Submitted by Guilherme Espirito Santo Silva (guilherme.ess@gmail.com) on 2018-05-25T20:32:38Z No. of bitstreams: 1 A busca pelo Cuidado Baseado em Valor em um hospital universitário.pdf: 3828086 bytes, checksum: c2ae46952beae6b1b42cb4d40ed22f0c (MD5) / Rejected by Simone de Andrade Lopes Pires (simone.lopes@fgv.br), reason: Boa Noite Guilherme, Recebemos a postagem do seu trabalho na biblioteca digital e para ser aprovado será necessário alguns ajustes: 1º RESUSMO E ABSTRACT vem depois do AGRADECIMENTOS. 2º Na pagina da ficha catalográfica falta a frase " Ficha catalográfica elaborada por...." Por favor, faça as alterações e post o trabalho novamente na biblioteca. Atenciosamente Simone de A Lopes Pires on 2018-05-25T22:30:26Z (GMT) / Submitted by Guilherme Espirito Santo Silva (guilherme.ess@gmail.com) on 2018-05-26T02:52:27Z No. of bitstreams: 1 A busca pelo Cuidado Baseado em Valor em um hospital universitário.pdf: 3828639 bytes, checksum: 4d18934e4b18b9ac063ff23e76b195c0 (MD5) / Rejected by Simone de Andrade Lopes Pires (simone.lopes@fgv.br), reason: Prezado Guilherme, Ainda há alterações necessárias para aprovação. O RESUMO e ABSTRACT vem antes, da lista de tabelas, ilustrações e sumário. Atenciosamente, Simone de Andrade Lopes Pires SRA on 2018-05-29T17:12:57Z (GMT) / Submitted by Guilherme Espirito Santo Silva (guilherme.ess@gmail.com) on 2018-05-29T17:38:21Z No. of bitstreams: 1 A BUSCA PELO CUIDADO BASEADO EM VALOR EM UM HOSPITAL UNIVERSITÁRIO.pdf: 2226528 bytes, checksum: b7bd4d32df6d9f2b0d14fe5beb0478bf (MD5) / Rejected by Simone de Andrade Lopes Pires (simone.lopes@fgv.br), reason: Boa Tarde Guilherme, Falta somente 1 alteração. CAPA: o nome vem acima do título. Aguardo nova postagem. Atenciosamente, Simone de A Lopes Pires on 2018-05-29T19:27:18Z (GMT) / Submitted by Guilherme Espirito Santo Silva (guilherme.ess@gmail.com) on 2018-05-29T20:31:13Z No. of bitstreams: 1 A BUSCA PELO CUIDADO BASEADO EM VALOR EM UM HOSPITAL UNIVERSITÁRIO.pdf: 2227413 bytes, checksum: 92d485106b343bc707a3e4d0372d833a (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-05-29T21:25:57Z (GMT) No. of bitstreams: 1 A BUSCA PELO CUIDADO BASEADO EM VALOR EM UM HOSPITAL UNIVERSITÁRIO.pdf: 2227413 bytes, checksum: 92d485106b343bc707a3e4d0372d833a (MD5) / Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-05-30T13:46:27Z (GMT) No. of bitstreams: 1 A BUSCA PELO CUIDADO BASEADO EM VALOR EM UM HOSPITAL UNIVERSITÁRIO.pdf: 2227413 bytes, checksum: 92d485106b343bc707a3e4d0372d833a (MD5) / Made available in DSpace on 2018-05-30T13:46:27Z (GMT). No. of bitstreams: 1 A BUSCA PELO CUIDADO BASEADO EM VALOR EM UM HOSPITAL UNIVERSITÁRIO.pdf: 2227413 bytes, checksum: 92d485106b343bc707a3e4d0372d833a (MD5) Previous issue date: 2018-05 / A estratégia do Cuidado Baseado em Valor propõe que o objetivo final das organizações e sistemas de saúde deve ser entregar alto valor aos pacientes, sendo este definido pela relação entre os resultados que importam para os pacientes e seus custos. Neste sentido, pretende-se estimular que a competição no mercado da saúde seja baseada em valor, não apenas no volume de procedimentos. Porém, a execução desta estratégia traz grandes desafios por exigir uma mudança radical no modelo assistencial predominante. Os hospitais universitários são os principais centros formadores de profissionais da saúde, o que lhes confere papel central nesta agenda transformadora. O presente trabalho buscou identificar os fatores críticos no processo inicial de implantação do Cuidado Baseado em Valor em um hospital universitário. Trata-se de uma pesquisa qualitativa exploratória e descritiva, realizada com o método da pesquisaação. O estudo descreve o processo de implantação desde as discussões iniciais sobre o tema até o desenvolvimento de um projeto piloto. Neste, é detalhada a preparação e o início da execução de uma Unidade de Prática Integrada para doenças cardíacas valvares, criada com o objetivo de aprimorar os desfechos clínicos e reduzir desperdícios. Os principais fatores críticos identificados foram: o poder de mobilização do tema sobre as equipes assistenciais; o potencial ganho de qualidade e eficiência no processo assistencial; a importância da presença da liderança e da construção coletiva no processo de implantação; a dificuldade em mudar o comportamento dos profissionais; e a complexidade da tomada de decisão em hospitais universitários. Por fim, o trabalho conclui que a implantação de estratégia da Cuidado Baseado em Valor tem potencial mobilizador positivo, mas que, para além desafios técnicos, exige intenso gerenciamento da mudança organizacional. / The Value-Based Health Care strategy proposes that the goal of health care organizations should be to deliver high value to patients – which is defined by the relation