Today patients and their companions use various sources to gain knowledge of cancer. The ability to clearly determine their current and future information sources can help both physicians and patients to better communicate and make more efficient decisions together, but limited studies have done for this. A survey was implemented in the oncology clinic of the Vanderbilt Ingram Cancer Center, Nashville, TN. Of the 468 individuals approached, 424 (91%; 257 patients and 167 companions) completed the questionnaires, with 166 patients paired with companions. Over 95% believed information enhanced their involvement in decision making and abilities to cope with cancer; 77% reported that information reduced anxiety. 85% will continue to search for cancer information in the future. Physicians, nurses, and medical pamphlets are still the most trusted sources. Internet and email were not used as much as expected but showed more potential uses and better quality in the future. Demographics including education, income, gender, age and working status are found as good predictors for cancer information source preferences. Future research is needed on physicians¡¯ views on cancer patients¡¯ medical information sources.

A Supply Network (SN) is a collection of firms that maintain local autonomy but who interact together to fulfill customer requirements. SN researchers have focused on the need to understand the reasons behind the diversity in the number and types of supply networks, as well as how these diverse networks interact, change and adapt over time. My research focuses on the dynamic growth aspect of SNs and addresses two fundamental questions: 1) how do Supply Networks grow and emerge and 2) are there simple rules and conditions that control the growth and emergence process? The dissertation presents an investigative framework for studying these and other questions concerning the growth and evolution of complex supply networks. An inductive approach is used to answer these questions. It starts by creating a new theory-based unified model of supply network (called UMSN) that incorporates four theoretical lenses, namely 1) industrial growth theory, 2) network growth theory, 3) game & market structure theory and 4) complex adaptive systems theory. The UMSN provides a holistic view for modeling growth and emergence in SNs. A generic rule-based modeling framework and a simulation-based computational framework using software agent technology was developed to operationalize and implement the UMSN. For investigating the growth phenomenon data and parameters from the US automobile industry over the last 80 years were utilized. The results and analysis show similar growth trends as empirically published data of well-structured industries such as the US automobile industry. The SN system grew and emerged as a complex adaptive system. The research also presents statistically significant results that supply networks grow and emerge based on interactive effects of local decision-making rules and environmental conditions, and that there is an underlying order to the emergence process. This research also develops chaos theory analysis techniques for predicting the SN system behavior over time; showing how such techniques can generate insights for policy makers and managers. My research contributes by extending the current state of knowledge of SNs as a dynamic system (network) and developing novel classification and analysis techniques. The insights drawn can aid managers/decision makers towards a better understanding of how SN emerge and grow.

The Institute of Medicine (IOM) has identified error reporting systems as important components of patient safety improvement. Medical error reporting systems historically has been accomplished by disparate paper based processes. There has been a trend off late to shift to a more structured electronic system. A review of the literature shows that a limited study has been done to compare the electronic error reporting system versus the traditional paper based error reporting system. Therefore this thesis presents a comparative study in the reporting rates between the paper-based error reporting system and an electronic error reporting system. The study was done at the Vanderbilt University Medical Center. Error reporting data for a period of 17 months for each system was studied. Results of this study show an increased rate of error reporting using the electronic system. It also shows a higher severity of events reported using the electronic reporting system. Suggestions for additional areas to be explored in future research are suggested in the conclusion of this study.

This research explores the process of information system (IS) failure to understand how various organizational, users, technology, and implementation factors influence IS acceptance. The topic of IS implementation is particularly essential to the field of IS research because of the high propensity of IS implementation projects for failure. Although researchers have generated numerous theories and models that examine the effect of a wide range of factors on implementation success, the research on IS implementation and acceptance still remains fragmented and no unified view of IS implementation has been widely adopted (Larsen, 2003). An alternative model that aids in exploring IS implementation was developed. The model utilizes initiation, adoption, adaptation, and acceptance stages of Kwon and Zmuds (1987) model of Information Technology implementation as a framework and adds to it factors that previous research on IS implementation showed important to consider. <p> The proposed model was evaluated by analyzing quantitative and qualitative data from the case of a failed implementation of a computerized Clinic Documentation System (CDS) in a large teaching hospital. Organizational environment and user characteristics; strong management commitment and support; extensive planning of the implementation as a change process and not as a technology deployment are shown to be major influencing factors in the IS implementation outcome. Finally, this research shows that individual users assessment of technology advantages and compatibility with existing work practices influence users acceptance decisions.

As systems age and require new efforts for revitalization, the original supply chain faces risks that once were not an issue. The supply chain for a legacy system can diminish over time as factors such as new technologies, economic shifts and global considerations redirect suppliers. This study examines the potential level misalignment between engineers, who develop legacy system supply chain strategies, and managers who oversee the function of these systems. A two part survey, assessing the risk of a legacy supply chain, compares the responses of 331 engineers with 203 upper managers, all of who are associated with systems engineering. Despite the potential for functional misalignment among engineers and managers, we found few statistically significant differences of perceptions of supply chain risks. There were, however, notable differences in views concerning the necessary level of supplier assistance and ethical standards.

