Whereas health care resources are limited, demands upon them are insatiable. Drug expenditure has received particular attention in attempts to regulate increasing costs. For hospitals, contract purchasing is designed to regulate drug expense. This thesis examines the contract mechanisms. Information was collected from pharmacists and supplies officers in all English health regions and pharmaceutical companies supplying the bulk of hospital drug requirements. The main findings of the research are:- 1 There is a large, unexplainable difference in price charged to various health regions for an identical drug. Price charged is independent of all obvious correlates. 2 Despite the oligopgonistic power of the National Health Service there is no centralised interchange of price or purchasing information between health regions. 3 Pharmaceutical suppliers view hospital drug purchasing as fertile for opportunistic pricing within the context of total profit regulation. 4 There is an ill-defined working relationship between pharmacists and supplies officers in the implementation of drug contracts, often amicable locally but tense and competitive nationally. The overall impression is of a purchasing mechanism which, due to its political sensitivity, has, by default, become increasingly outmoded and represents a triumph of public accountability over individual negotiating skill. The overall regulation of pricing is in substantive conflict with the hospital contract system. One encourages UK research, the other not, while the savings in hospital purchase are redundant in the context of both overall corporate and Governmental financing. Cost savings are unknown. Other methods of acquisition such as prime vendor buying should be considered, as a means of improving purchase efficiency for both supplier and purchaser.

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This research evaluates the impact of automated and semi-automated devices on the process of loading, discharging, stacking and un-stacking of containers using Quayside Cranes (QSCs), Straddle Carriers (SCs), Rubber Tyred Gantry cranes (RTGs) and Rail Mounted Gantry cranes (RMGs) in container terminals. The emphasis of study is on the assessment of performance and cost effectiveness of the existing automated quayside and yard cranes. The study in this thesis examines the economic implications of reducing QSCs' cycle-times brought about by automatic features installed on the post-Panamax cranes. It demonstrates that a considerable increase in the productivity of QSCs is related directly or indirectly to an expected reduction of crane cycle-times. The concept offered by the proposed improvements distinguishes between the traditional system of loading and discharging of containers and the automated methods. It implies that automation devices installed on conventional QSCs significantly reduce the total turnaroundtime and hence the cost of containerships' waiting-times. It argues, however, that there should be a balance between the cost of containerships' waiting-times and the cost of automated berths' unproductive-times (idle-times). This study uses the elements of queuing theories and proposes a novel break-even method for calculating such a balance. The number of container Ground Slots (GSs) and the annual throughput of container terminals expressed in Twenty-foot Equivalent Units (TEUs) have been used as the efficiency and performance measure for many years. The study in this thesis introduces appropriate container yard design layouts and provides a generic model for calculating the annual throughput for container terminals using semiautomated SC and RTG and automated and semi-automated RMG operating systems. The throughput model proposed in this study incorporates the dynamic nature, size, type and capacity of the automated container yard operating systems and the average dwell-times, transhipment ratio, accessibility and stacking height of the containers as the salient factors in determining a container terminal throughput. Further, this thesis analyses the concept of cost functions for container yard operating systems proposed. It develops a generic cost-based model that provides the basis for a pair-wise comparison, analysis and evaluation of the economic efficiency and effectiveness of automated and semi-automated container yard stacking cranes and helps to make rational decisions. This study proposes a Multiple Attribute Decision-Making (MADM) method for evaluating and selecting the best container yard operating system amongst alternatives by examining the most important operating criteria involved. The MADM method proposed enables a decision-maker to study complex problems and allows consideration of qualitative and qualitative attributes that are heterogeneous in nature. An Analytical Hierarchy Process (AHP) technique has been employed as a weighting method to solve the MADM problem. The AHP allows for the decomposition of decision problem into a hierarchical order and enables a pair-wise comparison of the attributes and alternatives. The results of the AHP analysis provide the basis for a pair-wise comparison, judgement and selection of the best automated or semi-automated container yard operating system.

This thesis provides a conceptual framework of power in buyer-seller relationships. Power as the potential to influence (or resist) the actions of others is an integral part of social reality yet its conceptual development is limited in the inter-organisational literature, which is dominated by descriptive empirical studies. Gaps in the extant literature relate to; what constitutes power in buyer-seller relationships, its underpinning ontological position, what buyers and sellers seek to influence and what motivates them to use their power. To enable the complex nature of power to be empirically captured and to reduce ontological constraints, a mixed-method research design was used incorporating three phases. The first two phases were exploratory to allow the practitioner population to identify variables associated with the research questions. Based on these outputs a questionnaire was designed and used as the primary data collection method. Through factor analysis, the results provide evidence that power is pluralistic and composed of multiple embedded realities. Power is held by individuals, organisations and relationships. The conceptual framework of power developed in this research underlines the importance of separating the various elements of power. Despite identifying some differences in attitudes between buyers and sellers, the results demonstrate considerable consistency of opinion between roles. Through this research, contributions are made to the conceptual development of power in buyerseller relationships.

The work described in this thesis is concerned with economic and financial issues, including safety analysis, and their application to the companies operating in the Cyprus and Mediterranean cruise market. This thesis applies "financial and economic" methodologies suitable for a cruise product. They are used as the basis for the development of more scientific and objective financial and economic methods and safety modelling techniques applicable to the operation of cruise ships in the Cyprus and Mediterranean regions. A qualitative methodology is developed to analyse the passengers' attitudes to cruise tourism, the fundamental considerations of competition at sea and the factors considered important for choosing a destination in the Cyprus and Mediterranean regions. A business strategy model is developed to provide an established mechanism for cruise companies in making decisions on the coming into service of a cruise ship or when entering the cruise market. A Formal Safety Assessment (FSA) model is developed to determine its applicability to cruise ships. For this reason, a test case study, which is limited to one accident category, namely fire, is conducted in order to demonstrate the feasibility of the proposed methodology. A cost, benefit and risk assessment methodology is developed to help cruise companies in their strategic planning and decision-making process for the safest, economic and efficient operation of cruise ships. This thesis also presents a proposed methodology involving the use of investment appraisal and risk assessment techniques. This approach may be used by cruise companies to evaluate project alternatives and make decisions that will be beneficial for them. A generic cruise ship and anonymous cruise companies are used to demonstrate the methodologies developed in this thesis. Finally, the results of the research project are summarised and the areas where further effort is seen to be required to improve the developed methodologies are outlined.