yes / Purpose: 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 background 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.

Yes / This paper presents a mixed-methods study protocol that will be used to evaluate a recent implementation of a real-time, centralised hospital command centre in the UK. The command centre represents a complex intervention within a complex adaptive system. It could support better operational decision-making and facilitate identification and mitigation of threats to patient safety. There is, however, limited research on the impact of such complex health information technology on patient safety, reliability and operational efficiency of healthcare delivery and this study aims to help address that gap. We will conduct a longitudinal mixed-method evaluation that will be informed by public-and-patient involvement and engagement. Interviews and ethnographic observations will inform iterations with quantitative analysis that will sensitise further qualitative work. Quantitative work will take an iterative approach to identify relevant outcome measures from both the literature and pragmatically from datasets of routinely collected electronic health records. This protocol has been approved by the University of Leeds Engineering and Physical Sciences Research Ethics Committee (#MEEC 20-016) and the National Health Service Health Research Authority (IRAS No.: 285933). Our results will be communicated through peer-reviewed publications in international journals and conferences. We will provide ongoing feedback as part of our engagement work with local trust stakeholders. / National Institute for Health Research Health Service and Delivery Research Programme (NIHR129483)

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.

Este estudo tem por objetivo analisar o impacto das variáveis tamanho e localização na eficiência operacional de usinas de cana-de-açúcar no Brasil. Para isso, foram utilizados os dados referentes à moagem e produção de açúcar e de etanol das usinas brasileiras listadas no anuário da cana-de-açúcar na safra 2008/2009. Desta forma, realizou-se um estudo de eficiência operacional, por meio da aplicação da Análise Envoltória de Dados (DEA), na qual foi possível identificar as usinas mais eficientes dentre um universo de 355 usinas e classifica-las por tamanho, localização e eficiência operacional. A análise quantitativa sugere que existe uma maior concentração de usinas classificadas como eficientes e de tamanho grande, localizadas no estado de São Paulo. Objetivando uma análise em profundidade foi realizado um estudo de múltiplos casos em um grupo de usinas. Ademais, foi feita uma entrevista com especialistas do setor sucroalcooleiro. Dessa forma, conclui-se que a eficiência operacional de usinas de cana-de-açúcar depende da variável tamanho, na medida em que as usinas de maior porte tendem a investir mais em tecnologias que proporcionam um maior ganho de eficiência operacional. A eficiência também depende da variável localização, na medida em que o estado de São Paulo apresenta condições edafoclimáticas mais favoráveis à extração de uma cana-de-açúcar com maior teor de sacarose, que, consequentemente, pode influenciar na eficiência operacional de usinas de cana-de-açúcar. O presente estudo, portanto, fornece subsídios para que gestores destas empresas possam alcançar maior eficiência operacional, bem como fornecer suporte a decisões de investimento nesse setor, uma vez que a escolha da localização e da tecnologia pode influenciar na eficiência. / This research aims to analyze the impact of the variables size and location over the operational efficiency of sugarcane mills producing sugar and ethanol in Brazil. Thus, data concerning total milling and total production of sugar and ethanol plants, was collected regarding Brazilian sugarcane mills listed in the 2008/2009 sugarcane yearbook. A ranking of operational efficiency was developed, applying Data Envelopment Analysis (DEA) technique, through which was possible to verify which were the most efficient among 355 sugarcane mills and, therefore, compare the variables size, location and operational efficiency among the Brazilian mills. The quantitative analysis suggests that among the efficient groups, there is a major concentration of larger mills, located in the state of São Paulo. Aiming an in-depth analysis, a multiple-case study was conducted in a group of sugarcane mills, and interviews with experts in the sugarcane industry were developed. Therefore, the conclusion is that operational efficiency of sugarcane mills depends on the variable location, as larger mills tend to invest more in technologies that provide major gain in operational efficiency. The operational efficiency depends also on the location of the sugarcane mill, as the state of São Paulo provides favorable edaphoclimatic conditions for the juice extraction of sugarcane with a higher level of sucrose content, hence possibly having influence over the operational efficiency. This study, therefore, provides subsidies so that managers may obtain higher levels of operational efficiency, as well as support decisions of investments in the sugarcane industry, as the decisions concerning location and size may influence the sugarcane mill efficiency.

