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Purpose of paper: This paper provides a critical evaluation of the impact of lean practices in informing healthcare policy. Methodology: Review of primary and secondary literature Finding: There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to address rising healthcare spending and disappointing patient safety indicators. This encompasses a number of practices in Operations Management and Human Resource Management, including Just-in-Time (JIT), Total Quality Management (TQM), Total Productive Maintenance (TPM), employee empowerment, and extensive training. Used together there is great potential to improve overall firm competitiveness. However, despite widespread enthusiasm about the potential of lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. Contribution to knowledge: Our paper contributes to the organisational management literature in healthcare by showing that even though lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.

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.

Made available in DSpace on 2016-04-25T16:44:36Z (GMT). No. of bitstreams: 1 Bianca Zapparoli Barbara.pdf: 1415802 bytes, checksum: b24f0ddec8a0c847e4f63ca627d2447b (MD5) Previous issue date: 2013-11-05 / This article seeks to identify the methods that can be used for cultural change in building a company cocreative, as well as obstacles faced in this process. The study analyzes the multinational GE Healthcare which gives the value creation overall strategy for ensuring greater access to the public health. As we used the theoretical model of strategic change Pettigrew, considerations of organizational culture Schein, Fleury and Deal and Kennedy, among others, and the four principles to Cocreate Prahalad and Ramaswamy. The method used was the case study, using the techniques of observation, analysis of internal and external content and half-structured opened interviews. The results indicated that the GE Healthcare Company owns an internal context that facilitated the use of a lot of mechanisms, due to its descentralized structure of power that enables a communication more efficient and also to have a culture opened for changes. The main challenge found by the organization was to provide a collaborative flow and to apply the new mindset between the administration and all cocriators inside the company / presente estudo busca identificar os métodos que podem ser utilizados para a mudança cultural na adoção de procedimentos cocriativos, bem como eventuais obstáculos enfrentados nesse processo. O estudo analisa a multinacional GE Healthcare que atribui à cocriação de valor a estratégia global que visa garantir mais acesso à saúde à população. Como embasamento teórico foi utilizado o modelo de mudança estratégica de Pettigrew, as considerações de cultura organizacional de Schein, Fleury e Deal e Kennedy, dentre outros autores, e os quatro princípios para Cocriar de Prahalad e Ramaswamy. O método utilizado foi o estudo de caso, valendo-se das técnicas de observação, análise de conteúdo interno e externo e entrevistas semiestruturadas abertas. Os resultados obtidos indicam que a empresa GE Healthcare possui um contexto interno que facilitou a utilização de diversos mecanismos, tanto pela estrutura de poder descentralizado que permite uma comunicação mais eficaz, quanto por possuir uma cultura aberta a mudanças. O maior obstáculo encontrado pela organização está em permitir um fluxo colaborativo e aplicar essa nova mentalidade entre a administração e todos cocriadores dentro da empresa

<p>The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use / the documentation of the practice of primary health care in the Khayelitsha Community Health Centre / an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service / and finally to draw conclusions and make recommendations.</p>

<p>The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use / the documentation of the practice of primary health care in the Khayelitsha Community Health Centre / an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service / and finally to draw conclusions and make recommendations.</p>

How New Zealand’s health-sector labour markets interact with District Health Board (DHB) Provider Arms is my thesis’ focus. Using health-service delivery data, workforce data, and DHB monthly financial information, I estimate the DHB Provider Arm economic production process and the interaction between DHBs and the health-sector labour and capital input markets. Production and input market interactions are modelled through simultaneously estimating a DHB production function together with the first order conditions for cost-minimisation in an econometric system-of-equations. Estimating a system-of-equations allows labour and capital market prices to interact with DHB marginal input productivities according to the first order conditions of cost-minimisation. Nationally-determined MECA labour prices influence health service output through their equality to DHB production-based input marginal productivities. Medical and nursing labour appears to have inelastic labour demand, providing scope for unions in those sectors to exploit market power. DHBs are employing fewer workers than they would and paying more for each worker than they should if the labour market was more competitive. New Zealanders are receiving less health care then they might, and experiencing more morbidity then they need bear, from the workforce restrictions generated in the health sector's labour market. The passed-through inflated labour costs are borne by taxpayers, who lack options for alternative provider care. The non-competitive labour market induce secondary labour market effects. Overseas-trained medical labour, attracted into New Zealand by above-competition wages, are denied employment within medical-skill-hungry DHBs. Graduate nurses over-supply a quantity-constrained labour market, generated entrenched unemployment. DHBs are induced to be allocative and technically inefficient through price distortions, creating higher output costs and an inefficient production input mix.