between outcomes that matter to patients and their corresponding costs. Thus, it is intended to encourage that competition in the health market should be based on value, not only on the volume of procedures. However, the implementation of this strategy presents major challenges, since it requires a radical change in the predominant care model. The university hospitals are the main training centers for health professionals, which gives them a central role in this transformational agenda. The present study sought to identify the critical factors in the initial process of implanting Value Based Health Care in a university hospital. This is an exploratory and descriptive qualitative research, carried out using the action research method. The study describes the implementation process from the initial discussions on the theme to the development of a pilot project. It details the preparation and start-up of an Integrated Practice Unit for cardiac valve disease, created to improve clinical outcomes and reduce waste. The main critical factors identified were: the mobilization power of the theme on the health professionals; the potential gain of quality and efficiency in the care process; the key role of the presence of leadership and collective efforts in the implementation process; the difficulty in changing the behavior of professionals; and the complexity of decision making in university hospitals. Finally, the paper concludes that the implementation of Value-Based Health Care strategy has a positive potential mobilizer, but that besides technical challenges, it requires intense management of organizational change.

Cette thèse se propose d’étudier les déterminants des prix des médicaments innovants de l’oncologie, en s’interrogeant à la fois sur le rôle des caractéristiques propres à chaque produit, en particulier sa valeur thérapeutique ajoutée, et sur l’influence d’éléments structurels, notamment les modalités des politiques de fixation des prix appliqués par les Etats.Une revue de la littérature nous permet tout d’abord de spécifier les modalités de fixation des prix ainsi que les nouveaux instruments mis en place par les décideurs pour réguler leur montant. Nous montrons que la détermination des prix des traitements innovants passe par l’évaluation de la valeur ajoutée et donc la mise en place de politiques d’évaluation de type Health Technology Assessment (HTA). Toutefois, nous mettons en lumière que les politiques de prix se réfèrent à des doctrines différentes tant dans les démarches évaluatives que dans la fixation des prix. Dès lors, nous proposons un cadre théorique de détermination des prix qui permet de prendre en compte ces différences. En complément, la constitution d’une base de données incluant les caractéristiques des anticancéreux et leurs prix fixés dans huit pays de l’OCDE, nous permet d’entreprendre différentes analyses statistiques.A partir des études empiriques, nous examinons dans un premier temps la relation entre les prix et le caractère innovant des anticancéreux. Nous commençons pour cela par nous intéresser à l’accès au marché de ces produits dans les pays retenus avant d’examiner les disparités de prix entres les pays.Si l’on constate qu’une majorité des médicaments de notre échantillon étaient bien disponibles dans ces pays, il apparaît néanmoins des différences en matière réglementaire, notamment concernant l’octroi du statut de médicament orphelin ou encore en matière de délais d’enregistrement. Une étude comparative plus fine des évaluations faites par le NICE et la HAS confirme l’existence de divergences sur les décisions et/ou recommandations de prise en charge malgré une appréciation similaire de la valeur ajoutée. Enfin lorsqu’on procède à la comparaison des prix, on constate un écart de prix considérable selon les modalités de fixation des prix appliqués par les Etats.Ce dernier constat nous conduit ensuite à rechercher des éléments d’explication à partir d’une approche économétrique permettant de mesurer l’effet de la valeur ajoutée, définie par la survie incrémentale, sur le prix des anticancéreux. De façon complémentaire, nous montrons que cette influence se manifeste même lorsque l’estimation de cette valeur ajoutée reste incertaine au regard du niveau de preuve obtenu.De façon complémentaire, les analyses économétriques confirment que les écarts de prix entre pays reflètent les différences internationales sur les choix de politique de prix. En effet, nous montrons que les prix les plus élevés sont relevés dans les pays exerçant une politique de prix libres. A l’inverse, les prix les plus bas sont retrouvés dans les pays pratiquant une évaluation économique. Et l’on retrouve à un niveau intermédiaire les pays ayant recours à la négociation et au référencement