Industries plagued by lengthy development times have always resorted to ad hoc resource allocation and expediting in an effort to reduce the development times. Instead of decreasing the time to market, these well meaning efforts result in firefighting, causing major problems leading to the frequent failure of the development activity. Ever increasing drug development times have lead National Institutes of Health to focus attention on efforts to decrease the drug development times. High priced drugs like cancer drugs have been at the center of these efforts, and expediting is a solution that is being tried in the cancer drug development process. In this paper a model is developed to study the effects of expediting on the cancer drug development process. The analysis of the model leads to interesting insights which will help in policy decisions on expediting in the drug development process. We see that, as the percentage of expedited studies in the system is increased the productivity of the system first increases, peaks when 16% of the studies in the system are expedited, and then the productivity begin to decrease. When more than 40% of the studies in the system are expedited, the productivity of the system goes below the base case value of 0% expediting, 100% expediting the productivity of the system is 30.8% below its base case productivity. We find that expediting can help in increasing the productivity of the system, but beyond a certain point, expediting has a negative effect on system productivity.

While ISO 9000 has been shown to improve internal metrics of firm performance, external measurements may be unaffected. This thesis examines the economic value of ISO 9000 by assessing the equity returns and risk parameters of 204 firms certified between 1999 and 2002 and is the first to examine the economic effects of ISO 9001:2000 versus the superseded 1994 standards. The complete sample experienced no significant changes in stock price or idiosyncratic risk. The market value of small firms increased between 0.63% and 0.85% and is significantly more positive than the reaction of large firms. The market value of ISO 9001:2000 registered firms increased between 0.98% and 1.20%, which is significantly more positive than the market reaction to ISO 9000:1994. Small firms also experienced a market value increase during the calendar quarter following ISO 9001:1994 certification, but industry-wide movements could be an extenuating factor. Because these results suggest that on average ISO 9000 is not associated with positive stock price performance, managers must justify the associated implementation costs by other means. However, those financial justifications may have greater credence for smaller firms. Furthermore, the financial payoff may be greater if a firm becomes certified to a more stringent quality standard or a replacement for incumbent and less strict guidelines.

This paper analyzes the impact of logistics and manufacturing outsourcing announcements on shareholder wealth. We assess this impact by measuring the abnormal return (which is the part of the return of a stock not related to market or industry wide movements) of 181 announcements from 1992 to 2003. We find that manufacturing outsourcing announcements increase the contract granting firm stock price by .4% and that logistics outsourcing announcements decrease the stock return by .6%. We also conducted a 60 day post announcement analysis and concluded that this is a transient effect. To gain further insight we preformed regression analysis with variables such as debt-to-equity ratio, market-to-book ratio, firm size, growth prospect and time of the outsourcing deal. None of the regressions were statistically significant. We then conducted sensitivity analysis on factors such as industry competitiveness, capital, research and development intensity and use of multiple outsourcing firms to validate our previous findings. Only one regression showed statistically significant results: manufacturing outsourcing for the retail and wholesale industry with value of -.05. Our findings suggest that shareholders value manufacturing outsourcing deals and penalize logistics outsourcing deals, but only in the short run.

A system by definition is composed of multiple elements. The loss of any one of these elements can impact the rest of the components in that system. Legacy systems, any system developed in the past that are mission critical and whose failure can have serious impact on business, are particularly vulnerable to such losses, yes such systems are becoming increasingly prevalent. This study examines the effects on legacy system supply chains when suppliers that were once there when the systems were created are no longer available to supply them with the necessary materials, parts, or support. A system dynamics model was created through the use of expert testimony; one expert in the field of system dynamics and two experts in the field of supply chain management. Despite the use of suggested independent / dependent variable pairs as suggested by the experts, the sensitivity analysis results did not always yield the expected outcome. There were, however, notable results concerning the relationship of managerial based decisions, legacy system lifetime, and supply base support to the model as a whole.

This research investigates the conditions under which customer information provided during the new product development (NPD) process improves business performance for radical innovations. I develop a model of the relation between customer inputs and business performance of the radical innovation. The model includes: 1) the technology and market information obtained from the customer, 2) the phase of the NPD process in which the information is obtained, and 3) the firms organizational learning (i.e., information acquisition, information utilization, information dissemination, and organizational memory of the firm). The model was estimated with survey data from managers responsible for product development in the medical device market (N=152). The findings suggest there are multiple factors that affect the business performance of a radical new product. First, at the project level, the results show that the type of information obtained from the customer and when it is obtained significantly affect the products business performance. Secondly, the firms organizational learning capabilities are part of a complex relationship which lead to the success of a new product. Finally, the post-hoc analysis of the interactions of organizational learning with the customer information and product business performance suggests different strategies are appropriate depending upon the state of a firms organizational learning capabilities.