A dissertação investiga como a corrupção e a ineficiência afetam os preços pagos pelo setor público na compra de bens. Comumente atribuem-se os preços elevados à corrupção. Contudo, em geral, não é possível separar os efeitos daqueles advindos da ineficiência gerada pela própria burocracia. Para distinguir as implicações dessas duas variáveis, utiliza-se a adoção do pregão eletrônico da Bolsa Eletrônica de Compras de São Paulo (BEC/SP) pelos órgãos do estado, pois considera-se que ele gera incentivos distintos para os órgãos a depender de qual efeito é mais importante para explicar os preços. As evidências empíricas apontam que os órgãos públicos pagam preços distintos por produtos semelhantes e que aqueles que pagavam preços mais altos têm mais chances de aderir ao pregão eletrônico da BEC, o que indica que as diferenças de preços se devem, sobretudo, à ineficiência. Além disso órgãos que pagavam preços mais baixos têm menos incentivos em aderir ao pregão eletrônico, pois já possuem mecanismos de compras mais eficientes, e manipulam os valores totais de suas aquisições para conseguir se enquadrar na categoria de dispensa de licitação. / The master thesis investigates how corruption and inefficiency affect the prices paid by public bodies for the purchase of goods. The high prices are commonly attributed to corruption, but in general it is not possible to separate the effects of inefficiency generated by the bureaucracy itself. In order to distinguish the implications of these two variables we use the adoption of the descending electronic auction through an online procurement platform (Bolsa Eletrônica de Compras de São Paulo - BEC/SP) by the public bodies of the state of São Paulo. It is possible to separate the effects on procurement prices because the descending electronic auction generates different incentives for the public bodies depending on which effect is the most important. The empirical evidence indicates that the agencies pay different prices for similar products and that those who pay higher prices are more likely to use the descending electronic auction, which indicates that price differences are mainly due to inefficiency. In addition, the lower-paying agencies have fewer incentives to join the descending electronic auction, because they already have more efficient purchasing mechanisms, and manipulate the total amounts of their purchases to be exempted from doing a bidding process.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-03-02T11:52:11Z No. of bitstreams: 1 larissacrivellaridecastro.pdf: 2626708 bytes, checksum: a16e13a5a96c83c9b87a53d6e80a8265 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-03-03T14:49:08Z (GMT) No. of bitstreams: 1 larissacrivellaridecastro.pdf: 2626708 bytes, checksum: a16e13a5a96c83c9b87a53d6e80a8265 (MD5) / Made available in DSpace on 2016-03-03T14:49:08Z (GMT). No. of bitstreams: 1 larissacrivellaridecastro.pdf: 2626708 bytes, checksum: a16e13a5a96c83c9b87a53d6e80a8265 (MD5) Previous issue date: 2013-02-08 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / No Brasil, quando se trata de Estabelecimentos Assistenciais de Saúde (EAS), o poder público desempenha papel fundamental tendo em vista que é o responsável pela produção destes edifícios para a rede pública de atendimento. Sendo os EAS espaços desenvolvidos para cuidados da saúde da população, eles possuem um importante papel para a sociedade, desta forma o profissional de arquitetura deve garantir que o projeto atenda às funções exigidas por esse tipo de edifício: conforto, durabilidade e flexibilidade. Por isso, esse tipo de edificação apresenta uma necessidade de maior planejamento para se organizarem, já que estão cada vez mais flexíveis e complexos. Sabe-se que o processo de projeto é um tema recorrente no meio acadêmico e vem sendo discutido por autores com foco tanto em seu reconhecimento como, por hipótese, na sua melhoria. Entretanto, uma grande parte das pesquisas realizadas em torno do tema processo de projeto na construção civil está voltada para os empreendimentos do setor privado, onde não existe um processo burocrático que envolva de maneira direta ou indireta o município, o estado ou a União. A falta de planejamento e até de fiscalização durante o processo de projeto de uma edificação pública são apontadas como causadoras de desperdícios de recursos por alguns autores. Desta forma, existe uma força para que haja um acréscimo de qualidade no processo de projeto de maneira que o resultado final sejam obras de qualidade sem que com isto prazos e custos sejam elevados. Assim, este trabalho irá apontar o modo como é realizado o processo de projeto pela Subsecretaria de Coordenação e Projetos (SSCP) locada na Secretaria de Obras da Prefeitura do município de Juiz de Fora, Minas Gerais. O trabalho se pautou por uma revisão bibliográfica e estudo de caso realizado na Prefeitura do município, recortando do conjunto de obras públicas realizadas pela mesma, as de unidades de atenção primária à saúde (UAPS). Como método de investigação procedeu-se análise do conteúdo do processo administrativo e a realização de entrevistas