multicenter, international study was conducted in Brazil and in France between 2016 and 2019. Data were produced through the use of semi-structured scripts. Focus group discussions and individual interviews were conducted with women who gave (...) birth, hetero-female couples who lived the experience of gestation and birth of a baby, and professionals of maternal and childcare services or members of the associations concerned with the health of mothers and babies. It was guided by the theoretical-methodological framework of institutional analysis in line with the French Institutional Socioclinics.ResultsSexual and reproductive health in the realities researched in Brazil and France are sometimes close and sometimes far apart. In what involves the Brazilian health system, abortion is criminalized and often performed illegally. Furthermore, pregnancy, childbirth, and the postpartum period are highly medicalized. In addition, childbirth is not assured as an experience for a woman and her family. This aspect is confirmed by high numbers of cesarean sections performed or by maternal and infant mortality indicators. The French health system prioritizes vaginal deliveries and seems to assure more autonomy to women, but at the same time, it is worn out by the logic of profit, the efficiency of actions, and the rationalization of practices. In association with these, there are other intrinsic elements in the functioning of the institution that delineates the format of each country: notion of women's rights, violence against women, and discussion regarding the oppression markers of race, gender, sexuality, and social class.ConclusionsBoth countries reveal aspects related to the social role of women's bodies. The established logic reflects in the decision to have children, motherhood, women's autonomy over their own bodies, and in the core values linked to the termination of pregnancy and the professional practices developed in prenatal care, childbirth, and postpartum. (shrink)

Introduction: Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. Objective: The objective of this study is to identify emergency health professionals’ views regarding refusal of (...) treatment. Methods: This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Ethical considerations: Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. Results: The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. Conclusions: This study has found that prehospital emergency health professionals generally respect the patient’s right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Organizational Ethics and Health Care: Expanding Bioethics to the Institutional Arena **Laura Jane Bishop (bio), M. Nichelle Cherry (bio), and Martina Darragh* (bio)In 1995, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expanded its patient rights standards to include requirements for assuring that hospital business practices would be ethical. Renamed “Patient Rights and Organization Ethics,” these standards are based on the realization that a hospital’s obligation to its (...) patients is derived from two relationships: the patient-provider relationship governed by “clinical ethics,” and the customer-supplier relationship governed by “business ethics.” “[This] boundary between ‘clinical’ ethics and ‘business’ ethics is not clear and in many cases is nonexistent. While marketing and admission practices are seen as issues related to ‘business’ ethics, they can lead to unneeded admissions or demand for unneeded services, both of which can unnecessarily expose the patient to the risk of side effects or complications. Likewise, underutilization of needed services is likely to lead to less than optimal health outcomes” (I. Schyve 1996, p. 17). “These new standards arose out of well-publicized concerns about abuses in which patients were admitted to hospitals unnecessarily and were discharged or transferred only after their insurance expired” (I. Schyve 1996, pp. 15–16).These abuses also sparked eloquent protests against threats to patient well-being and to the nature of the patient-provider relationship in the bioethics literature. The fiduciary responsibility of the provider to inform and to protect the patient was fragmented by insurer business practices such as gag clauses and economic credentialing of providers (VII. Scope Note 31, 1996). The background role that the institution plays, though poorly articulated historically, has been brought sharply into focus by the explosive growth of the managed practice of medicine. The context of medical ethics is no longer limited to the resolution of individual cases, but instead encompasses the adoption of institutional structures to protect and promote patient welfare (IV. Emanuel 1995, p. 335). In this new configuration, the institution and the providers are co-fiduciaries for populations [End Page 189] of patients, and the medicine that is practiced is “appropriately economically disciplined.” The expression “My patient always comes first” is no longer “... intellectually serious or morally responsible.” But, “... to be sure, both conceptually and in practice, being an economically disciplined fiduciary professional or institution is ethically unstable.... The task is to identify the boundaries outside of which institutional policy and behavior will not count as an ethically defensible form of being... [a] fiduciary.” (IV. McCullough 1997, pp. 143–44). This process of delimiting and enforcing boundaries requires the development of “... a language for talking about the ethical values of the organization. If such a language does not exist, discussions about ethics become cumbersome and unlikely to occur” (IV. Cleveland Clinic Foundation 1998, p. 2).As with bioethics generally, the literature addressing organizational ethics is multidisciplinary. JCAHO’s compliance guide for its revised standards, Ethical Issues and Patient