University of Macau / Faculty of Business Administration. / Department of Accounting and Information Management

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This research explores the contribution which systems theories, methodologies and models can make in the design and application of effective performance-evaluation processes. Approaches to performance assessment of organisations are reviewed, and the history and structure of the NHS, its objectives, and dimensions for evaluation are described. Drawing on questionnaire and interview data from health service and civil service staff, and secondary data, current performance evaluation and planning processes in the NHS are described and some problems identified. To test the hypothesis that attention to systemic factors could improve performance evaluation, eight topics are analysed by the application of systems methodologies or models. Four of the topic and methodology or model combinations have received detailed analysis: 1. Making and implementing strategic plans; the Open University's Hard Systems Methodology. 2. Controlling NHS performance through structure and process, e. g. the use of annual reviews, performance indicators; double-loop learning and cybernetic control model. 3. Improving the quality of NHS care; Stafford Beer's Viable System Model. 4. Assessing performance through the outcomes of care; Peter Checkland's Soft Systems Methodology. The areas studied in less detail are: 5. Planning for uncertainty and complexity; 6. Issues related to the politics of health; 7. Reducing the length of waiting lists and times; 8. Planning for health (health promotion and the prevention of ill health).

M.Comm. / Moving from a traditional organisation to a shared services business unit through the shared services evolutionary continuum, and eventually to an independent business model requires a significant investment in technology, infrastructure, planning and time. Once committed, the process is as rigorous as planning and implementing a new business venture (Van Denburgh & Cagna, 2000). From the basic shared services model through to the independent business model, and during each other phase, the shared services business unit needs to be managed. The shared services business unit executive finds himself in the position of managing a business unit that: Is service orientated. Operates in an evolutionary process. Operates in a changing environment. Runs on business principles. Is an income generating business unit in its own right. Crosses national and international borders. Considers communication between business units as an ongoing process. Is customer and process-focused. Continuously improves and benchmarks business processes against the best. The leadership challenge is now to practise these business processes in a shared services environment, to make them successful and efficient and to add value to the organisation (Gunn, Carberry, Frigo & Behrens, 1993).

M.Comm. / The supposition was made that when customer service is not formally planned and managed, it could result in customer service, as a competitive strategy, not being optimally exploited due to it being done in an unco-ordinated, disorganised and ad hoc manner. The aim of this study is to set guidelines for customer service and management to ensure that customer service, is optimally exploited as a competitive strategy. This study commences with a theoretical framework followed by empirical research. During the theoretical study, customer service was defined and related theoretical aspects discussed. Emphasis was given to the conditions for applying customer service in the enterprise including the service quality model of Parasuraman, Zeithaml and Berry (1988). General management tasks were defined and the content of each task briefly discussed. Thereafter, the principles of these tasks were applied to customer service management. A customer service model was formulated, which integrated the theory of customer service and general management tasks. The model is based on the assumption that customer service management can be applied at executive, functional and operational level. A questionnaire was designed with the theoretical review as foundation. All facets of customer service management were analysed and questions were posed to determine the extent to which local banks comply with these management principles. The questionnaire was sent to the top ten Commercial banks in South Africa, selected according to the size of their total assets. The completed questionnaires were then analysed with the following results. The management tasks satisfactorily applied in customer service management are: planning, organising and leading. Management tasks that are not satisfactorily applied in customer service management as a result of all the gaps identified are: control, motivation, discipline, communication, delegating, decision making and the management of information. This indicated that customer service is not always managed on a formal and structured way because some of the management tasks are neglected. None of the general management tasks should be neglected as the omission of one of these tasks may lead to an ineffective management process. A customer service manager should thus continuously focus on each one of these management tasks to ensure that they are effectively carried out. If all the management tasks are performed out effectively, and are not neglected or ignored, the management process will be completed satisfactorily and improved results can be expected. The enterprise will therefore have a continuous competitive advantage over its rivals and the primary objectives of a enterprise, namely optimization of income, can thus be attained.