semi-estruturadas junto ao subsecretário e profissionais da SSCP. x Os resultados permitiram identificar as etapas do processo de projeto desenvolvidas pelo órgão público em questão, e apontar as dificuldades enfrentadas durante a realização de tal processo, particularmente quanto às unidades de saúde, contribuindo assim com recomendações de possíveis modificações para melhoria de processos futuros bem como diretrizes que vise à realização de um processo de projeto mais organizado, com redução de retrabalho e que permita uma execução da obra com menor número de interferências. / In Brazil, when it comes to health buildings, the government is essential considering that is responsible for the constructions of buildings for public service. Being the health buildings spaces designed for health care of the population, it has an important role to society, so the professional architecture must ensure the project meets the required functions for this type of building: comfort, durability and flexibility. Therefore, this type of construction presents a need for more planning to organize, as they are increasingly flexible and complex. It’s known that the project process is a recurring theme in academia and has been discussed by both authors focused on its recognition as, by hypothesis, in its improvement. However, a larger part of research conducted around the theme project process in construction is facing for enterprises in the private sector, where there isn’t a bureaucratic process involving directly or indirectly the municipality, the state or the Union. The lack of planning and oversight even during the project process of a public building is identified as causing waste of resources by some authors. Thus, there is a force so there is an increase of quality in the project process so that the end result is quality works with it without deadlines and costs are high. Thus, this study will be point out how the process is carried out by the Subsecretaria de Coordenação e Projeto (SSCP) leased the Secretaria de Obras of the prefecture of the city of Juiz de Fora, Minas Gerais. The work is guided by a literature review and case study performed at prefecture of the city, cutting the number of public works made by the same, the units of primary health care (UAPS). The method of investigation proceeded content analysis of the administrative process and conducting semi-structured interviews with the responsible e professionals for SSCP. The results showed the steps of the project process undertaken by the public agency in question, and point out the difficulties faced during the course of this process, particularly in relation to health facilities, thus contributing with recommendations for possible chances to improve processes and future guidelines xii aimed at achieving a more organized project process, reducing rework and which allows the execution of work with fewer interferences.

Orientador: Maria Inês Monteiro / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T00:58:19Z (GMT). No. of bitstreams: 1 Paula_LuziaSandrade_M.pdf: 1876724 bytes, checksum: d4740c8ee1812716a44221ed577abf76 (MD5) Previous issue date: 2011 / Resumo: O adoecimento dos trabalhadores tem sido identificado como um problema de saúde pública. Com o objetivo de analisar o absenteísmo dos trabalhadores de enfermagem, 316 sujeitos foram pesquisados por meio de estudo epidemiológico transversal em hospital público municipal, em cidade de grande porte, no interior do Estado de São Paulo. Para determinar as diferenças entre as proporções e calcular as razões de chance Odds Ratio (OR), utilizou-se o programa computacional Statistical Analysis System versão 9.02 (SAS). No grupo estudado 38% apresentaram afastamento de até 15 dias, 16% mais de 15 dias e 46% não se afastaram. A média de idade foi de 45 anos para o grupo que não se afastou e, 42, para absenteísmo superior a 90 dias. Na análise de regressão logística identificou-se que trabalhadores com menos de 40 anos de idade tinham 1,6 vezes mais chances de se afastar por licença médica se comparados aos com mais de 40 anos (OR=1,6; IC 95%; 2,5). Entre os que tinham hábito de fumar, a chance também aumentou (OR= 2; IC 95%; 3,7). A presença de dor, queixa referida durante o exame médico foi significativa (OR=2,1; IC 95%; 3,8). A cobertura de exame periódico para a equipe de enfermagem foi de 59,4%, dos quais, 74,7% não apresentaram alteração no estado da saúde, em 13,6% houve predominância de doenças osteomusculares e tecido conjuntivo e 4,1% para transtorno psíquico. Os resultados desta pesquisa apontam para a necessidade do reconhecimento das circunstâncias de saúde da equipe de enfermagem para além da abordagem biologicista. O dados poderão ser utilizados como parâmetro para outros estudos, buscando relacionar estes achados com aspectos complexos do processo de trabalho / Abstract: The illness among workers has been classified as a public health problem. Aiming to analyze the absenteeism of nursing workers, 316 workers studied through a cross-survey. To determinate differences between proportions and to calculate the possibility ratio, the computer