Mapping ward managers’ core competencies using the Balanced Scorecard model

Fabio Mozzarelli PhD candidate, translational medical and surgery sciences, Faculty of Medicine and Surgery, University of Parma, Parma, Italy

Antonina Catinella Nurse, Guglielmo da Saliceto Hospital, Piacenza, Italy

Chiara Tuccio Nurse, Guglielmo da Saliceto Hospital, Piacenza, Italy; Gaia Decorato, nurse (currently not in employment)

Why you should read this article:

• • To enhance your knowledge of the Balanced Scorecard strategic business management framework

• • To read about a study using the Balanced Scorecard model to map the nurse ward manager role

• • To explore nurse ward managers’ core competencies from the viewpoint of healthcare professionals in Italy

Background Nurse ward managers have a crucial role in the effective functioning of hospital wards and in organising the work of the nursing team. The Balanced Scorecard model is a management framework that enables strategy to be translated into action by setting goals that lead to measurable outcomes. Few studies have used the Balanced Scorecard model to map the competencies of healthcare professionals.

Aim To use the Balanced Scorecard model to map the core competencies of nurse ward managers and determine relevant key performance areas (KPAs) and key performance indicators (KPIs).

Method This mixed-methods study was conducted in the surgical department of an Italian hospital using a qualitative and quantitative exploratory sequential approach. For the quantitative part, the authors asked a convenience sample of various clinical staff to rate a list of nine competencies in terms of their importance for the work of nurse ward managers. For the qualitative part, two focus group discussions were held with nurse ward managers.

Findings Responses to the questionnaires showed that all nine competencies were important to respondents, with no statistically significant differences between roles. Findings from the focus group discussions broadly confirmed the relevance and importance of the nine competencies. Based on these findings, the authors formulated a strategic map of the nurse ward manager role, with core competencies and associated objectives mapped against the four dimensions of the Balanced Scorecard model.

Conclusion A strategic map of the nurse ward manager role informed by the Balanced Scorecard model can help measure nurse ward managers’ performance and provide a benchmark for them to improve their competencies.

Nursing Management. doi: 10.7748/nm.2024.e2107

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

fabio.mozzarelli@unipr.it

Conflict of interest

None declared

Mozzarelli F, Catinella A, Tuccio C et al (2024) Mapping ward managers’ core competencies using the Balanced Scorecard model. Nursing Management. doi: 10.7748/nm.2024.e2107

Published online: 08 February 2024

Keywords :

competence - competency framework - leadership - leadership skills - management - matrons - professional - professional issues - ward managers

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Background

Nurse ward managers have a crucial role in the functioning of a hospital ward and in organising the work of the nursing team, as well as in contributing to their organisation’s corporate goals by coordinating clinical, training and research activities. Over the years, the role has evolved in terms of responsibilities, skills and training. Today, nurses who want to take up a nurse ward manager role need to possess nursing skills (including operational skills) and experience coupled with managerial skills (Van Bogaert et al 2015).

Klemp (1980) proposed a list of managerial skills – such as logical thinking and the ability to use initiative – that was refined and turned into a competency model by Spencer and Spencer (1993). Spencer and Spencer (1993) visually represented their competency model as an ‘iceberg’ encompassing a visible top part made up of the individual’s skills and knowledge, and an invisible or hidden bottom part made up of the individual’s motivations, personal traits and concepts of self.

Operational skills are technical skills related to what is commonly understood as know-how. Operational skills are supported by training and experience and are often referred to as ‘the knowledge’ or the ‘basic skills’ required by healthcare professionals such as nurses (Fukada 2018). Furthermore, for nursing teams to function effectively, certain competencies and traits are required from each individual team member, including intellect, motivation and positive self-image (Lucas 2019).

Given the complexity of the nurse ward manager role, it is important to identify and map its core competencies and clarify its measurable skills and responsibilities (Levati and Saraò 2002). This can help ensure that nurse ward managers are able to deliver the principles of transformational leadership in practice.

