Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

The movement or flow of employees into, around and out of organisations (‘employee flow’) has long been a central issue in human resource management and industrial psychology. This is especially so for the specific element of employee turnover, but also applies to staffing and internal talent development. Employee flow is especially salient in a South African context characterised by scarce skills. The voluminous literature on employee flow has tended to view each element such as recruitment or turnover separately, and has generally focused on internal outcomes (e.g. commitment or satisfaction). This thesis attempts to add two crucial features, namely EF as a whole system (i.e. inflows, intraorganisation flows and outflows of staff in conjunction), and customer-based outcomes. Something of a synthesis is thus sought between EF and ideas of marketing productivity. Marketing productivity has been proposed as one of the most important foci of the marketing discipline (Rust, Ambler, Carpenter, Kumar, & Srivastava, 2004; Sheth & Sisodia, 2002). It refers to links between marketing and organisational performance or value. Models such as the ‘service profit chain’ (Heskett, Sasser & Schlesinger, 1997) identify the antecedents of marketing productivity to be internal organisation characteristics such as staff satisfaction or loyalty. This thesis seeks to expand such models in the context of a system of EFs. Advanced decision theoretic utility theories of EF (e.g. Boudreau & Berger, 1985) allow for the complete, integrated value of employee movements over time to be modelled. Such a model is constructed and links to marketing metrics, notably service perceptions, investigated. Organisational value arising via the outcomes for customers are further investigated. Thus increased value of employee movements is proposed to generate organisational value, mediated by improved customer equity (e.g. Gelade & Young, 2005). An empirical, survey-based study was conducted to assess the model. EF was assessed in business-to-business relationships from the perspective of the customer using conceptions of decision theoretic utility analysis, and both intermediate and outcome-based customer perceptions of service quality used as dependent variables. Moderation effects from frequency of interaction and integration of the customer into the supply chain were also tested, as well as controls for characteristics of the transaction, organisation and industry. Results suggest that EF does significantly affect various stages of service quality provision, notably ‘potential quality’, which it appears mediates links to other aspects of service provision, especially final service outcomes. In addition, EF was also found to affect outcomes through the intermediate relational element of 'soft process quality', possibly highlighting the importance of relationship management and soft skills in B2B relationships. Employee outflows in particular showed evidence of relatively strong effects, possibly highlighting the ongoing salience of turnover, in particular effective identification and management of functional versus dysfunctional turnover instead of a sole focus on retention. Results were significantly stronger for service industries than others (presumably as service is the outcome), and when there were relatively few supplier contact staff (perhaps due to social networking, bonding, exchange or emotional contagion). This thesis adds substantially to the methodologies underlying service profit chain models. It explicitly included new constructs (EF utility). Contextually, it was the first proper test of this model in South Africa. Theoretical contributions arose from new inter-disciplinary syntheses of utility models, finally linking employee and customer utilities to the organisation. Ultimately, practical significance may arise for managerial models, estimating and justifying human resource interventions.

<p>The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context.</p><p>The study included samples from the general population and patients with GHD from four European populations: England & Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database). </p><p>A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments. </p><p>This thesis reports QoL-AGHDA normative values for the populations of England & Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment. </p><p>For use in health economic evaluations, models for generating utilities (QoL-AGHDA_utility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices.</p><p>QoL-AGHDA_utility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDA_utility deficit before treatment and a gain after starting GH replacement. </p><p>The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology. </p>

The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context. The study included samples from the general population and patients with GHD from four European populations: England &amp; Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database). A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments. This thesis reports QoL-AGHDA normative values for the populations of England &amp; Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment. For use in health economic evaluations, models for generating utilities (QoL-AGHDAutility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices. QoL-AGHDAutility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDAutility deficit before treatment and a gain after starting GH replacement. The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology.