Rights, draws on a wealth of ideas from both clinical ethics and business ethics. This is often an awkward alliance. “Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff” (I. Boyle 1998, p. 2). The fact that “... there is an ancient history that reflects widespread doubt about the moral probity of business” (II. Frederick 1995, p. 209) does not help. To begin, “Aristotle had rude things to say about business” (II. Jackson 1998, p. 401). A brief review of introductions to several of the business ethics textbooks cited in this bibliography reveals that a rebuttal of “business ethics as an oxymoron” is the standard opening paragraph. This stigma is unfounded, and “increased stability” has characterized the state of business ethics literature during the 1990s (II. Beauchamp and Bowie 1997, p. ix). Significant attention has been given to elaborating two often overlapping theories—stakeholder and social contractarian.Originating in the 1960s as a pun on “stockholder,” proponents of stakeholder theory claim that a corporation’s fiduciary responsibility extends beyond increasing its profitability to protecting the rights of individuals or groups affected by its actions. Popular as a strategic planning tool in the... (shrink)

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with (...) key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When OPRR Comes Calling:Enforcing Federal Research RegulationsCharles R. Mccarthy (bio)In an update following this article, Ruth Macklin responds to the revelation that the controversial Hall-Stillman embryo-splitting experiment at George Washington University was conducted—contrary to federal regulations—without prior institutional review board (IRB) review. This revelation altered Dr. Macklin's view of the ethical status of the research. Undoubtedly such revelations also raise general questions for administrators and researchers in many institutions, (...) including, for example: How do allegations of noncompliance with federal regulations arise? When should allegations of infractions of the regulations be reported? Who has an obligation to report? To whom should reports be made? What sort of inquiry should take place? Who should conduct the inquiry? If a determination is made that infractions have occurred, what sanctions are appropriate? And, what publicity is given to the allegations, before, during, and after an evaluation?Some of these questions can be answered in a straightforward manner, while the answers to others depend on the circumstances of the case. This article provides some general answers to these questions.1BackgroundThe Department of Health and Human Services (DHHS) is the largest supporter of biomedical and behavioral research in the world. Somewhere between 25 and 33 percent of its medical research budget is devoted to the support of research involving human subjects. In accordance with the Public Health Service Act, DHHS has issued Regulations for the Protection of Human Subjects (45 CFR 46). The DHHS Secretary has delegated responsibility for promulgating and administering the regulations to the Office for Protection from Research Risks (OPRR), which is located within the National Institutes of Health.When an institution receives an award from a DHHS agency to carry out research involving human subjects, it is required to negotiate, or to have on file, an "assurance of compliance" document that provides detailed information [End Page 51] specifying how the institution plans to comply with the regulations for the protection of human subjects. Most major research institutions in the country have on file a "multiple project assurance" (MPA) document, which extends DHHS regulations to all human subjects research conducted or sponsored by that institution, irrespective of the source of funding. The regulations and the assurance of compliance require any research project involving human subjects to be reviewed and approved by an institutional review board (IRB) prior to initiation of the research. In addition, the project must be re-reviewed by the IRB at appropriate intervals—in no case, less than once a year. Institutional compliance with these and other requirements of the regulations has improved during the last 30 years and appears to be at a high level. However, from time to time, allegations of noncompliance arise, as they did in the George Washington University embryo-splitting experiment, and set in motion the review process described below.How do Allegations of Noncompliance Arise?Allegations or indications of noncompliance with federal regulations for the protection of human subjects may come from a variety of sources. Most commonly, the institution's IRB discovers that research involving humans is going forward without the required prior IRB review and approval, or that approved research is being conducted in a way that is contrary to the stipulations of the IRB. The Hall-Stillman case came to the attention of George Washington University's IRB because the research protocol was submitted to the IRB after the research had been carried out. In this case, there could be no doubt that an infraction had occurred.Information about possible noncompliance also frequently derives from a funding agency's Initial Review Group (IRG) (commonly called a Study Section) when it has reason to suspect noncompliance in a project it is reviewing for possible funding. An actual case that occurred some years ago involved a research application that proposed to perform brain biopsies on normal volunteers. The IRG that reviewed the application lost little time in questioning whether an IRB had approved the protocol. In this case, it was not enough for the IRG to recommend disapproval of the proposal for funding; it also was obliged to report the possible infraction to OPRR.Whistleblowers, including research subjects, nurses, students, members of the... (shrink)