international. / This PhD thesis focused on the regulation and the determinants of innovative drugs prices in oncology. First, with a literature review we provided a comprehensive description examining the pricing mechanisms of innovative drugs in OECD countries. This approach shows us that most of the countries determine their prices according the assessment of the added value of the pharmaceutical product, and use HTA policies in their decisions making. Based on that conclusions and regarding the differences observed between the policies’ countries we assumed a framework to describe the pricing mechanism.In addition, we developed an original database which contains the anticancer drugs characteristics and their prices in 8 OECD countries. From empirical studies, we examined the relationship between the prices and the drugs characteristics. Before assessing prices disparities between the selected countries, we focused on the market approval of these medicines in each country. Nevertheless, even if most of the products were available in all studied countries, we observed differences between their regulations notably concerning the orphan status designation as well as for the time to market authorization.Thereafter, we achieved a comparative study to assess the discordance between the NICE and HAS. This analysis shows that despite a similar estimation of the added value, there is divergences between these HTA bodies in term of decisions making. Then, when we investigated the trends in prices across the selected countries, the level of pricing disparities observed, in most cases, seems to reflect the differences in pricing regulations.Finally, in order to highlight the determinants of these disparities between countries with respect to anticancer drug prices, we used the econometric approaches, we assessed both the effects on the prices of the added value (the incremental survival) and the pharmaceutical policy: It appears that the incremental survival impacts on the prices, independently of its uncertainties and its level of evidence provided in the clinical trials. In addition, the analysis confirms that the prices disparities reflect the pricing policy applied. Indeed, the countries using a free pricing policy have the highest-level prices, followed by the countries using the pricing negotiation and external reference pricing. Lastly, the countries using economic evaluation have the lowest prices.

How authors and scholars have approached leadership studies – in terms of their thinking, defining and studying – has changed remarkably over time. According to literature, this is predominantly due to greater optimism about the field and greater methodological diversity being employed to better understand complex, embedded phenomena. As a result, there has been a significant rise in the use of qualitative research approaches to the study of leadership. Numerous definitions, classifications, explanations and theories about leadership, exist in the contemporary literature. However, despite the vast array of literature, the challenge of failing leadership persists. Challenges, such as the speed of technological advancements, social, and economic change are ever-present, while the impact of COVID-19 is, as yet, uncertain. Despite these challenges, can companies compete successfully in the marketplaces they operate in while also remaining ethical and engaged with the challenges of the broader business and social environment? To answer this question, this study has undertaken qualitative research on the bouquet of trait, situational and value-based leadership theory, in order to re-assess both established and developing theories. The predominant aim is to describe, explain and analyse available literature in an attempt to ascertain academic guidance on how it might be possible to enable leaders and society to mitigate leadership challenges by proposing a conceptual framework that could support leadership theory and, in so doing, take an academic stance in providing better answers or guidance to the failures currently being experienced. Several authors have noted that leadership makes a difference with resulting impacts on many which implies that to make the world a better place, leadership has two contradictory elements; good and bad. These elements are reflected in today’s connected world where the media, either showers praise on leaders or writes articles deriding their incompetence and abuse of their roles at all levels The proposed conceptual framework of this study endeavours to enable society and leaders, practically and at an individual level, to evaluate leadership issues and link leadership frameworks to their everyday lives and, in so doing, aid in mitigating the challenges being faced. / Business Management / D.B.L.

