Yes / 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 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)

Doctor of Philosophy / This study explores whether companies that engage in outsourcing suffer negative audit-related consequences. Outsourcing exposes companies to third-party risk, which is the risk associated with outsourcing IT systems and/or business operations to external companies. Publicly traded companies in the United States are required to file a financial report with the Securities and Exchange Commission each year that includes a discussion of significant risks the company faces. I use this disclosure to identify companies that reveal third-party risk as a major threat to their organization and use machine learning to develop a measure that distinguishes companies exposed to third-party risk from those that are not. Using this measure, I examine whether companies exposed to third-party risk arrangements are more likely to suffer from low quality internal controls, to experience a cybersecurity incident, or to pay higher fees to their external auditor. The results do not show an association between my measure of third-party risk and the likelihood that a company reports a problem with internal controls. However, I do find that companies exposed to third-party risk are more likely to experience a cybersecurity incident. Lastly, I find that companies exposed to third-party risk pay higher fees to their external auditors in the initial year that this risk appears in their annual report. Overall, these results provide initial empirical evidence on the existence and consequences of third-party risk. The findings may be of interest to accounting professionals and managers who are in the early stages of learning to identify and manage their third-party risk exposure. Regulators may also benefit from this study as they contemplate updating the auditing standards related to outsourcing.

This study examines the determinant and consequences of having a chief operating officer (COO). Specifically, we investigate chief executive officer (CEO) related factors that affect the choice to employ a COO and look into the impact of having a COO on firm operational efficiency using a data envelopment analysis (DEA)-based measure. Although prior literature has extensively investigated the role of CEOs and chief finance officers (CFOs) on firm outcomes, few studies focus on the impact of COOs. Thus, this study explores characteristics associated with the likelihood that a firm will have a COO. This research also sheds light on the effect of COOs on firm operational efficiency because the core duties of COOs include optimizing operational performance and improving cost efficiency. Our results imply that CEO busyness, CEO ability, CEO demographic characteristics, and CEO network size have a significant impact on the decision to employ a COO. We also find that firms that have a COO have a lower level of operational efficiency than firms that do not. This result implies that the cost of having a COO outweighs the benefit of having one. The effects last for three years on average. Further, we find that firms with a COO have lower receivables turnover and sales to cost of goods sold ratio, lower sales to PPE expense ratio than firms without a COO. Finally, we find evidence that COOs with industry expertise are associated with higher operational efficiency than those without such expertise and outside COOs perform better than inside COOs in terms of operational efficiency.

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.

Las empresas constructoras presentan distintos problemas en el desarrollo de sus operaciones, un adecuado control permitirá mitigar muchos de estos, haciendo también que la empresa sea más eficiente. Nos encontramos con una realidad donde las deficiencias presentadas nos llevan a realizar un análisis y determinar un diagnóstico con la finalidad de desarrollar propuestas de soluciones que puedan promover el continuo desarrollo, de forma que la empresa trabaje bajo una adecuada gestión adquisiciones y así también pueda controlar sus salidas de dinero, es decir, haciendo tan solo las compras estrictamente necesarias. Por esta razón la investigación presenta por objetivo determinar de qué manera la evaluación de la gestión de adquisiciones dará lugar a una mejora en la eficiencia dentro del área tesorería. Esto se llevará a cabo mediante una investigación de tipo aplicada presentando un enfoque cualitativo a un nivel descriptivo y con un diseño no experimental; la investigación se desarrollará en la empresa constructora Jeeb Vital Sac, donde se entrevistará al gerente con el propósito de recolectar información sobre los aspectos generales de la empresa y también sobre las deficiencias, sus causas y la repercusión que representa en la gestión de adquisiciones y del área de tesorería. En este sentido la empresa podrá tener un mejor desarrollo de sus operaciones y un mejor aprovechamiento de las oportunidades que se le presente. / Construction companies present different problems in the development of their operations, adequate control will mitigate many of these, also making the company more efficient. We find ourselves with a reality where the deficiencies presented lead us to carry out an analysis and determine a diagnosis in order to develop proposals for solutions that can promote continuous development, so that the company works under adequate acquisition management and thus can also control their money outflows, that is, making only the strictly necessary purchases. For this reason, the objective of the research is to determine how the evaluation of acquisition management will lead to an improvement in efficiency within the treasury area. This will be carried out through an applied type of research presenting a qualitative approach at a descriptive level and with a non-experimental design; The investigation will be carried out in the construction company Jeeb Vital Sac, where the manager will be interviewed with the purpose of collecting information on the general aspects of the company and also on the deficiencies, their causes and the repercussion that it represents in the management of acquisitions and the treasury area. In this sense, the company will be able to have a better development of its operations and a better use of the opportunities that are presented to it.

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.