Transformational leadership, often considered the most effective leadership style for modern healthcare organisations (Specchia et al 2021), involves leaders acting as a source of motivation for team members, enabling them to achieve their potential. Transformational leaders show empathy so that they can collaborate with team members and instil in them the confidence to achieve their potential in every situation. They foster clear communication, which helps resolve issues and leads in turn to the fulfilment of the team’s objectives. They encourage organisational change, inspiring team members to be open to alternative points of view and find alternative solutions to challenges, thereby enabling them to fully express their skills and competencies (Robbins and Davidhizar 2020). Boamah et al (2018) and Seljemo et al (2020) found that transformational leadership in nursing could enhance patient satisfaction and patient safety.

Balanced Scorecard model

To map the core competencies of nurse ward managers it is necessary to define the role through a set of objectives and outcomes demonstrated through specific actions and expected behaviours. For nurse ward managers, as for any professional role, this can be done via a job description (Melnyk et al 2014), but it can also be done using a conceptual framework such as the Balanced Scorecard model (Kaplan and Norton 1992).

The Balanced Scorecard model is a business management framework that enables strategy to be translated into action by setting goals that lead to measurable outcomes. It is a system for formalising an organisation’s activities by representing its objectives using a conceptual map. It has been described as a strategic and integrated approach that aims to measure business processes and individual staff performance, enabling the identification of key performance areas (KPAs) and key performance indicators (KPIs). The model comprises four dimensions: financial, client, business processes and learning (Kaplan and Norton 1992).

The Balanced Scorecard model has become popular as a strategic management system and is widely recognised internationally. It is used in private, not-for-profit and public sector organisations of all sizes and types, including in healthcare (McDonald 2012). According to Inamdar and Kaplan (2002), the Balanced Scorecard model can provide the following benefits to healthcare organisations:

• • Aligning the organisation with a more market-oriented, customer-focused strategy.

• • Facilitating, monitoring and assessing the implementation of the organisation’s strategy.

• • Providing a mechanism for communication and collaboration.

• • Assigning accountability for performance at all levels of the organisation.

• • Providing continual feedback on strategy and promoting adjustments to marketplace and regulatory changes.

• • Improving the organisation’s market position, financial results and customer satisfaction.

While there have been some studies on the use of the Balanced Scorecard model in the healthcare context to map organisational and budgetary outcomes (Cuccurullo and Tomasetti 2004, Frittoli and Mancini 2004, Broccardo 2015), few authors have explored its use to map the competencies of healthcare professionals (Berti and Mozzarelli 2021).

Implications for practice

• • The role of nurse ward manager can be defined through a set of objectives and outcomes demonstrated through specific actions and expected behaviours

• • The Balanced Scorecard model is a business management framework that enables strategy to be translated into action by setting goals that lead to measurable outcomes

• • A research team in Italy has used the Balanced Scorecard model to formulate a strategic map of the nurse ward manager role with nine core competencies and associated objectives

• • Mapping the nurse ward manager role against the Balanced Scorecard model can produce a useful tool for measuring and improving performance

Aim

To use the Balanced Scorecard model to map the core competencies of nurse ward managers and determine relevant KPAs and KPIs.

Methods

This was a mixed-methods study that used a quantitative and qualitative exploratory sequential approach. It was conducted at the surgical department of Guglielmo da Saliceto Hospital in Piacenza, Italy, at the request of the department’s nurse ward managers.

Quantitative part

The quantitative part of the study involved the development of a questionnaire on the competencies of nurse ward managers and its completion by a sample of healthcare professionals working at the surgical department of Guglielmo da Saliceto Hospital.

Questionnaire

To establish a list of competencies, the research team (the authors of this article) consulted several sources, including:

• • Spencer and Spencer’s (1993) competency model.

• • The professional competencies identified by the University Hospital of Ferrara (Azienda Ospedaliero – Universitaria di Ferrara 2010).

• • The nursing competencies drafted by the Federazione Nazionale dei Collegi IPASVI (2015), Italy’s national federation of nursing colleges, which represents all nursing professions. (It has recently been superseded by a new organisation called Federazione Nazionale degli Ordini delle Professioni Infermieristiche, or FNOPI.)

The research team established a preliminary list of nine nurse ward manager competencies with associated objectives and expected behaviours (Table 1).

Table 1.

