In the face of increasing pressure to improve patient satisfaction, the health-care industry must continue to seek improved methods to measure the effects of its continuous improvement efforts. While measurement instruments in this area abound, most are global in perspective and inflexible in form, sometimes leading to less than optimally germane outputs. Patient satisfaction information is critically important to the health-care provider, and this paper presents the results provided by an instrument that was locally designed to provide the most utile aggregation and presentation of patient satisfaction information for individual health-care providers. These results provide substantial evidence to support the notion that local, rather than global, measurement instruments are needed to provide the most relevant and useful results when assessing patient satisfaction as part of a continuous improvement effort.

Competitive pressures in the global manufacturing environment are forcing manufacturing organizations to re-engineer in order to become more competitive in the marketplace. Toward that end, management of these organizations is paying closer attention to the changing nature of manufacturing performance, and the systems, processes and measures used in its evaluation. Examines the literature concerned with issues related to the different facets of manufacturing organizational performance. Reviews and classifies articles published in relevant journals between 1988 and 2000. Based on this extensive literature review, identifies and discusses several issues relevant to both practice and theory of manufacturing performance measurement. Concludes by presenting a conceptual framework outlining the evolution of manufacturing performance measures and measurement in an organizational context.

This study compared the longitudinal performance of two groups of toddlers with palatal clefts and an age-matched group of children without palatal clefts on measures of elicited symbolic play at 18, 24, and 30 months. The results indicated that the group with isolated cleft palate differed significantly from both the cleft lip and palate group and the noncleft group on all but 1 play measure. Correlational analyses for each group indicated significant positive correlations between a number of the play variables at 18 months and productive vocabulary and MLU at 24 and 30 months of age. The findings suggest that assessment of early play gestures may assist clinicians in identifying children with clefts who are at risk for later language impairment.

The health care industry can expect an expanding need to measure and report the quality of performance and related outcomes. This article presents a flexible application operationalizing the strategies of total quality management and continual and rapid improvement in the area of assessing patient satisfaction. Mountain States Health Alliance established seven strategic criteria for the Outcomes Assessment Strategy and Information System (OASIS) design based on its own strategic initiatives and quality improvement principals. These initiatives are supported by the software application referred to as ContAct. Substantial process improvements have resulted. As pressures from stakeholders continue to mount, it will become increasingly important that patient satisfaction information be used to improve processes. The system presented provides one piece of an overall approach that will result in a rise to world-class status for the health care industry.

This paper seeks to investigate the reasons why, in an increasingly competitive health care milieu, patients choose certain hospitals over others. It introduces the modified importance-performance analysis technique and presents the method and findings of an empirical study which applied importance-performance analysis in a health care setting. The strategies derived from the study findings are discussed.

This research tests for correlation between corporate performance and use of financial measures, nonfinancial measures, and number of balanced scorecard categories used. Literature notes a preference for managing by nonfinancial measures because financial measures are lagging indicators, but little empirical evidence is available on the relationship between nonfinancial measures and financial performance, and few companies are found to realize the benefits of nonfinancial measurements. The balanced scorecard has been studied to find the impact of diversity of performance measures, and anecdotal improvements have been reported, but there is a paucity of empirical evidence regarding how the use of a balanced scorecard impacts organizational performance. These issues are investigated in this research with a web based survey distributed to a sample of publicly traded companies using a systematic selection process based on randomly selected numbers generated for each 3-digit NAICS category. The dependent variable is a rank of high, medium or low performance based on 12-month rolling average stock price comparisons from January 2005 to January 2009. These averages are analyzed as a percent change for each company, with performance standardized by 3-digit NAICS category to eliminate cross industry variance in performance ranking. Kruskal-Wallis one-way ANOVA is used to test for correlation. High performers show greatest utilization of both financial and nonfinancial measures, followed by medium performers, with low performers utilizing both measures the least. Nonfinancial performance measures are more correlated to firm value than financial measures with the high performers' mean score for nonfinancial measures being higher than for financial measures. By contrast, medium and low performers exhibit the opposite: higher mean scores for financial measures than for nonfinancial measures [p ≤ 0.05 for nonfinancial measures and p ≤ 0.1 for financial measures]. Correlation is found to be borderline significant (p = 0.06) for the number of balanced scorecard categories used with high performers utilizing the highest number of categories and low performers utilizing the lowest number of categories [p = 0.009 with inclusion of two respondents reporting no usage of balanced scorecard categories].