The growth rate of life insurance in Ghana is under 1% of GDP, and life insurance company leaders must identify and implement customer satisfaction strategies that will aid business growth and sustainability. Guided by the theory of customer satisfaction management systems (CSMS), the purpose of this multiple case study was to explore customer satisfaction strategies that life insurance company leaders execute to grow and sustain the life insurance business. Twelve life insurance company leaders working in the Accra-Tema geographic area participated in face-to-face semistructured interviews for this study. Data analysis involved compiling, disassembling, reassembling, interpreting, and concluding the data. Member checking and methodological triangulation augmented the creditability of participants' responses and confirmed research findings. The research findings accentuated 29 themes that coalesced into 4 major themes: quality service delivery, public perception of insurance, education and awareness creation, and business growth and sustainability. Findings indicated feedback on life insurance policy, understanding of life insurance function and benefits, responsiveness, and operational efficiency as determinants of customer satisfaction. These findings may contribute to social change by creating awareness of the relevance of life insurance in the socioeconomic development of individuals, families, organizations, and communities, leading to financial security to reduce poverty levels in Ghana. The research may be useful to insurance practitioners who desire to improve insurance penetration for business and sustainability.

Supply chain management is one of the newest and most fashionable managerial concepts to be sponsored by those organisations responsible for setting the change agenda in the construction sector. Its success elsewhere, its promise of productivity improvement and 'best practice' pedigree form the basis of arguments for its adoption in the construction sector. There are a number of assumptions that underpin this argument that are largely ignored by the promoters of such change and the construction management research community. Most notably, the transferability and utility of supply chain management in the context of organisations competing in the construction sector. However, it is argued in this thesis that these arguments fail to engage with the recursive relationship between context and practice. Managerial practice does not exist in a vacuum. The research therefore sets out to test the theory of supply chain management in the construction sector. In doing so, the research approach is informed by and draws on contextual approaches that are highly sensitive to the recursive relationship between context and practice. A multiple case study research strategy was chosen that sought to provide explanations for how practitioners make sense of supply chain management in the context of their organisations and forms the basis of theory testing. These explanations also provided a wealth of empirical evidence to test the assumptions that underpin calls for change in the construction sector. It is concluded that supply chain management does not make sense in the construction sector and that calls for its adoption lacked intellectual rigour and were indeed acontextual.

Este estudo tem por objetivo analisar o impacto das variáveis tamanho e localização na eficiência operacional de usinas de cana-de-açúcar no Brasil. Para isso, foram utilizados os dados referentes à moagem e produção de açúcar e de etanol das usinas brasileiras listadas no anuário da cana-de-açúcar na safra 2008/2009. Desta forma, realizou-se um estudo de eficiência operacional, por meio da aplicação da Análise Envoltória de Dados (DEA), na qual foi possível identificar as usinas mais eficientes dentre um universo de 355 usinas e classifica-las por tamanho, localização e eficiência operacional. A análise quantitativa sugere que existe uma maior concentração de usinas classificadas como eficientes e de tamanho grande, localizadas no estado de São Paulo. Objetivando uma análise em profundidade foi realizado um estudo de múltiplos casos em um grupo de usinas. Ademais, foi feita uma entrevista com especialistas do setor sucroalcooleiro. Dessa forma, conclui-se que a eficiência operacional de usinas de cana-de-açúcar depende da variável tamanho, na medida em que as usinas de maior porte tendem a investir mais em tecnologias que proporcionam um maior ganho de eficiência operacional. A eficiência também depende da variável localização, na medida em que o estado de São Paulo apresenta condições edafoclimáticas mais favoráveis à extração de uma cana-de-açúcar com maior teor de sacarose, que, consequentemente, pode influenciar na eficiência operacional de usinas de cana-de-açúcar. O presente estudo, portanto, fornece subsídios para que gestores destas empresas possam alcançar maior eficiência operacional, bem como fornecer suporte a decisões de investimento nesse setor, uma vez que a escolha da localização e da tecnologia pode influenciar na eficiência. / This research aims to analyze the impact of the variables size and location over the operational efficiency of sugarcane mills producing sugar and ethanol in Brazil. Thus, data concerning total milling and total production of sugar and ethanol plants, was collected regarding Brazilian sugarcane mills listed in the 2008/2009 sugarcane yearbook. A ranking of operational efficiency was developed, applying Data Envelopment Analysis (DEA) technique, through which was possible to verify which were the most efficient among 355 sugarcane mills and, therefore, compare the variables size, location and operational efficiency among the Brazilian mills. The quantitative analysis suggests that among the efficient groups, there is a major concentration of larger mills, located in the state of São Paulo. Aiming an in-depth analysis, a multiple-case study was conducted in a group of sugarcane mills, and interviews with experts in the sugarcane industry were developed. Therefore, the conclusion is that operational efficiency of sugarcane mills depends on the variable location, as larger mills tend to invest more in technologies that provide major gain in operational efficiency. The operational efficiency depends also on the location of the sugarcane mill, as the state of São Paulo provides favorable edaphoclimatic conditions for the juice extraction of sugarcane with a higher level of sucrose content, hence possibly having influence over the operational efficiency. This study, therefore, provides subsidies so that managers may obtain higher levels of operational efficiency, as well as support decisions of investments in the sugarcane industry, as the decisions concerning location and size may influence the sugarcane mill efficiency.