Preliminary list of nurse ward manager competencies with associated objectives and expected behaviours

Competency	Objectives	Expected behaviours
Focus on results	• Set goals for measurable outcomes • Clearly define staff responsibilities and oversee delegation • Achieve results on schedule	The nurse ward manager schedules regular meetings to update the staff on the goals of the ward and the available budget
Initiative	• Formulate proposals, ideas and projects for service improvement • Assess the results and redesign the proposals if necessary	The nurse ward manager, together with staff, formulates work plans for both departmental routines and emergency situations
User orientation	• Actively listen to the views and needs of others • Constantly check in with colleagues and managers to assess the quality of their performance	The nurse ward manager is available to answer any questions or concerns patients, staff or visiting family members may have
Supporting change	• Invest time and attention in motivating staff for, and promoting, change • Analyse change proposals to identify opportunities, needs and benefits	The nurse ward manager collaborates with staff to identify any issues that have emerged, for example with the use of clinical equipment, and treats these as an opportunity to improve skills, thereby promoting change
Team leadership	• Ensure that team goals are clear and simple while considering individual staff needs • Conduct meetings to define team objectives, team members’ roles, methods and timing • Emphasise positive results, thereby valuing teamwork	The nurse ward manager is committed to sharing any decisions that affect the ward or unit with the entire team, and obtains their approval; for example, this might include decisions around new medical equipment or training courses
Development	• Consistently provide colleagues with necessary information and knowledge • Provide constructive criticism for staff that enables them to progress	The nurse ward manager consistently updates colleagues on their contribution to achieving the team’s goals, giving credit to each individual for their work
Self-control	• Tolerate stressful and tense situations • React appropriately and constructively to tensions and provocations • Remain lucid and motivated when confronted with challenging situations	The nurse ward manager creates a positive atmosphere in meetings by avoiding conflicts, controlling their responses, and encouraging ‘content over emotions’
Flexibility	• Modify strategy in response to changes in the environment • Adapt plans to the needs of others to achieve team goals	The nurse ward manager accepts change and assists colleagues to quickly adapt to new regulations or policies
Service orientation	• Participate in committees, projects and commissions related to specific team or ward goals • Align own and staff behaviour with the organisation’s priorities, with constant attention paid to its code of professional ethics	The nurse ward manager reports any inappropriate staff behaviour to the department manager

Using the nine competencies and associated objectives (Table 1), the research team developed a questionnaire in which respondents were asked to rate the importance of each competency, with its set of objectives, for the work of nurse ward managers on a six-point Likert scale ranging from 1 (‘not important’) to 6 (‘most important’).

Recruitment, data collection and data analysis

A convenience sample of healthcare professionals working at the surgical department of Guglielmo da Saliceto Hospital was recruited using the organisation’s email network. The questionnaires were sent to participants, completed and returned in June 2022.

Statistical processing of the data obtained from the questionnaires was undertaken using a spreadsheet program. Comparison of the data was undertaken using analysis of variance (ANOVA), which is used to compare variance between the means of different groups. Social Science Statistics software (www.socscistatistics.com/) was used to undertake the ANOVAs. A P value <0.05 was considered statistically significant.

Qualitative part

For the qualitative part of the study two focus groups were held (Paturzo et al 2016, Mortari and Zannini 2017), each with eight nurse managers of surgical wards at Guglielmo da Saliceto Hospital. In the first focus group meeting, which took place in May 2022, participants were asked to share and discuss what they believed to be the competencies, objectives and expected behaviours of ward nurse managers. In the second focus group, which took place in September 2022, the results of the questionnaire survey were shared and discussed with participants.

The focus group discussions were facilitated by two members of the research team (FM and AC). They were conducted at the hospital in private rooms adjacent to clinical areas. The discussions were audio recorded and transcribed verbatim, following which the recordings were deleted. Data collected during the focus groups were analysed using Schilling’s thematic analysis model (2006).

Ethical considerations

The study was approved by the head of nursing at Guglielmo da Saliceto Hospital and authorised by its chief nursing officer, who also approved its ethical aspects. Staff who had agreed to complete the questionnaire were informed of the purposes of the study and were sent a consent form that they had to complete to take part. They were assured that their anonymity would be maintained, as per the requirements of personal data legislation in Italy. The completed questionnaires were kept in secure boxes. Data were processed in aggregate form so the identity of individual respondents remained hidden. Focus group participants took part voluntarily and, as for questionnaire respondents, their consent was sought and their anonymity protected.

