A gestão de stocks do serviço de assistência técnica na área da eletromedicina

Dissertação apresentada ao Instituto Superior de Administração e Contabilidade do Porto para obtenção do Grau de Mestre em Logística Orientada por: Professora Doutora Maria Clara Rodrigues Bento Vaz Fernandes

Proposition méthodologique : évaluation développement durable des stratégies de décontamination.

Il est maintenant commun de soumettre les projets à une analyse de durabilité avant qu’ils ne soient autorisés, et ce, malgré la diversité de sens que peut prendre ce type d’analyse. Cette démarche, grandement inspirée de l’évaluation d’impact, a pour principal objectif d’évaluer ex ante les enjeux sociaux, écologiques et économiques des projets au travers du prisme du développement durable. À cet effet, les principes comme l’efficacité économique, la prévention des dommages, l’acceptabilité sociale et l’équité intergénérationnelle, peuvent servir de guide après leur préalable traduction en indicateurs opérationnels. L’objectif de la recherche est de trouver comment le développement durable peut s’intégrer dans le processus décisionnel menant aux choix des stratégies de décontamination des sols et de proposer une démarche propre à l’évaluation de tels projets. La méthode développée devra permettre plus spécifiquement d’intégrer systématiquement les principes du développement durable dans le processus décisionnel; d’orienter les parties prenantes dans une démarche commune; de minimiser les effets négatifs sur l’environnement et les populations touchées et réduire les risques économiques; et finalement, d’adopter une vision holistique des projets.

Construção de base organizacional e suas implicações para performance corporativa: evidências da área abastecimento do Petróleo brasileiro S.A.

Esta dissertação examina algumas implicações do processo de implementação de estratégias para a performance corporativa. Este relacionamento é examinado na Área de negócios Abastecimento, da empresa Petróleo Brasileiro S.A, durante o período de 1996 e 2003. A despeito da profusão de estudos sobre estratégia empresarial, ainda há escassez de trabalhos que examinem o processo de implementação de mudanças organizacionais e suas implicações para o aprimoramento de certos indicadores de performance corporativa. Adicionalmente, tendem a prevalecer na literatura gerencial, abordagens pontuais de caráter imediatista e prescritivo, que não captam o processo de mudança organizacional e suas implicações para performance ao longo do tempo. o exame da implementação de estratégias é realizado com base em seis variáveis organizacionais extraídas da literatura existente: "comportamento da liderança"; "interação e influência"; "inovação e aprendizado"; "gestão de pessoas"; "comunicação e fluxos de conhecimento" e "estrutura organizacional". As implicações das mudanças na base organizacional para performance corporativa são examinadas a partir de dezenove indicadores, agrupados em três categorias: (i) operacionais, (ii) econômico-financeiro e (iii) segurança, meio ambiente e saúde. Esta dissertação consiste num estudo de caso individual, o qual é baseado em evidências empíricas qualitativas e quantitativas, coletadas em trabalhos de campo. A coleta dos dados baseou-se em fontes e técnicas múltiplas. Os efeitos das variáveis organizacionais que comporiam o Abastecimento, antes da criação da Área de negócio, em 1996, foram pequenos. Esses efeitos foram moderados no período entre 1996 a 2000, só apresentando impactos relevantes sobre indicadores operacionais entre 2000 e 2003, com reflexos positivos sobre o desempenho econômico, pois muitos custos foram reduzidos. Isso sugere que estratégias tecnológicas de longo prazo são um rumo robusto e consistente. As evidências sugerem que a empresa optou pela construção de uma base organizacional visando melhoria de performance no longo prazo, alinhando-se com autores que defendem essa construção como forma de fortalecer a competitividade no longo prazo. Esta dissertação contribui para o entendimento de fatores organizacionais que favorecem a implementação de estratégias e dos mecanismos que alavancam aprendizado e inovação numa empresa nacional. Este estudo conclui que a utilização de estruturas organizacionais, com o suporte da liderança e prática de baixas barreiras interfuncionais, alavancaram o aprendizado e a inovação, favorecendo resultados econômicos. Isto contradiz a proposição de autores que afirmam que reestruturação organizacional possui baixo potencial de geração de resultados, ou que enfatizam soluções de curto prazo para obtenção imediata de resultados, em detrimento da competitividade da empresa nos médio e longo prazos.