The business climate is undergoing a transformation and managers are faced with several challenges, not the least of which is related to pricing strategy. With an increased transparency in the market as well as anincreased competitive pressure, and with more sophisticated and well-informed consumers, retail businesses find it hard to navigate the pricing jungle. At the same time, the conventional wisdom in the field of pricing and the theoretical models on the topic, originate from a time long before the digitalization. Old models are not a problem in itself, but when there are new forces in the pricing ecosystem, driven by technological advancement, an assessment of the incumbent models is in the best interest of both businesses and academia. The reason for this is that, the use of old models that rely on inaccurate assumptions may impact businesses’ prioritizing of resources or their overall business strategy. In addition, researchers might be distracted and the research field disrupted. Thus, the purpose of this study is to discuss whether or not there are additional dimensions in pricing strategy that are not covered by the incumbent pricing models. Here, dimensions refer to the key components of businesses’ strategic decision making in regards to pricing. This thesis examines pricing models in today’s business context in order to answer the research question: “Are there additional dimensions of the empirical reality of pricing strategy that are not covered by the incumbent pricing models?” The research question has been studied qualitatively through a literature review, a pilot study and twelve case studies, where the pilot study had the purpose of exploring the depth, whereas the multiple case studies focused on the breadth, of pricing strategies. The case studies cover businesses in different retail industries and of different sizes, namely the industries of Clothing & Accessories, Daily Goods, Furniture and Toys & Tools, and of the following sizes: micro, small, medium and large. The empirical data has mainly been gathered by conducting interviews with production, sales and management personnel at the case businesses. The data has been structured, reduced and analysed with the help of a framework of analysis that has been developed throughout the pilot study. The results of this study lean on previous research and a main divider in pricing strategies has been identified as businesses use either a data-driven or an intuition-driven approach in their strategic work with pricing. As such, it is proposed that the division of pricing strategies need to be acknowledged, since the separate methodological approaches may lead to different results, while implying different costs, resources and required knowledge. Furthermore, the division may form a basis for competitive advantage, be extended to other areas of strategic management and become clearer, since the adoption of technology and its impact will increase in the future. As a result, in the future of pricing, they key is going to be to account for both the strategic perspectives and the methodological approaches in the strategic decision making process of pricing. / Affärsklimatet genomgår en omvandling och företagsledare står inför flera utmaningar, inte minst utmaningar som är relaterade till prissättningsstrategi. Med en alltmer transparent marknad och en ökad konkurrens företag emellan samt en mer sofistikerad och välinformerad konsument, finner företagen i detaljhandeln det svårt att navigera i prissättningsdjungeln. Samtidigt härrör den konventionella visdomen inom prissättning och de teoretiska modellerna på samma ämne från en tid långt innan digitaliseringen. Gamla modeller är inte ett problem i sig, men när det finns nya krafter i prissättningens ekosystem, som drivs på av teknologisk utveckling, är en omprövning av de befintliga modellerna i både företag och akademikers intresse. Användningen av gamla modeller som bygger på felaktiga antaganden kan dock inverka på företagens prioritering av resurser eller på deras övergripande affärsstrategi. Dessutom kan forskare distraheras och forskningsfältet störas. Syftet med denna studie är således att diskutera huruvida det finns ytterligare dimensioner i prissättningsstrategi som inte omfattas av de befintliga prissättningsmodellerna. Här avser dimensioner nyckelkomponenter i företagens strategiska beslutsfattande när det gäller prissättning. Denna avhandling undersöker prissättningsmodellerna i dagens affärssammanhang för att svara på frågan: "Finns det ytterligare dimensioner av den empiriska verkligheten av prissättningsstrategi som inte omfattas av de befintliga prissättningsmodellerna?" Forskningsfrågan har studerats kvalitativt genom en litteraturgranskning, en pilotstudie och tolv fallstudier, där pilotstudien hade till syfte att utforska djupet, medan de flera fallstudierna inriktades på bredden, av prissättningsstrategier. Fallstudierna omfattar företag i industrin för detaljhandeln och företag av olika storlekar, nämligen inom