Findings

Quantitative part

Overall, 287 questionnaires were sent to clinical staff working at the surgical department of Guglielmo da Saliceto Hospital. Of these 287 questionnaires, 112 (39%) were returned to the research team. Table 2 shows the role and number of years of service of staff who returned the questionnaire. Eight questionnaires were deemed invalid because they were incomplete. The final sample of 104 respondents comprised 76 women and 28 men.

Table 2.

Role and number of years of service of staff who returned the questionnaire (n=112)

Role	Number (%)	Mean number of years
		Working in the surgical field	Working in healthcare
Nurse ward manager	8 (7%)	27	27
Nurse	73 (65%)	14	16
Doctor	11 (10%)	6	10
Healthcare assistant	17 (15%)	5	15
Speech therapist	2 (2%)	8	18
Audiologist	1 (1%)	8	18

Analysis of the data collected from the questionnaires showed no statistically significant differences between roles regarding the importance of each competency (P=0.10). All competencies obtained a mean score above 4.5 (out of 6), showing that they were all considered important. The competency that received the highest score was self-control, with a mean score of 5.12 points. Figure 1 shows the mean questionnaire score for each nurse ward manager competency.

Figure 1.

Mean questionnaire score for each nurse ward manager competency

Qualitative part

Findings from the focus group discussions broadly confirmed the relevance and importance of the nine competencies established through the questionnaire survey. The second focus group discussions showed that the eight participating nurse ward managers broadly agreed with the scores attributed by questionnaire respondents to each of the nine competencies.

Using the findings of the focus groups, the research team considered the ward nurse manager role with reference to the four dimensions of the Balanced Scorecard model:

• • Financial – the achievement of results relies on the nurse ward manager’s competency in controlling costs, managing budgets, maintaining team performance and organising resources.

• • Client (in this case the nurse ward manager) – optimal teamwork relies on the nurse ward manager’s competency in providing positive leadership, ensuring the team has access to professional development opportunities and promoting staff well-being and satisfaction.

• • Business processes – key business processes such as workflow management, the supervision of nursing activities and the achievement of clinical objectives rely on the nurse ward manager’s competency in exercising self-control in moments of tension and in involving team members in decision-making.

• • Learning – the nurse ward manager has responsibilities in developing their colleagues’ knowledge and initiatives such as staff training, as well as in explaining the benefits of information systems and new technologies.

Strategic map of the nurse ward manager role

Finally, the research team used the Balanced Scorecard model to formulate a strategic map of the nurse ward manager role, with the nine core competencies and associated objectives arranged into KPAs and KPIs (Table 3).

Table 3.

Strategic map of the nurse ward manager role formulated using the Balanced Scorecard model

Balanced Scorecard model dimension	Key performance area (core competency)	Key performance indicators (objectives)
Financial	Focus on results	• Set goals for measurable outcomes • Clearly define staff responsibilities and oversee delegation • Achieve results on schedule
Client	User orientation	• Actively listen to the views and needs of others • Constantly check in with colleagues and managers to assess the quality of their performance
	Team leadership	• Ensure that team goals are clear and simple while considering individual staff needs • Conduct meetings to define team objectives, team members’ roles, methods and timing • Emphasise positive results, thereby valuing teamwork
	Development	• Consistently provide colleagues with necessary information and knowledge • Provide constructive criticism for staff that enables them to progress
Business processes	Self-control	• Tolerate stressful and tense situations • React appropriately and constructively to tensions and provocations • Remain lucid and motivated when confronted with challenging situations
	Supporting change	• Invest time and attention in motivating staff for, and promoting, change • Analyse change proposals to identify opportunities, needs and benefits
	Service orientation	• Participate in committees, projects and commissions related to specific team or ward goals • Align own behaviour and staff behaviour with the organisation’s priorities, with constant attention to its code of professional ethics
	Flexibility	• Modify strategy in response to changes in the environment • Adapt plans to the needs of others to achieve team goals
Learning	Initiative	• Formulate proposals, ideas and projects for service improvement • Assess the results and redesign the proposals if necessary

Discussion

Identifying and discussing the core competencies required of nurse ward managers, along with their associated objectives and expected behaviours, resulted in the development of a tool that allows them to take a broader view of the role. As proposed by Jeffs et al (2011), the research team found that using the Balanced Scorecard model to map the core competencies of nurse ward managers could produce a useful tool for healthcare decision-makers, enabling them to set measurable KPAs and KPIs. A map of core competencies informed by the Balanced Scorecard model can help measure nurse ward managers’ performance and ensure that their abilities correspond to the requirements of their role. It can also provide a prompt and a benchmark for nurse ward managers to think about the qualities required for their role and improve their competencies.