Nutrients are the number one water pollution problem for U.S. lakes, reservoirs, and ponds. Excessive nutrients, such as nitrogen and phosphorus, lead to eutrophication, a condition that can include low oxygen levels, noxious algal blooms, and fish kills. Since eutrophication is a condition that manifests itself differently in different systems, there is not a criterion variable with a clear threshold that can be used to set the criterion level. This dissertation presents an approach to address the question: How should States and Tribes choose nutrient criteria to determine eutrophication-related impairments of the designated use? To address this question I used a combination of water quality modeling and decision analysis to determine the optimal nutrient criterion variables and levels. To choose criterion variables that are predictive of the designated use, I utilized statistical models (structural equation models, multiple regression, and binomial regression model) to link the measured water quality variables to expert elicited categories of eutrophication and the designated uses. These models were applied successfully to single waterbodies, the Kissimmee Chain-of-Lakes region, and the State of North Carolina to assess which candidate criterion variables were the most predictive. Additionally, the models indicated that the variables that were most predictive of eutrophication were also the most predictive of the designated use. Using the predictive nutrient criteria variables, I applied a decision-analytic approach to nutrient criteria setting in North Carolina. I developed a nutrient criteria value model that included two submodels, a water quality model and a multiattribute value model. The submodels were parameterized using a combination of water quality data, expert elicitation data, and utility assessments. The outcome of the nutrient criteria value model is the overall expected value for a criterion level choice; the optimal criterion level would be the choice that maximized the expected value. Using the preferences of North Carolina environmental decision-makers and a total phosphorus criterion variable, the optimal criterion level was between 0.03 mg/L and 0.07 mg/L. Ultimately, I hope this research will establish methodology used to set appropriate water quality criteria. / Dissertation

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Background Stress urinary incontinence (SUI) is the leakage of urine when coughing, sneezing, or on exertion. It affects 10-35% of women, and can impair quality of life (QOL). First-line treatment is pelvic floor muscle training (PFMT). However, access barriers and embarrassment may prevent women from seeking care. There is a need for new, easily accessible ways to provide treatment. Aim To evaluate the treatment outcome, patient satisfaction, and cost-effectiveness of an Internet- based treatment programme for SUI. Methods We recruited 250 community-dwelling women aged 18-70 years, with SUI ≥1/week via our website. Participants were randomised to 3 months of PFMT with either an Internet-based programme (n=124), or a programme sent by post (n=126). We had no-face-to face contact with the participants, but the Internet group received individually tailored e-mail support from an urotherapist. Treatment outcome was evaluated after 4 months with intention-to-treat analysis. After treatment, we telephoned a strategic selection of participants (Internet n=13, postal n=8) to interview them about their experiences, and analysed the results according to grounded theory principles. We also performed a cost-utility analysis with a 1-year societal perspective, comparing the treatment programmes with each other and with a no-treatment alternative. To scrutinize our measure of QOL, we performed a reliability study of the ICIQ-LUTSqol questionnaire. Results Participants in both intervention groups achieved highly significant improvements (p&lt;0.001) with large effect sizes (&gt;0.8) in the primary outcomes symptom score (ICIQ-UI SF: mean change Internet 3.4 [SD 3.4], postal 2.9 [3.1]), and condition-specific QOL (ICIQ-LUTSqol: mean change Internet 4.8 [SD 6.1], postal 4.6 [SD 6.7]); however, the differences between the groups were not significant. Compared with the postal group, more participants in the Internet group perceived they were much or very much improved after treatment (40.9%, vs. 26.5%, p=0.01), reduced their use of incontinence aids (59.5% vs. 41.4%, p=0.02), and indicated satisfaction with the treatment programme (84.8% vs. 62.9%, p&lt;0.001). Results from the interviews fell into three categories: about life with SUI and barriers to seeking care; about the treatments and the patient-provider relationship; about the sense of empowerment many women experienced. A core category emerged: “Acknowledged but not exposed.” The extra cost per quality-adjusted life year (QALY) gained through use of the Internet-based programme compared with the postal programme was €200. The extra cost per QALY for the Internet-based programme compared with no treatment was €30,935. The condition-specific questionnaire ICIQ-LUTSqol is reliable in women with SUI, with high degrees of agreement between overall scores (Intraclass correlation coefficient 0.95, p&lt;0.001). Conclusion Internet-based treatment for SUI is a new, effective, and patient-appreciated treatment alternative, which can increase access to care in a sustainable way.