Made available in DSpace on 2016-03-15T19:32:38Z (GMT). No. of bitstreams: 1 Marcos Pucci.pdf: 2062257 bytes, checksum: e136cb48da7561d36d9e8d05f5e99c59 (MD5) Previous issue date: 2013-02-04 / One of the challenges of contemporary businesses is to enhance and strengthen the human resource, one of the most important in the current competitive scenario (YOUNDT; SUBRAMANIAM; SNELL, 2004). Although the search for maximizing the performance of organizations (and the people involved with them, regarding their decision-making processes) is not a new concern in disciplines related to management and production, there are still gaps to be filled. For the development of this research was used as a theoretical model for Decision Making from a research line called neuroaccounting, which is been developing in the Center for Research on Controlling of Mackenzie Presbyterian University. The research question is to understand how the manager of healthcare makes decisions related to budget goals. Always focusing on the process of decision-making for budget, it discusses theoretical foundations from classic to the contemporary, including cognitive psychology, economics and information processing. Through the application of electronic questionnaires, which were directed to hundreds of hospital managers involved in decision-making budget, we obtained sufficient data to conduct an analysis of the cognitive processes adopted by these managers. Once with the data collected, was used descriptive statistics and multivariate factor analysis (to reveal constructs) and Structural Equation Modeling (to assess the correlations between the constructs suggested by theoretical) via method Partial Least Squares (PLS). The results, in line with previous studies on the same topic and line of research confirms, the pattern of behavior of managers in relation to the search for information to make budget decisions. Among the results highlight the pronounced influence of socio-affective, which can interfere with the quality of the decision-making process for budget. Besides the academic contribution that was obtained by confirmation of a specific model of Decision Making, operated by Neuroaccounting line of research, was proposed a study being conducted in partnership with software developers specializing in hospital management. It was found that there is a need for developed a study is more technical, detailed and focused on socio-affective aspects, aiming at the development of a computational functionality that be able mitigate the undesirable effects in the Process of Decision Making Health Sector Budget with the elimination of such effects, it is expected to extend the authorizing rationality, mitigate budget deviations and so save resources so scarce for the sector. / Um dos desafios das empresas contemporâneas é valorizar e potencializar o recurso humano, um dos mais importantes no atual cenário competitivo, uma vez que sua potencialização pode se reverter em sucesso para as empresas. Ainda que a busca de maximização do desempenho das organizações (e das pessoas com elas envolvidas, com relação aos seus processos de tomada de decisão) não seja uma preocupação nova nas disciplinas relacionadas à gestão e à produção, ainda há lacunas a serem preenchidas. Uma dessas lacunas está relacionada à compreensão do processo de tomada de decisão de médicos ou de outros profissionais que atuam como gestores em ambientes hospitalares cada vez mais competitivos. Para compreender esse processo decisório teve-se como questão de pesquisa: Qual é o modelo adotado pelo gestor do Setor de Saúde, que atua em organizações hospitalares, ao tomar decisões relacionadas às metas orçamentárias?Com enfoque no processo de tomada de decisão orçamentária, o referencial teórico deste estudo abordou as modelos econômicas clássicos para decisão bem como modelos oriundos da psicologia cognitiva. Em termos metodológicos, o enfoque do estudo foi quantitativo. Os dados foram colhidos utilizando-se questionários eletrônicos, que foram enviados a centenas de gestores hospitalares envolvidos no processo de tomada de decisão orçamentária, obtendo-se uma amostra de 76 respondentes (70 com a segunda parte do questionário totalmente preenchida). Os dados foram analisados com estatística descritiva e multivariada, com ênfase na Modelagem de Equações Estruturais para avaliação das correlações entre os constructos sugeridos pelo referencial teórico, via método Partial Least Squares (PLS). Dentre os resultados encontrados destaca-se a pronunciada influência dos aspectos socioafetivos sobre a decisão, mostrando a influência social na decisão e o medo relacionado às decisões em si ou ao resultado obtido com a decisão. Como desdobramento prático apresenta-se a proposição de um estudo a ser realizado em parceria com desenvolvedores de softwares especializados em gestão hospitalar, especialmente no tocante à análise dos efeitos em médio e longo prazo de decisões ancoradas em aspectos sócio-afetivos, propondo-se a inclusão de indicadores do custo de oportunidade sócio afetivo . Com o controle desse tipo de custo espera-se ampliar a racionalidade no processo de estimativa de metas do gestor hospitalar, contribuindo para melhor alocação de recursos sempre tão escassos para o setor.