Ports are actively pursuing greater operational efficiency to effectively handle the increasing global flow of goods, while striving to improve the energy efficiency of their operations to comply with new environmental regulations. As a result, innovation-leading ports have begun to recognize the potential of digital twins to overview, coordinate and optimize port processes, resulting in energy savings, and reductions of costs and of CO2 emissions. While digital twins have gained momentum in other domains such as smart manufacturing and aerospace, their adoption in ports has been comparatively slow. This can be explained, among other things, by the multi-stakeholder nature of the port and the high complexity of the often interconnected port processes. Thus, this thesis, grounded in the context of ports, discusses what constitutes a digital twin, proposes characteristics to assess the maturity of existing digital twins, and introduces and evaluates mathematical models to support a key port process, which can be used as components of a digital twin for the port. / Hamnar strävar aktivt efter ökad operativ effektivitet för att hantera den ökande globala varuflödet, samtidigt som de strävar efter att förbättra energieffektiviteten. Som ett resultat har ledande hamnar börjat se potentialen hos digitala tvillingar för att skapa överblick samt koordinera och optimera processer i hamnen. Målet med användningen av digitala tvillingar är energibesparingar samt minskning av kostnader och CO2-utsläpp. Medan digitala tvillingar har använts inom andra områden såsom tillverknings-, flyg- och rymdindustrin, har införandet i hamnar varit jämförelsevist långsamt. Detta kan förklaras, bland annat, av hamnens många olika involverade aktörer och den höga komplexiteten i de ofta sammanlänkade hamnprocesserna. Därför fokuserar denna avhandling, med utgångspunkt i hamnkontexten, vad som utgör en digital tvilling, presenterar egenskaper för olika mognadsnivåer hos befintliga digitala tvillingar, och introducerar samt utvärderar matematiska modeller som kan bli delkomponenter i en digital tvilling för hamnen.