program SAS (Statistical Analysis System version 9.02) was used. The value of p was considered significant when inferior 0.5%. From the total studied 46% didn't present sick leaves 38% failed work days for until fifteen days and 16%, more than fifteen days. The average age was 45 years old for the group who didn't fail work days and 42 for sky leaves greater than ninety days. The logistic regression analysis showed that workers under 40 years are 1.6 times more likely to stay away due to sick leave compared with workers with more than 40 years of age (OR=1,6; IC 95%; 2,5). Among workers who shoked the chance was also higher (OR= 2; IC 95%; 3,7). The presence of pain, a complaint reported in the medical examination, was also significant (OR=2,1; IC 95% - 3,8). The coverage of periodic examination to the nursing staff was 59.4% of which 74.7% of the sample showed no change in their health status, 13.6% had predominance of musculoskeletal illnesses and conjunctive tissues and 4.1% for psychic disorders. These results point to the need to acknowledge the health circumstances of the nursing staff in addition to biological risks. The results may serve as parameters for other studies. To search for relationships along these findings and complex aspects of their working process / Mestrado / Enfermagem e Trabalho / Mestre em Ciências da Saúde

[pt] O presente trabalho buscou trazer uma melhor compreensão sobre o processo de construção do contrato psicológico dos indivíduos com as organizações no contexto atual. Este estudo focaliza um fenômeno que tem sido característico da década atual, quando se verifica um aumento considerável do número de indivíduos que se candidatam a empregos públicos. Este é um fenômeno que, de certo modo, reverte uma tendência das décadas anteriores, nas quais havia um fechamento das contratações nestas empresas e uma desvalorização da imagem do funcionário ligado ao setor público. A proposta de utilização da abordagem do contrato psicológico deveu- se ao pressuposto de que este modelo permitiria identificar fatores explícitos ou implícitos que norteavam a relação entre empresa e indivíduo, seja na construção do contrato ou mesmo na quebra das expectativas dos novos funcionários. Optou-se por desenvolver uma pesquisa exploratória baseada em entrevistas com a penúltima turma de trainees do curso de formação de Administração de uma empresa de sociedade de economia mista, do ramo de energia. Estas entrevistas foram feitas com base em questionários semi-estruturados, foram gravadas e transcritas, visando a identificar os principais motivos que estimularam a entrada destes indivíduos na empresa pública e como as experiências vividas influenciaram a sua relação com a organização. Os resultados confirmam algumas crenças popularizadas acerca da motivação dos indivíduos para escolherem um emprego estatal, destacando-se a busca por uma situação de maior estabilidade. Observa-se, também, que os participantes da pesquisa revelam uma percepção positiva do setor público, no que se refere à existência de oportunidades concretas de crescimento profissional, aliadas à possibilidade de um melhor gerenciamento da qualidade de vida. Os resultados conduziram, ainda, a proposição de um quadro de referência para a análise do processo de construção do contrato psicológico dos indivíduos com a empresa. / [en] The purpose of this study is to have a better understanding of the process of construction of the psychological contract with the individuals that has ocurred recently. This study has focused on a phenomenon that is very usual in this decade, characterized by an increase in the number of individuals that are looking to build a career in the public sector. This phenomenon has reverted a trend that had ocurred in the previous decades, that is, a decrease in the number of new employees as well as a devaluation in the image of the employees who work in the public sector. The proposal of using the psychological contract theory was motivated by the idea that this model would be capable of identifying the main factors (hidden or not) that influence the relationship between individuals and organisations, even in the process of contract building or in the contract breach. In order to test these factors, an exploratory methodology was developed, through various interviews with a group of the most recent trainees of the Administration Course of a company that belongs to the public sector (energy industry). These interviews were based on previous questionnaries. All interviews were recorded, and latter written out, aiming at identifying the main aspects that stimulated the decisions of those individuals to work in the public sector. The main results of this study confirm that individuals are looking for stability in their jobs. Additionally, the perception in relation to the public sector is positive, regarding that individuals recognize that is possible to have a career development as well as quality of life. Finally, the study purpose a framework that enables the analysis of the process of the psychological contract building between individuals and firms.