Acumulação de competências tecnológicas e suas implicações para performance operacional: análise comparativa de duas empresas do grupo Lupatec em Caxias do Sul - RS

This work focuses on the implications of accumulation of technological competences for improvement of operational performance indicators. This relationship is examined in two mechanical industry firms in Caxias do Sul-RS, in the period 1985-2000. Based on a comparative case study, this work finds its ground in both qualitative and quantitative empirical evidences, collected in different sources in the firms, which are being studied. The examination of accumulation of technological competences is done through a structure of analysis existing in literature, which is specifically adapted to the mechanical industry. The examination of performance improvement is based on a set of typical operational indicators pertaining to mechanical industry. Studies of this nature are already found, mainly in Latin American literature, since the eighties. But, the application of these analytic structures in industrializing firms in Brazil is found only in the nineties. This work shows that within a unique enterprise group there is a different accumulation of technological competences, and it demonstrates that this process is not automatic. Moreover, it contributes to explain not only the differences between both firms, in terms of operational performance at some points in time, but also, how both firms got to (or did not get to) improve their performance indicators along time. This conclusion is not different from that of previous studies, but it derives from a study made in a specific industry (mechanical), which has not yet been studied in the south of Brazil.

Uma investigação empírico-exploratória acerca da causalidade dos indicadores operacionais de call center com a satisfação dos clientes

Year after year the call center industry comes presenting high growth, either in Brazil or the world, using increasing contingent of people and receiving large amount of financial resources. Supporting all this industry, exists a theoretical reference that privileges the search of the improvement of diverse operational performance indicators. This study, empirically examines the relationship between caller satisfaction and diverse operational performance indicators currently used for call center management in Brazil. For in such a way, a group of telecommunications segment call centers will be used searching to determine which indicators are really more significantly correlated with the customer satisfaction. Of this form, it is aimed at to add new evidences and explanations to existing literature, in way that companies of call center industry can give a more adequate service to their customer, opposite to solely focus its efforts in the improvement of a great set of performance pointers that, effectively, can not become related with the customer satisfaction.

Avaliação operacional do Programa de Controle da Hanseníase nas unidades de saúde do Distrito Dagua no município de Belém-PA

O presente estudo descreve a avaliação operacional das açoes de controle do programa da hanseniase nas unidades de saúde do distrito administrtivo do Guamá- dagua do municipio de Belém no Estado do Pará. Trata de um estudo quantitativo ecológico do tipo transversal. Realizada no periodo de 2005 a 2010 em 11 unidades de saúde sendo 05 Centros de saude e 06 casas familias . Os dados utilizados foram secundários obtidos através do Sistema de informação de agravos de notificação- SINAN relacionado a 05 indicadores operacionais utilizados pelo Ministerio da Saúde para avaliação do Programa de Controle da Hanseniase e os dados primários coletados por meio de entrevistas com os profissionais de saúde . Os resultados encontrados no distrito foram: coeficiente de detecção no periodo de 22,6 a 39,7 casos de hanseníase por 100.000 habitantes muito alto de acordo com os parametros do MS.Na avaliação de incapacidade no momento do diagnóstico o resultado encontrado foi regular (81,3%) levando-se em consideração o total dos casos notificados.Evidenciou-se uma precariedade na avaliação do grau de incapacidade dos casos curados em todo o período de estudo. Quanto as altas curadas o percentual encontrado foi acima de 90% na maioria das unidades.Observou-se que o abandono de tratamento nas unidades do Distrito Dagua se manteve estável, apresentando percentuais abaixo de 10% em (6) seis das onze unidades.Identificou-se que as unidades do bairro da Terra Firme contribuíram para elevação dos percentuais de alta por abandono.Na entrevista realizada com profissionais sobre as capacitações recebidas, a associação entre as variáveis, aptidão para diagnosticar e tratar hanseníase e complicações e ou reações, com as variáveis como idade, categoria profissional e tempo de serviço. identificou-se que a variável tempo de serviço foi considerada estatisticamente significante com um p= 0,0206. Conclui-se que a qualidade do serviço nas unidades do Distrito dagua esta aquém do preconizado em função do real papel e cobertura das equipes de saude da familia e que o controle da hanseníase como problema de saúde pública em Belém requer medidas adicionais de vigilância epidemiológica, além daquelas que atualmente vêm sendo utilizadas.

