abstract: Despite significant growth in research about supply chain integration, many questions remain unanswered regarding the path to integration and the benefits that can be accrued. This dissertation examines three aspects of supply chain integration in the health sector, leveraging the healthcare context to extend the theoretical boundaries, as well as applying supply chain knowledge to an industry known to be immature in terms of its supply chain practices. In the first chapter, a supply chain operating model that breaks away from the traditional healthcare supply chain structures is examined. Consolidated Service Centers (CSCs) embody a shared services strategy, consolidating supply chain functions across multiple hospitals (i.e. horizontal integration) and disintermediating several key roles in healthcare supply chains such as the group purchasing organizations and national distributors. Through case studies, key characteristics of CSCs that enable them to reduce the level of supply chain complexity are examined. The second chapter investigates buyer-supplier relationships in healthcare (i.e. supplier integration), where a high level of distrust exists between hospitals and their suppliers. This context is leveraged to study both enablers and barriers to buyer-supplier trust. The results suggest that contracting counteracts the negative effects of dependence on trust. Furthermore, the study reveals that hospital buyers may, in some situations, perceive dedicated resource investments made by suppliers as trust barriers, associating such investments with supplier upselling and entrenchment tactics. This runs contrary to how dedicated investments are perceived in most other industries. In the third chapter, the triadic relationship between the hospital, supplier, and physician is taken into consideration. Given their professional autonomy and power, physicians commonly undermine hospital efforts in supply base rationalization and standardization. This study examines whether physician-hospital integration (i.e. customer integration) can drive physicians towards supply selection practices that align with the hospital’s sourcing strategies and ultimately result in better supply chain performance. This study utilizes theory on agency triads and professionalism and tests hypotheses through a random effects regression model applied to data about hospital financial performance and physician-hospital arrangements. / Dissertation/Thesis / Doctoral Dissertation Business Administration 2016

Trata-se de uma pesquisa sobre possibilidades e limites da constituiÃÃo de sujeitos na gestÃo em saÃde, a partir da experiÃncia de Fortaleza no perÃodo de 2005 a 2008. Aborda-se o sujeito a partir de um referencial histÃrico-cultural, o qual considera a interaÃÃo dialÃtica entre o individual e o coletivo no aprofundamento da consciÃncia humana sobre si e o mundo. Nesta perspectiva, reflete-se sobre propÃsitos e modelos de gestÃo em saÃde e sua corelaÃÃo com a ampliaÃÃo da autonomia dos atores. Foram realizados grupos focais com gestores vinculados à AtenÃÃo PrimÃria à SaÃde e utilizados dados secundÃrios. Por meio de uma abordagem hermenÃutica dialÃtica procurou-se compreender o sentido das narrativas construÃdas, considerando-se as condiÃÃes histÃricas de sua existÃncia. Identificaram-se categorias empÃricas que foram analisadas: cointencionalidade de mudanÃa, direcionalidade polÃtica e conceitual, gestÃo humana, diminuiÃÃo da hierarquia, fragmentaÃÃo do processo de trabalho, concentraÃÃo do poder de decisÃo. SobressaÃram-se reflexÃes sobre trÃs polÃticas estratÃgicas de fortalecimento de sujeitos: cogestÃo, humanizaÃÃo e educaÃÃo permanente em saÃde. Concluiu-se que, apesar da persistÃncia de obstÃculos, para a melhoria da qualidade dos sistemas e serviÃos de saÃde à imprescindÃvel instituir uma gestÃo democrÃtica por meio de arranjos organizacionais e mÃtodos participativos que potencializem a inserÃÃo e o comprometimento dos atores do Sistema Ãnico de SaÃde (SUS). / Strengthening of subjects in health management: advances and challenges in the experience of Fortaleza, ce. This research work deals with the potentialities and limitations on the strengthening of subjects in health management, based on the experience of Fortaleza in the period from 2005 to 2008. The subject is approached from a historical-cultural standpoint, which considers the dialectic interaction between the individual and the collective in deepening human consciousness about itself and the world. From this perspective, a reflection is made on the health management purposes and models and their correlation with an increased autonomy of the actors. Focus groups were conducted with managers linked to Primary Health Care and secondary data were utilized. Through a hermeneutic dialectic approach it was sought to understand the meaning of the constructed narratives by considering the historical conditions of their existence. Empirical categories were identified and analyzed: co-intentionality of change, political and conceptual drives, human management, reduction of hierarchy, fragmentation of the work process, concentration of the decision power. Three main strategic policies aimed at strengthening the subjects came out from the analyses: co-management, humanization, and continuous education on health. It was concluded that, despite the persistence of obstacles, in order to improve the quality of healthcare services it is essential to establish a democratic management system through organizational arrangements and participatory methods that enhance integration and commitment of the Public Health System (SUS) actors.