A tese abordou questões relacionadas à economia da saúde, particularmente à visão econômica dos transplantes renais. Foi conduzida uma análise de custo-utilidade para verificar qual tratamento, transplante renal ou hemodiálise, possui menor razão de custo por anos de vida ajustados por qualidade. O resultado obtido corrobora as evidências internacionais, as quais indicam o transplante renal como estratégia mais custo-efetiva. No caso deste estudo, a razão de custo-utilidade para o transplante renal e hemodiálise foi de R$ 18.161,00/AVAQ e R$ 40.872,00/AVAQ, respectivamente. Apesar de o transplante renal ser uma estratégia dominante, a escassez de órgãos impede que essa estratégia seja amplamente utilizada, reduzindo, assim, os ganhos de eficiência na alocação dos recursos escassos. Nesse contexto, também foi alvo desta tese a questão da escassez de órgãos. Pelo levantamento feito, há tendência de aumento do desequilíbrio entre demanda e oferta de órgãos, visto que a primeira cresce rapidamente, enquanto a segunda mostra pequena tendência de crescimento. Assim, alternativas para contornar esse problema foram analisadas, especialmente as relacionadas a mudanças institucionais na lei de doação de órgãos. Entre elas, foi argüido que a lei de consentimento presumido seria a opção mais factível, por não ferir o pressuposto do altruísmo. Objetivando estimar quanto seria o eventual incremento na doação de órgãos por doador cadáver devido à lei de consentimento presumido, fez-se uso do ferramental da econometria da saúde, aplicando, para uma amostra de 34 países ao longo de cinco anos, o método de regressão quantílica para dados de painel. Os resultados obtidos nessa aplicação indicam que há benefício na adoção da lei de consentimento presumido, que tem um efeito positivo sobre a taxa de doação de órgãos, em torno de 21-26%, comparada à lei de consentimento informado. / The thesis broaches questions related to health economics, particularly the economic vision of renal transplants. A cost-utility analysis was conducted to assess which treatment, renal transplant or hemodialysis, has a lower cost rate per quality-adjusted life years. The result obtained corroborates the international evidence, which indicates renal transplant as the most cost effective strategy. In the case of this study, the cost-utility ratio for renal transplant and hemodialysis was US$ 11,157/QALY and US$ 25,110/QALY, respectively. In spite of renal transplant being the dominant strategy, the scarcity of organs hinders this strategy to be widely used, reducing in this way, the efficiency gain in the allocation of scarce resources. Within this context, the organ shortage was also a target issue of this thesis. Through the survey performed, there is a tendency towards the increase of unbalance between the demand and supply of organs, being that the first grows rapidly while the second shows small tendency towards growth. Within this context, the investigation target of this thesis was to look into possible alternatives to by-pass this problem, especially those related to institutional changes in the organ donation law. Among them, it was argued that the law of presumed consent would be the most feasible option, since it does not harm the presupposition of altruism. With the object of estimating what would be the eventual increase in organ donation, per cadaveric donor, due to the law of presumed consent, the health econometric tool of quantile regression method for panel data was used, applied to a sample of 34 countries during a five-year period. The results obtained in this application indicate that there is benefit in adopting the law of presumed consent, which has a positive effect on the organ donation rate, around 21 – 26%, compared to the law of informed consent.