detaljhandeln för Kläder & Accessoarer, Dagligvaror, Möbler och Leksaker & Verktyg, och av följande storlekar: mikro, små, medelstora och stora. Den empiriska datan har huvudsakligen insamlats med hjälp av intervjuer med produktions- och försäljningspersonal samt företagsledare hos företagen i fallstudierna. Uppgifterna har strukturerats, reducerats och analyserats med hjälp av en analysram som har utvecklats under pilotstudien. Resultaten av denna studie tar rygg på tidigare forskning och en huvuddelare i prissättningsstrategier har identifierats, eftersom företag använder antingen ett data-drivet eller ett intuition-drivet tillvägagångssätt i sitt strategiska arbete med prissättning. Som sådan föreslås att uppdelningen av prissättningsstrategier måste tas hänsyn till eftersom de separata metodologiska metoderna kan leda till olika resultat, samtidigt som de innebär olika kostnader samt kräver olika resurser och nödvändig förkunskap. Dessutom kan uppdelningen ligga till grund för konkurrensfördel, utvidgas till andra strategiska områden för företagsledare och bli tydligare, eftersom teknikens utbredning och påverkan kommer att öka i framtiden. Som en följd av detta kommer nyckeln i framtidens strategiska prissättning att vara att ta hänsyn till både de strategiska perspektiven och de metodologiska metoderna i den strategiska beslutsprocessen för prissättning.

Kommunen är huvudman för äldreomsorgen vilket innebär att organisationen är politiskt styrd. Att arbeta som första linjens chef inom äldreomsorgen är därmed ett komplext uppdrag där flera olika perspektiv konstant måste tas i beaktning. Första linjens chefer inom äldreomsorgen har krav på sig både uppifrån och nedifrån vilket kan skapa lojalitets konflikter. Förstalinjens chef står i direkt kontakt med den operativa verksamheten och dem verksamheten är till för (brukarna). Brukarnas och personalens intressen ska därmed pareras gentemot organisationens intressen och krav och det finns en relevans i att titta på hur eventuella lojalitetskonflikter hanteras och vilket handlingsutrymme första linjens chef har. Syftet med uppsatsen var att undersöka hur första linjens chefer upplever lojalitetskonflikter mellan verksamhetens uppdrag och arbetsgivaransvaret samt vilka strategier de använder i handlingsutrymmet. Studiens design var en kvalitativ intervjustudie med semistrukturerade frågor och materialet analyserades med hjälp av kvalitativ innehållsanalys. Dataanalysen resulterade i två huvudkategorier vilka var att leda genom lojalitet och att våga handla. Informanterna ansåg att deras lojalitet låg hos arbetsgivaren och att deras uppgift var att implementera politikers och lednings beslut. Informanterna var samtidigt tydliga med att brukarnas bästa kommer i första hand. De prioriterade och ignorerade vissa beslut utifrån om de kunde se ett tydligt syfte med arbetsuppgiften eller inte. Från NPM och detaljstyrning till dagens fokus på tillits- och värdebaserad styrning menar författarna att det är viktigt med chefers etiska kompetens eftersom de enligt denna studie verkar genomföra beslut baserat på om de själva finner syfte och värde i verksamheten de leder. / Swedish elderly care is a politically controlled organizationwith the municipality as principal. Working as a first-line manager in elderly care is thus a complex task where several different perspectives must constantly be taken into account. First-line managers have demands on them both from above and below, which can create loyalty conflicts. The first-line manager is in direct contact with the operational activities and those the activities are for (the users). The interests of the users and the staff must be balanced against the interests and demands of the organization and the reis a relevance in looking at how potential conflicts of loyalty are handled and what margin for manoeuvre the first-line manager has. The purpose of the essay was to investigate how first-line managers experience loyalty conflicts between the organizations mission and the employer's responsibility and which strategies they use in the margin for manoeuvre. The design of the study was a qualitative interview study with semistructured questions and the material was analyzed using qualitative content analysis. The data analysis resulted in two main categories which were leading through loyalty and daring to act. The informants believed that their loyalty lay with the employer and that their task was to implement the decisions of politicians and management. At the same time, the informants were clear that the best interests of the users come first. They prioritized and ignored certain decisions based on whether or not they could see a clear purpose for the work task. From NPM and detailed management to today's focus on trust and value-based management, the authors believe that managers' ethical competence is important because, according to this study, the managers seem to implement decisions based on whether they themselves find purpose and value for their operation unit.