Magister Administrationis - MAdmin / The general aim of this study is to undertake an assessment of the health care service provision in the Khayelitsha Community Health Centre taking into consideration the underlying principles of the Primary Health Care. More specific objectives include: an overview and discussion of the framework approach to primary health care and its use; the documentation of the practice of primary health care in the Khayelitsha Community Health Centre; an analysis of the results and findings which will highlight the obstacles in the pursuit of a better primary health care service. The perspective of the patients and nurses will be solicited and examined with a view to highlighting factors that facilitate and constrain the delivery of service; and finally to draw conclusions and make recommendations. / South Africa

Policy transfer defies the notion of national boundaries in policy making and development. With globalisation processes in the picture, purely state centric policy making models are not the only option. International and domestic policy entrepreneurs have been pivotal in transfer processes. For developing countries, international donor organisations have been instrumental through conditioning assistance to policy reform. Due to the prevailing hierarchical aid regimes, the assumption is that developing countries would implement these policies for the fear of losing the much-needed aid. However, this study argues that the actual implementation of reforms emanating from the global arena is not an automatic process even in the context of coercive transfers, as it is mediated by country specific contextual frameworks. Moreover, even if implemented, the extent to which the transfers attain the promised transformation ends depends on prevailing environmental factors, appropriateness of the reforms, and the implementers' in-depth understanding of the reform instruments. The analysis used the cases of hospital autonomy and district health management decentralisation reforms which are based on the new public management (NPM) paradigm to examine the mechanisms of policy transfer; factors constraining or facilitating the adoption and/or implementation of transferred policies; and the impacts of the policy programmes on service delivery transformation in Malawi. A multilevel framework was used to analyse the dynamics at international, national and application levels. It used a qualitative research strategy. Therefore, data was collected through in-depth interviews, focus group discussions, documents, and observations. The study finds that due to Malawi's heavy aid reliance, international donor organisations attempted to introduce the hospital autonomy and district health management decentralisation reforms on its policy agenda through aid conditioning mechanism which has coercive attributes. In the former, USAID as an international institutional entrepreneur was the driving force through its non-project assistance (NPA) aid regime while in the later case it was the European Commission within the institutional framework of the Lome IV Convention. A comparative analysis of the two reforms revealed that a combination of contextual issues of: mode of transfer, policy content and political-economic context, path dependence, parliament-cabinet configuration, bureaucratic politics, pressure from citizens, institutional compatibility and prerequisites, and social economic forces; determined their adoption and subsequent implementation. While hospital autonomy was rejected by cabinet, and not implemented, despite large amounts of donor resources invested in the transfer processes because of these contextual issues, decentralisation was implemented as the environment was favourable, although it met bureaucratic resistance. However, the study found that when implemented, decentralisation faced several contextual challenges including modest levels of application, reproductions, reversals, cultural factors, and unintended consequences so that it has not achieved the intended transformational results. To this end, the findings provide a better understanding of the dynamics of policy transfer in developing countries and work as a springboard for donor organisations to reorient their approach in aiding policy development in developing countries.