Made available in DSpace on 2010-04-20T21:00:20Z (GMT). No. of bitstreams: 3 luciodemouraturma2004.pdf.jpg: 20441 bytes, checksum: 88cf6cdd8e24efb67c11f2b4a395f165 (MD5) luciodemouraturma2004.pdf: 1710779 bytes, checksum: 33e28962fb47888081c7ec2cbd7246ef (MD5) luciodemouraturma2004.pdf.txt: 217573 bytes, checksum: fca734f12f4bb43fad5b2da284145866 (MD5) Previous issue date: 2007-02-12T00:00:00Z / The literature on Human Resources advises its professionals to emphasize the potential contribution that may be made by the projects and programs to the business objectives of their companies, whenever they seek approval for the investments and priority allocation required for their development and implementation. The companies, pressed by the rising competition, expect that their HR professionals justify those investments in a manner that clearly demonstrates the benefits that the programs may bring to the achievement of their business objectives. To do that, they should speak a language that necessarily relates to the financial and economic results of their companies. If the influence ability of HR areas is low, or if the priority given to the implementation of their programs is insufficient, this is nothing more nothing less than a rational response from the part of their companies management, who, despite intuitively “knowing” the benefits of their activities, does not have any objective measure of such benefits. In the absence of such measure, the organization cannot adequately prioritize HR programs into their investment plans. Utility Analysis offers an answer to this problem. It consists of a family of theories and metrics designed to describe, predict and/or explain how useful and desirable are the decision options presented by the various HR programs – selection, training, performance evaluation, compensation, etc., and may be seen as a cost benefit analysis process: costs reduce utility and benefits increase it. Utility Analysis is a tool well suited to the business environment because it insists that both costs and consequences of decisions be always considered beforehand. Its merit resides in that it results in decisions that are based on robust, rational and conscious analysis, and expressed in the language most used in today’s business world – costs, benefits, returns on investments and their effect on the bottom line of financial and economic results. In this study we execute the methodology defined by Sturman et al. (2003), which is aimed at using Utility Analysis to evaluate the economic value of different compensation policies, to the case of a large bank in Brazil. Our conclusions demonstrate the usefulness of Utility Analysis in justifying the adoption of compensation policies that add high value to the business. The justification is based on estimates of the incremental value added by the human resources that such policies help to retain, on one hand, and by the risks involved in their implementation, on the other. Such compensation policies, if judged by the traditional standards of costs, would certainly be discarded. VIII We demonstrate that Utility Analysis provides a common language between the HR area, senior management and other areas of any company – contribution to its business objectives. This should facilitate the communication of benefits, implementation and monitoring of HR programs and initiatives. / A literatura de Recursos Humanos sugere a seus profissionais que, ao buscar aprovação para investimentos em projetos e programas de RH, enfatizem a contribuição que eles podem dar ao atingimento dos objetivos de negócios de suas organizações. As empresas, impelidas pela competição cada dia mais acirrada, esperam que seus profissionais de RH justifiquem os investimentos em linguagem que demonstre de maneira clara os benefícios que possam adicionar na busca de tais objetivos - esta linguagem necessariamente se relaciona ao resultado financeiro e econômico das empresas. Se é reduzida a influência das áreas de RH ou baixa a prioridade dada à implementação de seus programas, esta situação pode não ser nada mais nada menos do que uma resposta racional da direção das empresas, que apesar de "conhecer" intuitivamente os benefícios da atividade, não dispõe de uma medida objetiva sobre eles. Na falta de tal medida, a organização não consegue priorizar adequadamente os programas de RH em seu plano de investimentos. A Análise da Utilidade oferece uma resposta a este problema. Ela consiste em uma família de teorias e medidas desenhadas para descrever, predizer e/ou explicar quão úteis e desejáveis são as opções de decisão relativas aos diversos programas da Gestão de RH – seleção, treinamento, avaliação de desempenho, remuneração, etc., e pode ser considerada como uma análise de custos e benefícios: os custos reduzem a utilidade e os benefícios a aumentam. A Análise da Utilidade é um instrumento adequado ao ambiente de negócios porque insiste em que tanto os custos como as conseqüências das decisões sejam sempre considerados de antemão. O mérito de sua abordagem é que ela resulta em decisões fundamentadas em raciocínio robusto, racional e consciente, através da linguagem mais utilizada no mundo dos negócios da atualidade – custos, benefícios, retornos de investimentos, e seus impactos sobre os resultados finais, financeiros e econômicos. Neste trabalho aplicamos a metodologia definida por Sturman et al. (2003), destinada ao uso da Análise da Utilidade na avaliação do valor econômico de diferentes políticas de remuneração, ao caso de uma grande empresa do setor financeiro no Brasil. Nossas conclusões demonstram o valor do uso da Análise da Utilidade na justificação de políticas de remuneração de alto valor. Esta justificação se baseia nas estimativas de valor incremental dos recursos humanos que tais políticas ajudam a reter, contrabalançado pelos riscos de sua implementação. Tais políticas, se julgadas pelos padrões tradicionais de custo, seriam descartadas. Demonstramos que a Análise da Utilidade viabiliza uma linguagem comum entre a área de RH, a alta direção e demais áreas da empresa – contribuição aos objetivos do negócio. Isto deve facilitar a comunicação e divulgação dos benefícios, implantação e monitoração dos programas de RH.