Análise da influência da adoção de práticas de Green Supply Chain Management no desempenho ambiental e operacional: estudo de caso

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Financial impact of the Medicare prospective payment system on long term acute care hospitals

Objective. Long Term Acute Care Hospitals (LTACs) are subject to Medicare rules because they accept Medicare and Medicaid patients. In October 2002, Medicare changed the LTAC reimbursement formulas, from a cost basis system to a Prospective Payment System (PPS). This study examines whether the PPS has negatively affected the financial performance of the LTAC hospitals in the period following the reimbursement change (2003-2006), as compared to the period prior to the change (1999-2003), and if so, to what extent. This study will also examine whether the PPS has resulted in a decreased average patient length of stay (LOS) in the LTAC hospitals for the period of 2003-2006 as compared to the prior period of 1999-2003, and if so, to what extent. ^ Methods. The study group consists of two large LTAC hospital systems, Kindred Healthcare Inc. and Select Specialty Hospitals of Select Medical Corporation. Financial data and operational indicators were reviewed, tabulated and dichotomized into two groups, covering the two periods: 1999-2002 and 2003-2006. The financial data included net annual revenues, net income, revenue per patient per day and profit margins. It was hypothesized that the profit margins for the LTAC hospitals were reduced because of the new PPS. Operational indicators, such as annual admissions, annual patient days, and average LOS were analyzed. It was hypothesized that LOS for the LTAC hospitals would have decreased. Case mix index, defined as the weighted average of patients’ DRGs for each hospital system, was not available to cast more light on the direction of LOS. ^ Results. This assessment found that the negative financial impacts did not materialize; instead, financial performance improved during the PPS period (2003-2006). The income margin percentage under the PPS increased for Kindred by 24%, and for Select by 77%. Thus, the study’s working hypothesis of reduced income margins for the LTACs under the PPS was contradicted. As to the average patient length of stay, LOS decreased from 34.7 days to 29.4 days for Kindred, and from 30.5 days to 25.3 days for Select. Thus, on the issue of LTAC shorter length of stay, the study’s working hypothesis was confirmed. ^ Conclusion. Overall, there was no negative financial effect on the LTAC hospitals during the period of 2003-2006 following Medicare implementation of the PPS in October 2002. On the contrary, the income margins improved significantly. ^ During the same period, LOS decreased following the implementation of the PPS. This was consistent with the LTAC hospitals’ pursuit of financial incentives.^

Financial impact of the Medicare prospective payment system on long term acute care hospitals

Objective. Long Term Acute Care Hospitals (LTACs) are subject to Medicare rules because they accept Medicare and Medicaid patients. In October 2002, Medicare changed the LTAC reimbursement formulas, from a cost basis system to a Prospective Payment System (PPS). This study examines whether the PPS has negatively affected the financial performance of the LTAC hospitals in the period following the reimbursement change (2003–2006), as compared to the period prior to the change (1999–2003), and if so, to what extent. This study will also examine whether the PPS has resulted in a decreased average patient length of stay (LOS) in the LTAC hospitals for the period of 2003–2006 as compared to the prior period of 1999-2003, and if so, to what extent. ^ Methods. The study group consists of two large LTAC hospital systems, Kindred Healthcare Inc. and Select Specialty Hospitals of Select Medical Corporation. Financial data and operational indicators were reviewed, tabulated and dichotomized into two groups, covering the two periods: 1999–2002 and 2003–2006. The financial data included net annual revenues, net income, revenue per patient per day and profit margins. It was hypothesized that the profit margins for the LTAC hospitals were reduced because of the new PPS. Operational indicators, such as annual admissions, annual patient days, and average LOS were analyzed. It was hypothesized that LOS for the LTAC hospitals would have decreased. Case mix index, defined as the weighted average of patients’ DRGs for each hospital system, was not available to cast more light on the direction of LOS. ^ Results. This assessment found that the negative financial impacts did not materialize; instead, financial performance improved during the PPS period (2003–2006). The income margin percentage under the PPS increased for Kindred by 24%, and for Select by 77%. Thus, the study’s working hypothesis of reduced income margins for the LTACs under the PPS was contradicted. As to the average patient length of stay, LOS decreased from 34.7 days to 29.4 days for Kindred, and from 30.5 days to 25.3 days for Select. Thus, on the issue of LTAC shorter length of stay, the study’s working hypothesis was confirmed. ^ Conclusion. Overall, there was no negative financial effect on the LTAC hospitals during the period of 2003–2006 following Medicare implementation of the PPS in October 2002. On the contrary, the income margins improved significantly. ^ During the same period, LOS decreased following the implementation of the PPS. This was consistent with the LTAC hospitals’ pursuit of financial incentives. ^