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No. of bitstreams: 2 Dissertação - Maria Cláudia Honorato Da Silva E Souza - 2012.pdf: 1423526 bytes, checksum: 3c4cddca9eddd2bffeb69eb23fd1b55f (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-10-03 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The Sanitary Districts are the extension of the central level of the Municipal Health Department in the Health Units which are part of the process of decentralization of the municipal management. To develop assistance continuously in a solvable way it is necessary that the manager and the teams in the units and Sanitary Districts know about the flows, that partnerships are established and agreed upon. In this study we aimed to diagnose elements of the work developed in the management of the Sanitary District in the Municipal Health Department in Goiânia, Goiás. We used a descriptive exploratory research methodology with professionals working in the health field who carried out duties of directors and supervisors in the seven Sanitary Districts of the Municipal Health Department in 2011. A well-structured interview was used to collect data. Thus it was organized in a way that allowed its analysis in the SPSS 15.0 program. Data were coded to proceed with the descriptive analysis based on the theoretical frame of reference. This study was assessed and approved by the Ethics Committee for Human and Animal Research of the Clinical Hospital of the Federal University of Goiás, under Protocol number 031/2009. Twenty managers of various professional categories who represent 95% of the district directors, took part in the research at the time of the study. The results show that most managers are female between 31-50 years old, and are graduated from private universities for more than 10 years. 80% of them have active employment whereas 90% exert their management under exclusive dedication. The political appointment is the aspect which influenced 55% of the management positions. 80% of the managers participated in specific training in management. Amongst the management activities considered important, the team management was cited by many, whereas the planning was devalued. From this study we intend to consolidate proposals of ongoing training, reinforcing the aspects appointed as weak and those which are essential to good management. / Os Distritos Sanitários são a extensão do nível central da Secretaria Municipal de Saúde no território das Unidades de Saúde e fazem parte do processo de descentralização da gestão municipal de saúde. Para o desenvolvimento da assistência, de forma continua e com resolubilidade, é necessário que o gestor e a equipe das unidades e Distritos Sanitários conheçam os fluxos e as parcerias sejam estabelecidas e pactuadas. Neste estudo, tivemos como objetivo diagnosticar elementos do trabalho de gestão desenvolvido nos Distritos Sanitários na Secretaria Municipal de Saúde de Goiânia – Goiás. Utilizamos a metodologia de pesquisa descritiva exploratória, realizada com profissionais da área de saúde que desenvolvem funções de diretores e supervisores dos sete Distritos Sanitários da Secretaria Municipal de Saúde no ano de 2011. Para a coleta de dados utilizou-se uma entrevista estruturada, organizada de forma que permitisse a sua análise no programa SPSS 15.0. Os dados foram codificados para proceder com a análise descritiva com base no referencial teórico. Este estudo foi avaliado e aprovado pelo Comitê de Ética em Pesquisa Médica Humana e Animal do Hospital das Clínicas da Universidade Federal de Goiás, sob Protocolo Nº: 031/2009. Participaram da pesquisa 20 gestores de diversas categorias profissionais que representam 95% dos diretores distritais na ocasião do estudo. Os resultados demonstram que a maioria dos gestores é do sexo feminino, possuem idade de 31 a 50 anos e se graduaram há mais de dez anos em universidades privadas. 80% possuem vínculo empregatício efetivo além, de 90% exercerem a gestão com dedicação exclusiva. A indicação política é o aspecto que influenciou em 55% dos cargos de gestão. Participaram em capacitações específicas para a gestão 80% dos gestores. Dentre as atividades de gestão consideradas importantes a gestão da equipe foi citada por muitos, enquanto o planejamento foi pouco valorizado. Pretendemos, a partir deste estudo, consolidar propostas de capacitações continuadas, reforçando aspectos apontados como fragilidades e aqueles imprescindíveis para uma boa gestão.