Events like earthquakes, terrorist attacks, water contamination etc. have drawn an increased attention on the way crisis preparedness can be improved by citizens, authorities and society as a whole. Current research has highlighted the importance of social media in crisis communication and why social media are important, but neglects to describe how social media is used by public organizations during crisis situations. By studying a particular crisis situation in a municipal organization, this thesis investigates how public organizations organize to collect and share information with the use of social media during crisis events. The results show that social media enabled fast response to citizens, due to the coordination and collaboration ability within the municipality. The importance of an existing digital strategy is recognized, for proper managing of social media as response to sudden change.

The objective of this study was to investigate IT projects within the Swedish public sector. Furthermore we have looked at the project closure in IT projects. The problem that occurs in this topic is that the projects can run overtime or over budget. In this research we used interviews to conduct the data collection. We have collected data from two public sector organizations – Jönköpings kommun and Domstolsverket, both of these orginzations have a dedicated IT department. Through the methods, theoretical framework and analysis we found many different activities and theories on how to handle project closure in IT. The main subjects that keep coming up when addressing the problems of project closure are communication and planning. The responsibilities of the project manager are investigated and the focus is on closing an IT project. A descriptive diagram has been created to show what is important during and before project closure

Abstract The goal of this thesis is to investigate whether the performance management systems of the university education process can be developed by using the mechanisms and indicators of operations management. This thesis is a result of a multiple-case study consisting of two polar cases: the Faculty of Technology and the Faculty of Humanities in the University of Oulu. Both faculties have several departments which constitute separate cases. This study explores the elements of the performance management systems used by the Ministry of Education during the first decade of the 21st century and considers whether these performance management systems have affected the university education process. First, the existing research is examined to understand what kind of factors affect the controllability and performance management of organisations. Furthermore, an empirical study was conducted on how the control mechanisms of the Ministry of Education reflect the main variable of controllability analysis. After that, the changes in the education processes in the various departments of the two faculties were examined using a controllability analysis. The results indicate that the financial models of the Ministry of Education reflect to some extent the main variables of controllability analysis. However, the models focus almost solely on output indicators. The Ministry of Education should consider expanding the models to include input and process variables. During the 21st century the number of university drop-outs has increased dramatically. This indicates that the process has become more ineffective. The focus of control has shifted from control of the quality of input to the quantity of the output. The finances of the Faculty of Humanities have decreased and it has had to adapt to the financial model of the Ministry of Education by seeking financial flexibility and by changing the production process (decreasing the number of new students, giving a more restricted variety of courses, restricting the maximum amount of credits). The Faculty of Technology faces a different situation. Most notably, the Department of Electrical Engineering has faced the problem of rapid growth. This has caused problems related to the quality of material (students), insufficient capacity and the inability to produce the volumes that the Ministry of Education desired. The Department of Electrical Engineering therefore made its own decision to decrease the number of new students. The reason for