The amount of information available on both public and private networks continues to grow at a phenomenal rate. This information is contained within a wide variety of objects, including documents, e-mail archives, medical records, manuals, pictures and music. To be of any value, this data must be easily searchable and accessible. Information Retrieval (IR) is concerned with the ability to find and gain access to relevant information. As electronic data repositories continue to proliferate, so too, grows the variety of methods used to locate and access the information contained therein. Similarly, the introduction of innovative retrieval strategies—and the optimization of older strategies—emphasizes the need for an infrastructure capable of measuring and comparing the performance of competing Information Retrieval solutions, but such an environment does not yet exist. The purpose of this research is to develop an infrastructure wherein Information Retrieval solutions may be evaluated and compared. In 1979, an expert in the field believed the need for a system-independent benchmarking utility was long overdue—twenty-five years later, progress in this area has been minimal. Contrastingly, new theories have emerged; new techniques have been introduced; all with the goal of improving retrieval performance. The need for a system-independent analysis of retrieval performance is more critical now.

Background: Sustainable Supply Chain Performance Measurement (SSCPM) and management are pivotal processes for any organisation to ensure the attainment of strategic intent. Large enterprises have been successful with the implementation of SSCPM. One of the reasons is that their motives and attitudes are consistent with SSCPM that yield sustainable returns. First, large companies usually have shareholders who are not the management of these companies. This means the management of the company is held accountable for adopting practices that create sustainable shareholder value. As such, management's attitudes to issues such as SSCPM tend to be positive because of the implications on the bottom-line of the firm. Consequently, management's behaviour is one of quick and comprehensive adoption of any practices that support the creation of sustainable shareholder value, and that includes SSCPM. Second, large companies tend to be in the spotlight when it comes to anything that can go wrong. Finally, these companies are also under pressure from their global suppliers and customers, who may want SSCPMs to be embedded in their operations as a condition for doing business with them. We can therefore conclude that there are three aspects associated with the adoption of SSCPM by large companies, namely motivation, attitude, and behaviour. What is not clear is whether the same aspects of motivation, attitude and behaviours operate in Small and Medium Enterprises (SMEs). This study focuses on three types of SMEs, namely necessity, opportunity, and legacy, as they relate to motives. Given the differences in ownership, management, and scope of operations between large companies and SMEs, do motives, attitudes and behavioural variables operate within SMEs in the context of the adoption of SSCPM? We do not seem to have enough research to answer this question. Therefore, this study seeks to understand how entrepreneurial motivation, attitude, and behaviour influence SSCPM in manufacturing SMEs. Moreover, SMEs, particularly in developing contexts, are still lagging behind with sustainability integration in their Supply Chain Management (SCM). While much is said about SMEs, there is less concern for integrated systems, SCM practices and their future. There is a dearth of research on how entrepreneurial motives, attitudes and behaviour influence these performance measurements by SMEs. Methodology: The researcher's purpose in this study was to observe reality as it existed to maintain an objectivity which is devoid of value judgements. This objectivity resonates with the researcher's philosophical view which lends itself to a functionalist paradigm. Quantitative data were collected through a survey of manufacturing SMEs on entrepreneurial motives, attitudes, and behaviour towards SSCPM. The survey was directly administered to approximately 566 manufacturing SMEs, of which 211 completed questionnaires were received. The data were analysed through Partial Least Square-structural Equation Modelling (PLS-SEM). Results: Opportunity-motivated entrepreneurs depict a positive attitude towards the adoption and implementation of SSCPM in their SCM. These SMEs are formed and run by professionals and experienced individuals who desire to grow their businesses. Legacy-motivated entrepreneurs do not show any attitudinal disposition towards SSCPM. As they are familyowned and run businesses that span many generations, legacy-entrepreneurs are likely to adopt the inherited culture in their practices. Necessity-entrepreneurs have a positive attitude towards SSCPM with a predominant focus on economic sustainability. They are mostly pushed into business by the need to survive and this makes them focus mostly on that which enables them to generate revenue while avoiding anything that entails having to invest in other areas. For instance, necessity-motivated entrepreneurs have a negative attitude towards environmental and social sustainability. The only time they begin to embrace it is when there are other forces around such as institutional pressures or resources that will directly affect their attitude towards SSCPM. The results reveal that institutional isomorphic patterns and resources impact in varying degrees on the SMEs' adoption and implementation of SSCPM. Government policies or coercive isomorphic pressures are generally weak about enforcing SSCPM at SMEs. For instance, limited resources hinder SMEs' willingness and ability to adopt and implement SSCPM practices in line with government policies. Limited resources therefore make the impact of government policies on the adoption and implementation of SSCPM at SMEs ineffective. The results showed that normative isomorphic pressures were major enablers of the adoption and implementation of SSCPM at SMEs. These normative pressures were mostly inflicted by large corporate customers who demanded that SMEs complied with sustainable sourcing and production. Mimetic isomorphic pressures come into play because of the need for all SMEs to attain economic sustainability. Resources are a major enabler for the adoption of environmental and social SSCPM while both the institution and resources shape the attitude of SMEs in a significant way towards sustainable developments. Lack of resources leads to a negative attitude to sustainability endeavours. Theoretical contribution: The study has contributed to sustainability literature, the interface among entrepreneurial motives, attitudes, and behaviour linkages with SSCPM. To the best of the researcher's knowledge this perspective has not been explored in either SCM or Sustainable Supply Chain Management (SSCM). Many frameworks in SCM focus on the Triple Bottom Line (TBL) from a measurement perspective. The framework created in this study interfaces SSCM with entrepreneurial motives, attitudes and behaviour in the adoption of SSCPM at manufacturing SMEs. It further places the application of theory (Institutional and Resource Based View Theories) in a new empirical situation; more importantly, confirming the inability of coercive pressures to be placed on the adoption of environmental and social sustainability while re-enforcing the impact of normative pressures on the uptake of SSCPM. The SMEs' entrepreneurial attitude towards environmental and social sustainability is predominantly negative without institutional isomorphic pressures and the direct impact of resources on their attitude towards SSCPM. The analysis methodology adopted in this study reveals the shortcomings of Cronbach Alpha, which is rarely, if not always, silent in the social sciences. Cronbach Alpha does not only measure internal reliability, but it is also a test of length. If Cronbach is used to test internal consistency where the items are few, the tau-equivalence is immediately violated and that decreases reliability. However, if the number of items in a scale are more, reliability increases. Researchers in the social sciences, particularly SCM researchers, ought to know about this revelation. Practical Implications: These results will assist governments to find strategies to support entrepreneurs that are intrinsically motivated towards adopting sustainable integration practices. Governments may also embark on a customer awareness programme to enforce the taking up of sustainability practices in organisations while also exerting pressure on entrepreneurs who exhibit a negative attitude towards SSCPM. This strategy will go a long way towards adopting sustainable integration practices. Normative pressures from large customers have been identified as major players in enforcing SSCM at manufacturing SMEs. Big corporations may partner with SME suppliers to assist and guide them through compliance and taking the necessary steps to achieve sustainability integration. Collaboration among SMEs may help mitigate resource constraints to adopting sustainability practices as this may enable collaborative efforts in assisting themselves to reach their SSCM goals. Practitioners may also provide training and development programmes on SSCM for manufacturing SMEs. These training programmes should be conducted at no cost (through government funding) with manufacturing SMEs to achieve a wider impact on sustainability advancement. SMEs are central to economic growth, hence providing support, mentoring, and coaching on SSCPM which may go a long way towards strengthening the sector. Government may fund special projects that address SDG 12 and bring about collaboration between international and local buyers to guide the process in these SMEs. This research provides a platform for SME development and the enhancement of the community. SMEs may engage with community activists and NGOs on how to create sustainable relationships that last longer than expected. Development communities ranging from the United States Agency for International Development (USAID), the World Bank and African Growth and Opportunity Act (AGOA), among others, may form partnerships with developing countries' governments specifically to address SSCM at manufacturing SMEs. For instance, AGOA may extend primary access to United States' (US) markets by adding sustainability support on export apparel to manufacturing firms in listed countries. The World Bank could direct resource support with clear accountability measures to developing countries on manufacturing SSCM-integration, while USAID may have ambassadors/directors in various countries to oversee its dedicated support for sustainable production in the developing contexts.