Organizational performance in the healthcare field is of great interest for many stakeholders. Efficient use of resources and delivery of high quality of care should be relevant to any taxpayer hoping to live healthily and grow old in Sweden. Simultaneously, the working conditions for the employees need to be sustainable if the impending lack of 170 000 workers in the healthcare sector by the year of 2030 is to be mitigated (Statistiska centralbyrån, 2012). The scope of this study is to examine how the quality management systems applied to ensure and improve the aforementioned objectives are perceived by the individual employees. Specifically, practitioners in the nursing professions are enquired about the design principles of enabling control as described by Adler and Borys (1996). The study has utilized a quantitative methodology and an online survey to collect personal perceptions and experiences from 400 individuals in the nursing professions on this topic. Major findings are that the majority of the respondents state that they perceive three out of four of the design principles of an enabling system to be present in the quality management system at their workplace. In addition, there is a strong association between the perception of the enabling characteristics flexibility and repair and general job satisfaction. Further studies with larger samples would increase the statistical power of these correlations. In addition, a large proportion of the respondents perceive that the quality management processes is negatively affected by financial constraints. Only a minority of the respondents perceive the workload constituted by tasks connected to quality management as reasonable.

No description available.

Yes / Advancing Industry 4.0 concepts by mapping the product of the automotive industry on the spectrum of Cyber Physical Systems, we immediately recognise the convoluted processes involved in the design of new generation vehicles. New technologies developed around the communication core (IoT) enable novel interactions with data. Our framework employs previously untapped data from vehicles in the field for intelligent vehicle health management and knowledge integration into design. Firstly, the concept of an inter-disciplinary artefact is introduced to support the dynamic alignment of disparate functions, so that cyber variables change when physical variables change. Secondly, the axiomatic categorisation (AC) framework simulates functional transformations from artefact to artefact, to monitor and control automotive systems rather than components. Herein, an artefact is defined as a triad of the physical and engineered component, the information processing entity, and communication devices at their interface. Variable changes are modelled using AC, in conjunction with the artefacts, to aggregate functional transformations within the conceptual boundary of a physical system of systems. / Jaguar Land Rover funded research “Intelligent Personalised Powertrain Healthcare” 2016-2019