To the best of the authors’ knowledge, the competencies required of nurse ward managers have not previously been mapped using the Balanced Scorecard model, since previous research has primarily investigated the competencies required of nurses more directly involved in patient care. Hall et al (2003) used the Balanced Scorecard model to map the competencies of nurses, linking them to nurse-sensitive outcomes such as patient satisfaction and financial performance. A mapping of competencies against care activities also emerged in work by Yang (2022), who used the Balanced Scorecard model to assess nursing performance in community health service centres, finding that the overall skills of community nurses could be developed and that the use of home visits by community nurses should be expanded. Jepsen (2015) used the Balanced Scorecard model to emphasise the work of clinical nurse specialists who often took the lead in clinical care but whose input and value were often not reflected in outcomes data.

Conclusion

This mixed-methods study conducted in Italy has produced a description of the nurse ward manager role with core competencies and associated objectives mapped against the Balanced Scorecard model, a management framework used by organisations of all types and sizes, including in healthcare, for strategic planning.

The authors obtained quantitative data by asking a sample of clinical staff working in different roles to rate the importance, for the work of nurse ward managers, of nine selected competencies. Qualitative data was obtained from two focus group discussions with nurse ward managers.

The outcome of the study, a strategic map of the nurse ward manager role with associated KPAs and KPIs, can be a useful tool for healthcare decision-makers to measure nurse ward managers’ performance and for nurse ward managers themselves to reflect on and improve their competencies.

