Volunteers have been present in healthcare settings for centuries, however there is little empirical evidence supporting the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high quality care at minimum expense. With the pressures of managed care and accrediting agencies, the benefits of using volunteers in a hospital setting are multiplied. Furthermore, as the population of the United States grows and the aging population creates more healthcare needs, the need for volunteers in hospitals may increase. This study utilized multiple regression analysis to explore the belief that the volunteer workforce is cost effective and can greatly enhance quality in a hospital setting. Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of profit margin, volunteer cost savings, and patient satisfaction scores were analyzed using American Hospital Association and Agency for Health Care Administration data sets along with data obtained from the questionnaire. Results indicate that the use of volunteers offer significant cost savings to hospitals. Furthermore, the assignment of volunteers in patient settings can enhance a hospital's patient satisfaction scores. It also suggests that there is a need to further explore the impact of volunteers on other performance measures. Future research opportunities and policy recommendations are suggested.

Quality management is a significant component of any construction project and the cost of quality can constitute a sizable part of total construction cost. US state highway agencies are in constant pressure to do more with less. Applying Lean construction management principles can be a viable way to eliminate waste and inefficiencies and maximize value and efficiency in quality assurance (QA). State highway agencies have implemented various QA practices and processes which include different QA standards and specifications, varying testing methods, central testing lab vs. on site testing, performance based vs. prescribed quality assurance practices, implementation of innovative quality assurance practices, etc. Therefore, there is an opportunity to assess different QA strategies and recommend lean QA practices that are cost effective. A survey was conducted among state highway agencies, which provided a detailed mapping of various QA practices and processes used as part of QA programs and identified areas where agencies can focus on for cost savings. The survey found that QA sampling and testing plans, optimization of sampling plans, optimization of QA standards and specifications, and implementation of innovative test methods and processes are the main areas the agencies should focus on to lean the current QA programs.

Yes / There has been considerable interest in implementing practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach attracting particular interest is Lean management, which is explored in this article. Design/methodology/approach: The exploratory research focuses on Lean management in the health sector. It is based on extensive secondary data and it is a practical in implication. Data provided both and context. Findings: Despite widespread enthusiasm about Lean management’s potential, evidence about its contribution to higher performance is inconsistent. Research limitations/implications: Major Lean operations management and human resource management concepts, including just-in-time (JIT), total quality management (TQM) and total productive maintenance (TPM) are explored. Practical implications: This article contributes to the healthcare organizational management literature by showing that although Lean management seems to have the potential to improve organizational performance; it is far from a panacea for underperforming hospitals. The article informs policy-making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than adopting practices from any particular managerial approach. Originality/value: A critical evaluation on Lean’s impact on informing healthcare policy is presented, which contributes to healthcare organisational management literature by showing that even though Lean management in healthcare appears to have the potential to improve performance; there remain problems with its application.

Master of Agribusiness / Department of Agricultural Economics / Vincent R. Amanor-Boadu / Over the last few years there have been many changes to the container export industry. There are a variety of reasons for these changes including exchange rate fluctuations, fuel and energy price fluctuations and their effects on bulk freight rates. The pressure to enhance and remain competitive has also increased amid these rapid changes. An effective strategy is for companies to focus attentions on costs they can control. In the container freight industry, one of these costs is reducing the “paper” aspects of operations and increasing its “electronic” aspects. This thesis focuses specifically on evaluating FileBound®, document management software, for the purpose of going “paperless” in a Container Freight, Non-Vessel Operating Common Carrier (NVOCC) and freight forwarding company. Going paperless has many advantages: increased efficiency, paper and printing cost savings, time savings, storage cost savings, environmental benefits, efficient file retrieval, and enhanced customer service. By adopting the FileBound® technology, the case study company hopes to achieve most of these benefits, allowing it to reduce overall costs, and especially, reduce the number of employees managing physical documents and move people into sales and marketing. The critical assumption of the study was that the electronic processes contributed to time savings and it is from these time savings that most of the other benefits emanated. Therefore, a time study was conducted to determine the time savings resulting from using FileBound® in comparison to the current method in the file completion process. The data collected was analyzed using regression analysis to determine the factors that influenced time savings, if any, and their statistical significance. There are three specific activities involved with the process of completing a transaction in the container freight business: booking, instruction and bill of lading. The analysis was conducted for each of these steps in the process. The results show that the different methods, FileBound® or manual, were not statistically significant on determining the time it took to complete the file. That being said, this thesis recommends that a mixture of both the FileBound® and manual method be used to take advantage of the potential cost savings.

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.

Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2008.