Made available in DSpace on 2016-04-25T16:44:43Z (GMT). No. of bitstreams: 1 Marcelo Jose de Sousa.pdf: 2491031 bytes, checksum: 7e9db405853b5513ea51a4f624e646cc (MD5) Previous issue date: 2015-04-01 / The main purpose of this study is to analyze the reverse logistic model introduced by a telecommunication company in Brazil and the relationship with its supply chain as well as to present how this company had adjusted its operational model and the key processes aiming to obtain efficiency and economic balance in its reverse chain. The qualitative and quantitative research has based on information and internal data of the company, in the period of 2009 until 2014. It has verified the goals, performance indicators and processes implemented, intending to adjust them to the requirements of the Solid Waste Nacional Policy (PNRS). Finally, it was discussed the adopted model in implementing the Reverse Logistic Center, including the relationship with business partners, governance and results achieved. This model and its concept has spread for many other operations of the company and nowadays, is recognized a reference of operational excellence in managing reverse chains / Este estudo tem como objetivos analisar o modelo de logística reversa de uma empresa do setor de telecomunicações e a relação com a sua cadeia de suprimentos; bem como a adequação do seu modelo operacional e processos-chave, para ganho de eficiência e equilíbrio financeiro na cadeia reversa. A pesquisa, de natureza qualitativa e quantitativa, foi realizada utilizando informações e dados internos da empresa, no período de 2009 a 2014. Verificou-se metas, indicadores de desempenho e processos implementados, em adequação às exigências da Política Nacional de Resíduos Sólidos, e em busca do equilíbrio financeiro da operação. Finalmente, discutiu-se o modelo adotado na implantação da Central de Logística Reversa, contemplando a relação com parceiros de negócio, governança e a evolução dos resultados. Este modelo foi ampliado para outros negócios e, atualmente, essa empresa é considerada uma referência em excelência operacional na gestão de cadeias reversas

Atualmente, no Brasil, a atenção ao setor de saneamento básico tornou-se uma questão de saúde pública e ambiental. A evolução dos indicadores recentes mostra que o nível de cobertura se encontra em patamares aquém do necessário frente a uma elevada demanda, decorrente do crescimento populacional e de um histórico insuficiente de atendimento no país. Esse setor enfrenta dificuldades na captação de recursos para investimentos por parte das empresas públicas, pois estas se encontram submetidas a regras fiscais tais como limites de endividamento, contingenciamento de crédito e metas de superávit. Além disso, registram uma baixa geração de excedentes, ineficiência operacional e ingerência política. O avanço da iniciativa privada ocorreu de forma tímida no setor, decorrente do caráter fortemente social do mesmo e da ausência de diretrizes que definam suas políticas. Com a introdução de novo marco regulatório estabelecido por meio da Lei no 11.445/2007, surge um ambiente institucional com menos incerteza para atuação de investimentos privados. Diante das preocupações com processos de privatização, como, por exemplo, trade-off custo/qualidade com o qual a empresa privada pode se deparar, constatou-se, por meio de estimação de dados em cross section, via Mínimos Quadrados Ordinários, os tipos de prestadores que tiveram melhor desempenho nos indicadores que compõe as funções-objetivo de cada empresa enunciadas pela literatura do setor. Os resultados indicaram que a participação da iniciativa privada foi positiva para o setor na medida em que apresentou menores perdas de distribuição e de faturamento, maiores índices de produtividade, investimento e qualidade dos serviços. Portanto, pode-se sugerir que as parcerias entre setor público e privado são alternativas viáveis para acelerar o cumprimento das metas de universalização dos serviços. / Currently, in Brazil, the attention to basic sanitation sector has become a matter of public health and environmental concerns. The evolution of the recent researches states that the level of coverage is not enough to fulfill the high demand due to population growth and a history of inadequate investments in the country. This sector is facing difficulties in raising funds by public enterprises, as these are subject to tax rules such as limits on debt, curtailment of credit and surplus targets. In addition, they have had low generation of profit, operational inefficiency and political interference. The private enterprise investments in the sector have not being significant due to its evident social character and the lack of guidelines that define their policies. With the introduction of new regulatory framework established by the Law number 11.445/2007, an institutional environment have being created with less uncertainty for the private investments. In face of the concerns about the privatization processes, for instance the cost-quality trade-off which a private company may have to deal with, it was found through cross section data estimation via OLS (Ordinary Least Squares) the supplier types that had better performance on the indicators that comprise the objective functions of each company listed in the literature of the sector. The results indicated that the participation of the private capital was positive for the sector as it showed lower losses on sales and distribution, higher rates of productivity, investment and quality of services. Therefore, it can be suggested that partnerships between public and private sectors are viable alternatives to accelerate the achievement of the targets of a universalized service.