Communication and coordination in complex sociotechnical systems require continuous assessment on its artefacts and how they are utilized to improve system performance. Situation Awareness (SA) is considered as a fundamental concept in designing and understanding interactions between human and non-human agents (i.e., information systems) that impact system performance. The interaction efficiency is partly determined by quality of information or SA distributed across agents to ensure the accuracy of decision making and resource allocations. Disrupting SA distribution between agents can significantly affect operations of the system with financial and safety consequences. This research applied the Distributed Situation Awareness (DSA) theory to study and improve patient flow management. The main objective of this research was to advance methodology in the DSA literature for (1) deriving design implications from DSA models, and (2) developing quantitative DSA models to formally compare system designs. This DSA research was situated in the domain of patient flow management. Data were collected using the three-part method of data elicitation, extraction, and representation to investigate DSA at a patient flow command and control center at Carilion Clinic in Roanoke, VA. The data used were elicited from observations and interviews on workers daily activities and available historical database (i.e., TeleTracking). Then, data were represented into a combined network to highlight social, task and knowledge elements in patient flows for studying and assessing patient flow management. The influence of the DSA on complex systems was examined qualitatively and quantitatively. The DSA combined network qualitatively characterized patient flow management and identified deficiencies of the command-and-control center functions. The network characterized admission, clinical (inside-hospital) transportation, discharge, and environmental services functions managed by Carilion Transfer and Communications Center (CTaC). These characterizations led to the identification of design principles on job roles, tasks performed, and SA transactions and distribution adopted by the state-of-the-art patient flow management facility. In addition, the network representing the current operation of CTaC illustrated the connection between functional groups, arbitration of resources, and job roles that could become the bottlenecks in transmitting SA. The network also helped identify inefficient task loops, which resulted in delay due to missing/poor SA, and task orders that could be modified to improve the patient flow and thus reduce the likelihood of delay. The qualitative (i.e., combined network) model was partially translated into a quantitative model based on discrete event simulation (DES) and agent-based modeling (ABM) to simulate patient transportation inside the hospital. The simulation model consisted of 28 patient origins, 29 equipment origins, 12 destinations, and more than 200 entities (i.e., simulation objects). The model was validated by lack of significant difference on various outcome metrics between 100 simulation replications and historical data using one-way t-tests. The simulation model captured the distribution and transactions of knowledge elements between agents within the modeled processes. Further, the model successfully verified the deficiencies in the existing system (i.e., delay and cancelation), attributing various instances of deficiency to be either SA related or non-SA related. The simulation model tested two interventions for eliminating SA deficiencies revealed by the qualitative model: (1) updating the wards nurse before picking up patients from inpatient floor, and (2) updating the X-ray nurse/team before arriving with the patient. Both interventions involved updates from the transporters to nurses, transmitting SA on the estimated time of arrival and patient information for the nurse to become aware of the transport status. The simulation ran for 1500 replications for results on transport time and cancellation rate on these two interventions. One-way t-tests revealed that the intervention to update the wards nurse resulted in significant reductions in mean transport and cancellation rate time compared to historical data (i.e., TeleTracking), yielding 0.42 minutes to 1.24 minutes reduction in transport time and 2% to 5% less cancelations. However, the second intervention resulted in a significant increase in transport time and thus was ineffective. DES and ABM supplemented the qualitative modeling with quantitative evidence on DSA concepts and assessment of potential interventions for improving DSA in patient flow management. Specifically, the DES and ABM enabled comparison and prediction of performance outcome from recommended changes to communication protocols. These findings indicate that DSA is a promising framework for analyzing communication and coordination in complex systems and assessing improvement on SA design quantitatively. / Doctor of Philosophy / Hospitals aim to provide care and treatment to patients in a timely and effective manner but their operations can be hindered by delays and long treatment times, resulting in high operating cost. A potential cause of this problem is the complexity of patient treatment process and the number agents involved. The treatment is provided through nurses, doctors, and technicians who work together to deliver care to patients. They all rely on the information from various medical devices and communicate patient-related information continuously to streamline patient movement towards different locations for different retreatments in the hospital. Thus, studying and improving communication and coordination between the medical staff could improve patient flow that in turn reduce idling resources and patient time in hospital, thereby lowering the healthcare cost without sacrificing quality of care. This dissertation investigated patient movement in the hospital adopting Distributed Situation Awareness (DSA). DSA models communication and coordination by examining the distribution of situation awareness (SA) between human and machine agents for a given task. The primary objective of this dissertation was to investigate how to develop DSA models for studying and improving patient flow management. The dissertation showed how to build a network model that illustrated how SA were generated and distributed amongst hospital staff and information systems to manage admission, discharge, room cleaning, and patient transportation. The network model also helped identified the deficiencies associated with different activities. Further, simulation was used to study the processes and SA communicated quantitively. The simulation model was able to show how one recommended change to the communication protocol could reduce patient transport time and cancellation for one route but another. This dissertation enhanced the methodology DSA for real-world applications and demonstrated the method to quantify SA distribution and transaction in complex system.

No / Jayne Donaldson, Bryan McIntosh and Simon Jones argue that England can learn from Scotland's approaches to the nature of hospital capacity and the workforce's delivery of service.

No / Despite its rapid growth in recent literature, risks in project management have received limited critical attention when compared to Lean principles and total quality management. The aim of this article is to examine the ongoing dialogue within health services funders and providers concerning the relationship between project management and its relationship to hard and soft environmental risk factors. The failure of high profile projects and cost to the taxpayer is on the increase. This article argues that the lack of understanding in relation to a holistic assessment of project success factors contributes to increased risk of failure. It argues that greater emphasis is needed on placing risk relative to both operational and cultural factors, as opposed to the frequent use of prescriptive mechanistic methodologies. These changes have the potential not merely to improve the success rates of healthcare management projects, but health outcomes too.

No / The NHS must increase productivity by 6% per annum if it is to make projected efficiency savings of £21 billion by 2014. At the same time, it is expected to maintain or improve the quality of care. Given that staff costs are 60% of the current NHS budget, it is likely that both the number and composition of the 1.7 million strong workforces will need to be changed to meet these targets. Healthcare management will be greatly affected by these changes. We argue that skill maximisation (e.g. increasing the responsibilities of healthcare practitioners) is the key to increasing productivity and care quality. We argue that to increase output (represented by volumes of cases treated) and quality of care is not just necessary, but essential. We therefore argue that the key to addressing the future of healthcare is the maximisation of the use of human resource.