Abstract Heavy menstrual bleeding causes significant health and social problems for up to 30% of women at some point of their lives. Medical treatment is not always sufficient or tolerated by women. Hysterectomy is a definitive solution, but it is a major operation associated with long disability and potential severe complications. Endometrial ablation techniques have been developed to avoid the risks related to hysterectomy. Further evolution of these techniques also offers a possibility of a quick and simple outpatient procedure. This study evaluated the long-term effects of endometrial ablation on heavy menstrual bleeding and later endometrial diagnostics. Another aim was to compare the costs when the procedure was performed in different settings. Finally, the effect of hyaluronic acid gel on intrauterine adhesion formation was assessed. Endometrial ablation had a good long-term effect on heavy menstrual bleeding in a retrospective study of 172 women, and up to 84% avoided hysterectomy during the follow-up time mean of 5 years. Seventy-six per cent of the patients were satisfied with the procedure. Due to the formation of intrauterine adhesions, prior endometrial ablation compromised later diagnostics of endometrium, and outpatient endometrial sampling failed in 23% of 57 women who had undergone endometrial ablation a mean of 6 years earlier, but that did not seem to have clinical importance. In a prospective, randomized and double-blind pilot study of 36 patients, hyaluronic acid gel did not prevent the formation of intrauterine adhesions. In a cost-minimisation analysis based on real resource use, performing endometrial ablation as an outpatient procedure under local anaesthetic instead of a day case procedure performed in the operating theatre under general anaesthetic reduced the costs significantly, from 1,865 to 1,065 euros. In conclusion, the results of this study suggest that endometrial ablation is a good alternative for the treatment of heavy menstrual bleeding, and remarkable cost savings can be achieved by taking the procedure out of the operating theatre. The formation of intrauterine adhesions is common and cannot be prevented with hyaluronic acid gel. / Tiivistelmä Runsaat kuukautiset aiheuttavat merkittävää terveydellistä ja sosiaalista haittaa jopa kolmasosalle naisista jossain elämänvaiheessa. Lääkehoito ei aina ole riittävä, eivätkä kaikki naiset voi tai halua käyttää sitä. Kohdunpoisto on lopullinen ratkaisu, mutta se on iso leikkaus, johon liittyy pitkä työkyvyttömyys ja vakavien komplikaatioiden riski. Näiden riskien välttämiseksi on kehitetty kohdun limakalvon tuhoavia tekniikoita, joista nykyisin eniten käytetty on limakalvon tuhoaminen lämpöhoidon avulla. Nykytekniikoilla toimenpide voidaan myös tehdä helposti ja nopeasti polikliinisesti. Tässä tutkimuksessa arvioitiin kohdun limakalvon lämpöhoidon pitkäaikaisvaikutuksia runsaiden kuukautisten hoidossa ja sen vaikutusta myöhemmin tapahtuvaan kohdun limakalvon diagnostiikkaan. Niin ikään verrattiin päiväkirurgisen ja polikliinisen toimenpiteen kustannuksia. Lopuksi tutkittiin pystytäänkö hyaluronihappogeelin avulla estämään kohdunsisäisten kiinnikkeiden muodostumista. Lämpöhoidolla oli hyvä pitkäaikaisvaikutus runsaisiin kuukautisiin 172 naista käsittäneessä retrospektiivisessä tutkimuksessa, ja kohdunpoistolta välttyi keskimäärin 5 vuoden seuranta-aikana 84 % naisista. 76 % naisista oli tyytyväisiä hoitoon. Lämpöhoidon aiheuttamat kohdunsisäiset kiinnikkeet vaikeuttivat myöhempää kohdun limakalvon diagnostiikkaa. Polikliininen imunäytteen otto ei onnistunut 23 %:lla 57 potilaasta, joille oli tehty lämpöhoito keskimäärin 6 vuotta aikaisemmin. Tällä ei kuitenkaan näyttänyt olevan juurikaan kliinistä merkitystä. 36 potilasta käsittäneessä, prospektiivisessa, satunnaistetussa kaksoissokkotutkimuksessa hyaluronihappogeelin avulla ei pystytty estämään kohdunsisäisten kiinnikkeiden muodostumista. Todelliseen resurssien käyttöön perustuvassa kustannusten minimointianalyysissa todettiin, että tekemällä lämpöhoito polikliinisesti paikallispuudutuksessa leikkaussalissa nukutuksessa tehtävän toimenpiteen sijasta, kustannukset laskevat 1865 eurosta 1065 euroon. Tämän tutkimuksen perusteella kohdun limakalvon lämpöhoito tarjoaa hyvän vaihtoehdon runsaiden kuukautisten hoitoon, ja sen kustannuksia voidaan merkittävästi pienentää tekemällä toimenpide polikliinisesti. Kohdunsisäisten kiinnikkeiden muodostuminen on tavallista, eikä sitä pystytä estämään hyaluronihappogeelin avulla.