Syftet med denna magisteruppsats har varit att utforska hur Covid-19 pandemin har påverkat ledarskapet och organisationens riktning.    Covid-19 pandemin har påverkar olika delar av ledarskapet. Resultaten visar tydligt att chefer känner sig överbelastade eftersom de måste hantera många administrativa uppgifter och alternerande möten. På grund av brist på tid och balans mellan arbete och privatliv har förmågan att ha en helhetssyn, tolka och ta in perspektiv utifrån och in och inifrån och ut varit en utmaning för ledarna. Resultatet indikerar även på behovet av tydliga kommunikationskanaler mellan ledarna, de anställda och deras kunder om vilka åtgärder som krävs för att anpassa sig till den nya situationen som pandemin har medfört.   Under pandemin har organisationerna tvingats att vidta snabba åtgärder baserat på föreskrifterna och begränsningarna från Folkhälsomyndigheten och regeringen. Etablerade digitala kanaler har använts men nya digitala kanaler har behövts identifieras för att skapa interaktion och relationer inom organisationen samt med kunderna.   Den snabba omvandlingen till den digitala världen har påverkat organisationens riktning att tänka annorlunda, vara mer flexibel och anpassningsbar till nya oväntade förändringar, såsom pandemin. Organisationerna har använt nyckelindikatorer för att identifiera och få en tydlig bild av hur pandemin har påverkat organisationens riktning internt och externt gentemot sina kunder. Denna nya digitala omvandling har också tvingat kunderna att gå in på nya digitala plattformar och interagera online med organisationerna. Den nya digitala medvetenheten från kunderna har framkallat nya digitala krav och tjänster som i sin tur har resulterat i behov av nya digitala självservice tjänster och en högre och starkare digital kompetens från organisationens kundtjänst.   En bidragande diskussion till organisationerna och samhället är att hänvisa till begreppet lönsamhet som en värdeskapande effekt som är hållbar över tid, kopplad till tre element: ledarskap, organisationens riktning och kundbehov. / The purpose of this thesis has been to explore how the Covid-19 pandemic has affected the leadership and the direction of the organization.   The Covid-19 pandemic has affected various parts of the leadership. The results clearly indicate that managers feel overloaded since they have to handle a lot of administrative tasks and alternating meetings. Due to lack of time and balance between work and private life, the ability to have a holistic view, interpret and take in perspectives from outside-in and inside-out has been a challenge for the leaders. The results also indicated the need for clear communication between the leaders and the employees and their customers about what actions are required in order to adapt to the new situation that the pandemic has imposed.   During the pandemic the organizations were forced to take fast action based on the regulations and restrictions from the Public Health Agency and the government. Established digital channels were used but new digital channels had to be identified to create interaction and relations within the organization and with the customers.  The fast transformation to the digital world has affected the direction of the organization to think differently and be more flexible and adaptable to new unexpected changes, such as the pandemic. The organizations have used key indicators to identify and get a clear picture of how the pandemic has affected the direction of the organization internally and externally towards its customers. This new digital transformational shift has also forced the customers to enter new digital platforms and interact online with the organizations. The new digital awareness from the customers has induced new digital requirements and services which in turn have resulted in the need for new digital self-services and a higher and stronger digital competence from the organizations customer service.   A contributing discussion to the organizations and to the society is to refer to the concept of profitability as a value-creating effect sustainable over time, connected by three elements: leadership, direction of the organization and customer need. / <p>2021-06-06</p>