In this dissertation, we study several quantitative approaches centered on supply chain management, sustainability development, performance measurement frameworks, and environmental regulation mechanisms. The topic of sustainability has been of great interest for the past few years in academia. Many governments also have taken actions to incentivize firms to reduce their negative environmental and social impacts. It is unclear, however, how successful policy makers have been in reducing the sustainability threats. This raises the question of ``how can policy makers play an effective role in helping businesses become more sustainable, while complying with entrepreneurs and investors' expectations?'' This dissertation is organized on the basis of six chapters. Having reviewed the literature and research directions of sustainable supply chain management in Chapter 1, we present a review of sustainability performance measurement frameworks in Chapter 2. In addition to proposing a framework to assess sustainability efficiency in supply chains, we discuss research questions with a focus on the social aspect of sustainability development. In Chapter 3, we develop a two-stage data envelopment analysis model with an application to the energy sector. This approach measures relative efficiencies of a number of comparable decision makers and does not require predetermined weights of indicators. We relax some restricting assumptions used in previous studies and obtain a nonlinear problem, for which we develop a solution method. Chapter 4 investigates a more general multi-stage assessment framework that monitors suppliers, manufacturers, distributers, and retailers' sustainable practices. The major finding is developing a multi-stage data envelopment analysis to measure supply chains' sustainability efficiency. In Chapter 5, we investigate market-based schemes with a focus on curbing pollution emitted by business entities and develop a game-theoretic formulation. Finally, we summarize the major contributions of this dissertation and future research directions in Chapter 6. / Thesis / Doctor of Philosophy (PhD)

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