this was different from that of the Faculty of Humanities. The Department of Electrical Engineering was not able to increase the production volume to a sufficient level. The Faculty of Humanities instead had a problem of overproduction. The Ministry of Education does not compensate for production that is over its targets. / Tiivistelmä Tämän väitöskirjan tavoitteena on tutkia, voidaanko yliopistojen opetusprosessin suorituskyvyn johtamista kehittää käyttämällä tuotannonohjauksen menetelmiä ja indikaattoreita. Tämä väitöskirja muodostuu useista esimerkkitapauksista, jotka ryhmittyvät kahden toisilleen vastakkaisen tapaustutkimuksen alle: Oulun yliopiston teknillinen tiedekunta ja humanistinen tiedekunta. Molemmissa tiedekunnissa on useita laitoksia, jotka ovat jo sinällään itsenäisiä esimerkkitapauksia. Tässä tutkimuksessa kartoitetaan opetusministeriön 2000-luvun alussa yliopistojen suorituskyvyn johtamiseen käyttämiä menetelmiä ja pohditaan niiden vaikutuksia yliopistojen opetusprosessiin. Aluksi kartoitettiin olemassa olevien tutkimusten pohjalta niitä tekijöitä, jotka vaikuttavat organisaation ohjattavuuteen ja suorituskyvyn johtamiseen. Seuraavaksi selvitettiin empiirisen tutkimuksen avulla, miten opetusministeriön käyttämät ohjausmenetelmät heijastelevat ohjattavuusanalyysin keskeisiä tekijöitä. Lopuksi molempien tiedekuntien laitoksilla toteutettiin ohjattavuusanalyysi opetusprosessissa tapahtuneiden muutosten selvittämiseksi. Tulosten perusteella voidaan todeta, että opetusministeriön ohjausmallit heijastelevat jossain määrin ohjattavuusanalyysin keskeisiä muuttujia. Mallit keskittyvät kuitenkin lähes kokonaan prosessin loppupäähän eli tuloksiin. Ministeriön tulisikin harkita syöte- ja prosessimuuttujien lisäämistä malliin. 2000-luvun ensimmäisellä vuosikymmenellä opintonsa keskeyttäneiden määrä on kasvanut merkittävästi. Tämä kuvastaa sitä, että prosessista on tullut aiempaa tehottomampi. Ohjauksen painopiste on siirtynyt opiskelijavalinnan laadusta tutkintojen määrään. Humanistisen tiedekunnan rahoitus on vähentynyt tutkimusjaksolla ja tiedekunta on pyrkinyt sopeutumaan opetusministeriön rahoitusmalliin etsimällä taloudellista liikkumavaraa ja muuttamalla opetusprosessia (pienentämällä sisäänottoa, kaventamalla kurssitarjontaa ja rajoittamalla tutkinnon kokonaisopintopistemäärää). Teknillisen tiedekunnan lähtökohdat ovat erilaiset. Ennen kaikkea sähkötekniikan osasto on joutunut sopeutumaan nopeaan kasvuun. Tämän on aiheuttanut ongelmia mm. opiskelijoiden osaamistasossa, kapasiteetin puutteena ja kyvyttömyytenä päästä opetusministeriön asettamiin tutkintotavoitteisiin. Sähkötekniikan osasto päätti edellä mainituista syistä pienentää sisäänottoa. Osaston päätös perustui siten eri syihin kuin humanistisen tiedekunnan vastaava ratkaisu. Sähkötekniikan osasto ei pystynyt kasvattamaan opetusprosessin volyymia riittävälle tasolle. Humanistinen tiedekunta sen sijaan kärsi ylituotannosta. Opetusministeriö ei korvaa tavoitteet ylittäviä tutkintomääriä.

Objective: Public projects are used to delivery policy objectives. From a financial perspective, the Major Projects Authority (MPA) estimated a whole life investment of £488 billion for 199 major projects in 2014, only a small subset of the total number of public projects. Given the financial exposure, the impact of endemic public project failures could put the economic health of the nation at risk. This thesis studies the challenges facing public projects. It applies an organisational capabilities lens to investigate projectification, when organisations shift away from functional-based organising (FBO) toward project-based organising (PBO). Research Design: This study adopts an interpretivist research paradigm, with a constructionist epistemology and an idealist ontology, and employs an abductive research strategy. Structurally, it follows the Cranfield Executive Doctorate in Business Administration (DBA) methodology, with a linking document that summarises three complementary research projects: a systematic literature review (SLR) followed by two empirical studies that investigate the Department of Health (DoH) during the early phases of the Next Stage Review Implementation Programme (NSRIP). The findings are derived from over 250 academic literature sources, 100 government publications and 41 semi-structured interviews. ...[cont.]