M.Com. (Business Management) / Please refer to full text to view abstract

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Background: Preterm birth (PTM) (< 37 weeks gestation) has been associated with low economic status characteristics like rural residence, county with low average per capita income, poverty, and unemployment. Infants born PTM are at greater risk of health and developmental problems and mortality. The primary objective of this study was to explore the trends in the association between PTM and economic level for Appalachian counties in Tennessee. The results from this study will support hypothesis development for future study on PTM in this region. Methods: PTM data from year 2009 to 2013 for each county in Tennessee was used for the analysis of trend. Proportion of PTM live births for each county and each year was computed to estimate prevalence. Appalachian Regional Commission (ARC) uses an indexbased county economic classification system applying three economic indicators – three-year average unemployment rate, per capita market income, and poverty rate – to classify each county into one of the five categories, namely, Attainment, Competitive, Transitional, At-Risk, and Distressed, that is ranked from best off to worst off respectively. Using this classification by the ARC, Appalachian counties were stratified by economic level to explore the association with PTM prevalence. Results: Forty-three out of 95 counties in Tennessee are defined by ARC as Appalachian. When classified by economic level, none of the counties in the Appalachian region fell into the highest (Attainment) sub-category of economic level for any of the five years observed, and for years 2011 to 2013 none of the counties fell into the second highest sub-category (Competitive) of economic level. Moreover, just one county was categorized as Attainment in year 2009, and just two for the year 2010. Not much difference was observed in PTM prevalence for sub-categories of economic level of Appalachian counties over the five-year period (2013 Distressed 11.67%, At risk 11.47%, Transitional 11.64%; 2012 Distressed 11.51%, At risk 12.10%, Transitional 11.58%; 2011 Distressed 10.04%, At risk 11.52%, Transitional 11.50%; 2010 Distressed 12.03%, At risk 11.42%, Transitional 11.83%, Competitive 11.40%; 2009 Distressed 10.68%, At risk 11.75%, Transitional 11.04%, Competitive 10.85%). Regardless of the inconsistent pattern of PTM prevalence observed for both Appalachian and non-Appalachian counties, the average prevalence for Appalachian counties (2009 11.19%, 2010 11.73%, 2011 11.26%, 2012 11.75%, 2013 11.59%) has been higher than non-Appalachian counties (2009 10.77%, 2010 10.32%, 2011 10.35%, 2012 10.90%, 2013 10.70%) for all years observed. Interestingly, the national prevalence of PTM is declining while prevalence in Tennessee (2009 11.00%, 2010 11.09%, 2011 10.84%, 2012 11.36%, 2013 11.19%) has remained essentially unchanged. Conclusion: PTM prevalence is higher in Appalachian counties of Tennessee compared to nonAppalachian counties. No meaningful change in PTM prevalence was observed by categories of economic level. However, it is likely that analysis based on the aggregate data could have masked the true differences in PTM birth by economic status. Therefore, individual data on PTM and economic status would be necessary to make any inference on the association.

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Healthcare providers' (HCPs) recommendations for the Human Papillomavirus (HPV) vaccine are likely to increase the vaccination uptake. However, little is known about Ghanaian HCPs' general practices regarding HPV vaccination. We used Multi-Theory Model (MTM) constructs (i.e. participatory dialogue, behavioral confidence, environment, social and emotional transformation) to examine Ghanaian HCPs' attitudes towards HPV vaccination and their vaccination recommendation practices. Methods We conducted three, 60-minute focus group discussions (FGDs) with HCP in the secondlargest government hospital in Ghana. Sixteen semi-structured open-ended questions based on MTM constructs were used to guide the FGDs. We explored HCPs' general knowledge about HPV, vaccination recommendation behavior, physical environment, and sociocultural factors associated with the HPV vaccination. Data from the FGDs were transcribed and thematically coded using NVivo software. Results The sample of (n = 29) HCPs consisting of males (n = 15) and females (n = 14) between the ages of 29 and 42 years participated in the FGDs. Our analyses showed that HCPs (a) rarely offered HPV vaccination recommendations, (b) showed varied understanding about who should be vaccinated regarding age eligibility, gender, and infection status. Perceived barriers to HPV vaccination include (a) low urgency for vaccination education due to competing priorities such as malaria and HIV/AIDS; (b) lack of data on HPV vaccination; (c) lack of awareness about the vaccine safety and efficacy; (c) lack of HPV vaccine accessibility and (d) stigma, misconceptions and religious objections. HCPs expressed that their motivation for counseling their clients about HPV vaccination would be increased by having more knowledge about the vaccine's efficacy and safety, and the involvement of the parents, chiefs, churches, and opinion leaders in the vaccination programs. Conclusion The study's findings underscore the need for a comprehensive HPV vaccination education for HCPs in Ghana. Future HPV vaccination education programs should include information about the efficacy of the vaccine and effective vaccination messages to help mitigate HPV vaccine-related stigma.