References

1. Azienda Ospedaliero – Universitaria di Ferrara (2010) Riorganizzazione della Direzione delle Professioni: Le Competenze del Coordinatore e dei Professional. http://pdf4pro.com/view/azienda-ospedaliero-universitaria-di-ferrara-54e0e.html (Last accessed: 29 January 2024.)
   [Google Scholar]
2. Berti L, Mozzarelli F (2021) Breast care nurse: survey from care competences definition to organizational performance evaluation using the strategic approach of the balance scorecard. Italian Journal of Nursing. 37, 30-36.
   [Google Scholar]
3. Boamah SA, Spence Laschinger HK, Wong C et al (2018) Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook. 66, 2, 180-189. doi: 10.1016/j.outlook.2017.10.004
   [CROSSREF] [Google Scholar]
4. Broccardo L (2015) The balance scorecard implementation in the Italian health care system: some evidences from literature and a case study analysis. Journal of Health Management. 17, 1, 25-41. doi: 10.1177/0972063414560868
   [CROSSREF] [Google Scholar]
5. Cuccurullo C, Tommasetti A (2004) L’impiego delle mappe strategiche nella Balanced Scorecard: processo di costruzione ed effetti sistemici. Mecosan. 49, 47-62.
   [Google Scholar]
6. Federazione Nazionale dei Collegi IPASVI (2015) Evoluzione delle Competenze Infermieristiche. http://www.quotidianosanita.it/allegati/allegato2235488.pdf (Last accessed: 29 January 2024.)
   [Google Scholar]
7. Frittoli G, Mancini M (2004) Balanced Scorecard e aziende sanitarie. Mecosan. 49, 1, 21-46.
   [Google Scholar]
8. Fukada M (2018) Nursing competency: definition, structure and development. Yonago Acta Medica. 61, 1, 1-7. doi: 10.33160/yam.2018.03.001
   [CROSSREF] [Google Scholar]
9. Hall LM, Doran D, Laschinger HS et al (2003) A balanced scorecard approach for nursing report card development. Outcomes Management. 7, 1, 17-22.
   [Google Scholar]
10. Inamdar N, Kaplan RS (2002) Applying the Balanced Scorecard in healthcare provider organizations. Journal of Healthcare Management. 47, 3, 179-195. doi: 10.1097/00115514-200205000-00008
    [CROSSREF] [Google Scholar]
11. Jeffs L, Merkley J, Richardson S et al (2011) Using a nursing balanced scorecard approach to measure and optimize nursing performance. Nursing Leadership. 24, 1, 47-58. doi: 10.12927/cjnl.2011.22334
    [CROSSREF] [Google Scholar]
12. Jepsen S (2015) Using a scorecard to demonstrate clinical nurse specialists’ contributions. AACN Advanced Critical Care. 26, 1, 43-49. doi: 10.1097/NCI.0000000000000066
    [CROSSREF] [Google Scholar]
13. Kaplan RS, Norton DP (1992) The Balanced Scorecard: Measures that Drive Performance. http://hbr.org/1992/01/the-balanced-scorecard-measures-that-drive-performance-2 (Last accessed: 29 January 2024.)
    [Google Scholar]
14. Klemp GO (1980) The Assessment of Occupational Competence. Final Report: I. Introduction and Overview. National Institute of Education, Washington DC.
    [Google Scholar]
15. Levati W, Saraò MV (2002) Psicologia e Sviluppo delle Risorse Umane nelle Organizzazioni. Franco Angeli, Milan.
    [Google Scholar]
16. Lucas B (2019) Developing the personal qualities required for effective nurse leadership. Nursing Standard. doi: 10.7748/ns.2019.e11274
    [CROSSREF] [Google Scholar]
17. Melnyk BM, Gallagher-Ford L, Long LE et al (2014) The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve health care quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing. 11, 1, 5-15. doi: 10.1111/wvn.12021
    [CROSSREF] [Google Scholar]
18. McDonald B (2012) A Review of the Use of the Balanced Scorecard in Healthcare. http://www.academia.edu/27739460/A_Review_of_the_Use_of_the_Balanced_Scorecard_in_Healthcare (Last accessed: 29 January 2024.)
    [Google Scholar]
19. Mortari L, Zannini L (2017) La Ricerca Qualitativa in Ambito Sanitario. Roma Carocci, Rome.
    [Google Scholar]
20. Paturzo M, Colaceci S, Clari M et al (2016) I disegni di ricerca con metodo misto: un approccio metodologico innovativo per la ricerca infermieristica. Assistenza Infermieristica e Ricerca. 35, 2, 82-86. doi: 10.1702/2310.24838
    [CROSSREF] [Google Scholar]
21. Robbins B, Davidhizar R (2020) Transformational leadership in health care today. Health Care Manager. 39, 3, 117-121. doi: 10.1097/HCM.0000000000000296
    [CROSSREF] [Google Scholar]
22. Schilling J (2006) On the pragmatics of qualitative assessment: designing the process for content analysis. European Journal of Psychological Assessment. 22, 1, 28-37. doi: 10.1027/1015-5759.22.1.28
    [CROSSREF] [Google Scholar]
23. Seljemo C, Viksveen P, Ree E (2020) The role of transformational leadership, job demands and job resources for patient safety culture in Norwegian nursing homes: a cross-sectional study. BMC Health Services Research. 20, 799. doi: 10.1186/s12913-020-05671-y
    [CROSSREF] [Google Scholar]
24. Specchia ML, Cozzolino MR, Carini E et al (2021) Leadership styles and nurses’ job satisfaction: results of a systematic review. International Journal of Environmental Research and Public Health. 18, 4, 1552. doi: 10.3390/ijerph18041552
    [CROSSREF] [Google Scholar]
25. Spencer LM, Spencer SM (1993) Competence at Work: Models for Superior Performance. John Wiley & Sons, New York NY.
    [Google Scholar]
26. Van Bogaert P, Peremans L, de Wit M et al (2015) Nurse managers’ perceptions and experiences regarding staff nurse empowerment: a qualitative study. Frontiers in Psychology. 6, 1585. doi: 10.3389/fpsyg.2015.01585
    [CROSSREF] [Google Scholar]
27. Yang G (2022) The construction of nursing performance evaluation model in community health service center based on the balanced scorecard and hygiene factors. Scientific Reports. 12, 21793. doi: 10.1038/s41598-022-26334-4
    [CROSSREF] [Google Scholar]

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