This doctoral research is a contribution to the understanding of social activism and its socio-cultural formation in postcolonial Okinawa. It is based on eighteen months of fieldwork including participant observation and interviews at a public women’s organisation, Women’s Organisation Okinawa (WOO). This project centres on the lived practices of staff who attempted to produce and encourage gender equality in the public sector under neoliberal governance. I demonstrate through ethnographic analysis how the practice of law and social movements is distinct from the ideals of such movements as well as the particular individuals involved in them. WOO was established in the public sector by local government in alliance with various grassroots groups in Okinawa in the late 1990s. WOO embraced the dreams, hopes and anticipations of various actors - users and workers - who had been involved in the establishment, but in reality, it also contained various contradictions. First, WOO was a new workplace for those who wanted to work in activism and be paid for their work, but also reproduced precarious, low-waged, gendered labour. Second, WOO was a site which put law into practice, but it revealed that law internalised the inconsistency between what people had originally expected of the law and what law enacted as a result of institutionalisation. Third, WOO unexpectedly became a focal point of contact between neoliberal and feminist governance through public services and the requirements of performing accountability for citizens and for feminist activism. Thus frontline practitioners attempted to bridge the gap between ideal, reality, law and practice and to negotiate with neoliberal and feminist governance in the labour process. This thesis demonstrates how the inconsistencies between ideal and reality arose in the daily working practices of staff positioned between citizens, laws and social movements. More precisely, it explores how staff attempted to negotiate, accommodate and struggle with the gap between ideal and reality through their lived experience, rather than fiercely resisting or merely being subject to a form of governance or reality. In doing so, the thesis reveals how unstable and problematic the notion of ‘gender equality’ was as it was deployed at WOO.

Bakgrund: Processorientering kommer ursprungligen från den tillverkande industrin och är en förbättringsåtgärd som det har fokuserats på i den offentliga sektorn den senaste tiden. Den traditionella organisationsstrukturen i sjukvården är särskiljande på flera sätt. Processorientering anses kunna lösa problem som finns i den traditionella sjukvårdsorganisationen, däremot kan andra problem med processorientering i sjukvården uppstå. Syfte: Syftet med denna studie är att analysera processorienteringens tillämpningsmöjligheter i sjukvården. Vi ämnar därmed studera i vilken utsträckning processorientering är tillämpbar i svensk sjukvård. Kunskapsbidrag: Studien kommer bidra med att öka kunskapen om det processorienterade arbetssättet i sjukvården. Resultatet kommer att vara till nytta för landsting och regioner som arbetar med eller funderar på att implementera processorientering. Metod: Denna studie har tillämpat en kvalitativ fallstudiedesign. Fallet processorientering i svensk sjukvård har undersökts genom att studera sjukvården i tre regioner, där elva intervjuer har genomförts. Tre förutsättningar av processorientering har identifierats och sedan analyserats i en sjukvårdskontext för att undersöka tillämpbarheten i svensk sjukvård. De tre förutsättningarna är kundfokus, standardisering och helhetsbild. Slutsats: Processorientering i sin helhet är ej tillämpbar i svensk sjukvård. Kundfokus går ej att uppnå på grund av svårigheter att identifiera vad som skapar värde för kunden samt uppfylla och överträffa kundens behov. Standardisering kan inte uppnås på grund av arbetsprocessernas komplexitet. Förutsättningen helhetsbild av processer går att uppnå genom att skapa en förståelse för hur processen hänger ihop. Däremot kan processorientering vara tillämpbar i vissa delar av en sjukvårdsorganisation samt att utvalda aspekter av processorientering kan vara fördelaktiga i sjukvården. / Background: Process orientation originates from the manufacturing industry and is an improvement measure that has been in focus over the past few years in the public sector. The traditional organizational structure of health care is distinctive in several ways. Process orientation is often considered the solution to problems found in the traditional health care organization however, process orientation may also create other problems. Contribution: This study will increase knowledge about process orientation in health care. The results of the study will be useful for county councils and regions that work with process orientation or are considering implementing it. Aim: The aim of this study is to analyze the applicability of process orientation in health care. We intend to study in what extend process orientation is applicable in Swedish health care. Methodology: This study has a qualitative case study design. The case of process orientation in Swedish health care has been investigated by studying health care in three regions, where eleven interviews have been conducted. Three qualifications of process orientation have been identified and then analyzed in a health-care context, in order to investigate the applicability to Swedish health care. The three qualifications are customer focus, standardization and an overall picture of the process. Conclusion: Process orientation is not applicable to the Swedish health-care system. Customer focus cannot be achieved due to difficulties in identifying what creates value for the customer as well as fulfilling and exceeding the customer's needs. Standardization cannot be achieved because of the complexity of the work processes. An overall picture of the process can be achieved by creating an understanding of how the process is interrelated. However, process orientation can be applied to some areas of a health care organization and selected aspects of process orientation may be beneficial in health care.