A tese abordou questões relacionadas à economia da saúde, particularmente à visão econômica dos transplantes renais. Foi conduzida uma análise de custo-utilidade para verificar qual tratamento, transplante renal ou hemodiálise, possui menor razão de custo por anos de vida ajustados por qualidade. O resultado obtido corrobora as evidências internacionais, as quais indicam o transplante renal como estratégia mais custo-efetiva. No caso deste estudo, a razão de custo-utilidade para o transplante renal e hemodiálise foi de R$ 18.161,00/AVAQ e R$ 40.872,00/AVAQ, respectivamente. Apesar de o transplante renal ser uma estratégia dominante, a escassez de órgãos impede que essa estratégia seja amplamente utilizada, reduzindo, assim, os ganhos de eficiência na alocação dos recursos escassos. Nesse contexto, também foi alvo desta tese a questão da escassez de órgãos. Pelo levantamento feito, há tendência de aumento do desequilíbrio entre demanda e oferta de órgãos, visto que a primeira cresce rapidamente, enquanto a segunda mostra pequena tendência de crescimento. Assim, alternativas para contornar esse problema foram analisadas, especialmente as relacionadas a mudanças institucionais na lei de doação de órgãos. Entre elas, foi argüido que a lei de consentimento presumido seria a opção mais factível, por não ferir o pressuposto do altruísmo. Objetivando estimar quanto seria o eventual incremento na doação de órgãos por doador cadáver devido à lei de consentimento presumido, fez-se uso do ferramental da econometria da saúde, aplicando, para uma amostra de 34 países ao longo de cinco anos, o método de regressão quantílica para dados de painel. Os resultados obtidos nessa aplicação indicam que há benefício na adoção da lei de consentimento presumido, que tem um efeito positivo sobre a taxa de doação de órgãos, em torno de 21-26%, comparada à lei de consentimento informado. / The thesis broaches questions related to health economics, particularly the economic vision of renal transplants. A cost-utility analysis was conducted to assess which treatment, renal transplant or hemodialysis, has a lower cost rate per quality-adjusted life years. The result obtained corroborates the international evidence, which indicates renal transplant as the most cost effective strategy. In the case of this study, the cost-utility ratio for renal transplant and hemodialysis was US$ 11,157/QALY and US$ 25,110/QALY, respectively. In spite of renal transplant being the dominant strategy, the scarcity of organs hinders this strategy to be widely used, reducing in this way, the efficiency gain in the allocation of scarce resources. Within this context, the organ shortage was also a target issue of this thesis. Through the survey performed, there is a tendency towards the increase of unbalance between the demand and supply of organs, being that the first grows rapidly while the second shows small tendency towards growth. Within this context, the investigation target of this thesis was to look into possible alternatives to by-pass this problem, especially those related to institutional changes in the organ donation law. Among them, it was argued that the law of presumed consent would be the most feasible option, since it does not harm the presupposition of altruism. With the object of estimating what would be the eventual increase in organ donation, per cadaveric donor, due to the law of presumed consent, the health econometric tool of quantile regression method for panel data was used, applied to a sample of 34 countries during a five-year period. The results obtained in this application indicate that there is benefit in adopting the law of presumed consent, which has a positive effect on the organ donation rate, around 21 – 26%, compared to the law of informed consent.