Contributors from the mid 20th century up to now have developed and refined virtual assistants, taking the technology from a set of rules to assistants driven by Artificial Intelligence. Today, virtual assistants can provide value in organisation and support a sustainable society by conducting basic and repetitive tasks, and help reduce inequalities caused by biased advisors on sensitive topics. Despite its prosperity, current research somewhat lack focus on the evaluation of virtual assistants in industrial applications. The purpose of this paper is to evaluate virtual assistants from a technical, economical and organisational perspective, in order to understand their performance and value in an industrial environment. This has been done in collaboration with IBM and a client company which prefers to remain anonymous in this report. In this company, two IBM Watson Assistants are under development; one for the IT Service Desk, and one for the Ethics & Compliance department. To cover all aspects of the virtual assistants’ performance, quantitative and qualitative methods were used by conducting user testings and surveys. In this process, discussions have been conducted with IBM experts and employees of the firm for which the practical implementation has been studied, to gain a general and specific understanding from different perspectives. From this paper, the following can be concluded. First, technological performance can be described using quantitative metrics such as coverage, confidence, precision and helpfulness, and should be complemented using qualitative measures such as user satisfaction and perceived user understanding. Second, specific technological performance is relative and the technical limitations as well as it’s maturity should be used as a complement to the evaluation of the assistants. Third, identified organisational benefits include: • reduced time-to-resolution, • reduced handling time, • all-hour-support, • scalability and • user understanding Conclusions specific for the use cases show that an assistant implemented in a narrower use case, that is the Ethics & Compliance assistant, easier can be implemented and performs relatively well also in less developed environments. A broader use case, such as the IT assistant, requires more effort to perform at a high level but may be even more beneficial than in the narrow use case once sufficiently refined. / Från mitten av 1900-talet har virtuella assistenter utvecklats och förfinats där teknologin gått från en mängd regler till assistenter drivna av artificiell intelligens. Idag kan virtuella assistenter tillföra värde till organisationer och bidra till ett hållbart samhälle bland annat genom att utföra enkla och återkommande uppgifter samt minska ojämlikheter orsakad av partiska rådgivare i känsliga frågor. Trots framgången har nuvarande forskning inte fokuserat på evalueringen av virtuella assistenter i industriella sammanhang. Syftet med denna rapport är att utvärdera virtuella assistenter från ett tekniskt, ekonomiskt och organisationellt perspektiv för att förstå dess prestation i industriella miljöer. Arbetet har genomförts i samarbete med IBM och en av deras kunder som föredrar att förbli anonyma. I detta företag är två IBM Watson Assistant under utveckling; en för deras IT Service Desk och en för deras avdelning för Ethics & Compliance. I studien har både kvantitativa och kvalitativa metoder använts, däribland användartestning och frågeformulär, för att inkludera alla aspekter av de virtuella assistenternas prestation. I denna process har diskussioner förts med experter inom IBM samt medarbetare på företaget för vilket den praktiska implementationen studerats för att få en förståelse för både generell och specifik kunskap ur olika perspektiv. I denna rapport kan följande slutsatser dras. Ett, den tekniska prestationen kan bestämmas med kvantitativa mätetal så som täckning (coverage), säkerhet (confidence), precision och hjälpsamhet (helpfulness), och kompletteras med kvalitativa mätetal som användarnöjdhet och upplevd förståelse för användaren. Två, specifik teknisk prestation är relativ och de tekniska  begränsningarna samt mognad bör användas som komplement till utvärderingen av assistenterna. Tre, identifierade organisationsfördelar inkluderar: • reducerad time-to-resolution, • reducerad hanteringstid, • support ¨öppen dygnet runt, • skalbarhet, och • användarförståelse Slutsatserna i de specifika fallen visar att en virtuell assistent som implementeras inom ett smalare område, som en assistent för Ethics & compliance, enklare kan implementeras samt presterar relativt bra även i en mindre utvecklad miljö. Bredare områden, som en assistent för IT-support, kräver mer arbete för att prestera på en hög nivå men kan vara ännu mer värdefull än assistenten i det smala området när den blivit tillräckligt utvecklad.

Thesis (M.Pharm. (Pharmacy Practice))---North-West University, Potchefstroom Campus, 2008.