Performance analysis of brazilian public and philanthropic hospitals

This paper presents the results of a research that aimed at identifying optimal performance standards of Brazilian public and philanthropic hospitals. In order to carry out the analysis, a model based on Data Envelopment Analysis (DEA) was developed. We collected financial data from hospitals’ financial statements available on the internet, as well as operational data from the Information Technology Department of the Brazilian Public Health Care System – SUS (DATASUS). Data from 18 hospitals from 2007 to 2011 were analyzed. Our DEA model used both operational and financial indicators (variables). In order to develop this model, two indicators were considered inputs: Values (in Brazilian Reais) of Fixed Assets and Planned Capacity. On the other hand, the following indicators were considered outputs: Net Margin, Return on Assets and Institutional Mortality Rate. As regards the proposed model, there were five hospitals with optimal performance and four hospitals were considered inefficient, upon the analysis of the variables, considering the analyzed period. Analysis of the weights indicated the most relevant variables for determining efficiency and scale variable values, which is an important tool to aid the decision-making by hospital managers. Finally, the scale variables determined the returns on production, indicating that 14 hospitals work with scale diseconomies. This may indicate inefficiency in the resource management of the Brazilian public health-care system, by analyzing this set of proposed variables.

Firm social, cultural and intellectual capital : strategic indicators of international client satisfaction

Despite the increasing significance of the construction industry as an emerging sector of the Australian economy, there is inadequate research performed on construction design firms in terms of theoretical and empirical foundations. Although past research has identified the barriers and success factors for firm market entry, evidence suggests that to date no research has explicitly explored the sustainability of construction design firms in international markets. SMEs and their approach to firm internationalisation differ significantly from large manufacturing firms and a vast majority of construction design firms operate as SMEs. This paper develops a sustainable business model for construction design SMEs, which rely upon the development of clear Client Following (CF) versus Market Seeking (MS) strategies to support internal firm strategic and operational management. The understanding of these strategies is vital as the application of either will shape the design management approach of firms, which would in turn impact on the sustainability of these firms in foreign markets. Long-term sustainability of firms in international markets relies heavily upon client satisfaction. Client and project team participants’ communication during various design processes has often been problematic and the added difficulty of communicating across international boundaries further compounds the problem of capturing and maintaining client’s requirements. Therefore this paper develops a model for economic sustainability of Australian construction design firms working in international markets by exploring factors that affect client satisfaction across international boundaries, through the development of business performance indicators. These include not only the critical financial capital but also other ‘softer’ indicators, namely: social, cultural and intellectual capital. These act as a firm’s measure of success and the acquisition of this type of capital will provide significant advantages to firms’ success, hence sustainability in international markets.

designing creative clusters : some indicators

This paper explores how the design of creative clusters as a key strategy in promoting the urban creative economy has played out in Shanghai. Creative Clusters in Europe and North America context have emerged ‘organically’. They developed spontaneously in those cities which went through a period of post-industrial decline. Creative Industries grew up in these cities as part of a new urban economy in the wake of old manufacturing industries. Artists and creative entrepreneurs moved into vacant warehouses and factories and began the trend of ‘creative clusters’. Such clusters facilitate the transfer of tacit knowledge through informal learning, the efficient sourcing of skills and information, competition, collaboration and learning, inter-cluster trading and networking. This new urban phenomenon was soon targeted by local economic development policy in charge of re-generating and re-structuralizing industrial activities in cities. Rising interest from real estate and local economic development has led to more and more planned creative clusters. In the aim of catching up with the world’s creative cities, Shanghai has planned over 100 creative clusters since 2005. Along with these officially designed creative clusters, there are organically emerged creative clusters that are much smaller in scale and much more informal in terms of the management. And they emerged originally in old residential areas just outside the CBD and expand to include French concession the most sort after residential area at the edge of CBD. More recently, office buildings within CBD are made available for creative usages. From fringe to CBD, these organic creative clusters provide crucial evidences for the design of creative clusters. This paper will be organized in 2 parts. In the first part, I will present a case study of 8 ‘official’ clusters (title granted by local govenrment) in Shanghai through which I am hoping to develop some key indicators of the success/failure of creative clusters as well as link them with their physical, social and operational efficacies. In the second part, a variety of ‘alternative’ clusters (organicly formed clusters most of which are not recongnized by the government) supplies with us the possibilities of rethinking the so-called ‘cluster development strategy’ in terms of what kind of spaces are appropriate for use by clusters? Who should manage them and in what format? And ultimately what are their relationship with the rest of the city should be defined?

Filter design using radial basis function neural network and genetic algorithm for improved operational health monitoring

The problem of denoising damage indicator signals for improved operational health monitoring of systems is addressed by applying soft computing methods to design filters. Since measured data in operational settings is contaminated with noise and outliers, pattern recognition algorithms for fault detection and isolation can give false alarms. A direct approach to improving the fault detection and isolation is to remove noise and outliers from time series of measured data or damage indicators before performing fault detection and isolation. Many popular signal-processing approaches do not work well with damage indicator signals, which can contain sudden changes due to abrupt faults and non-Gaussian outliers. Signal-processing algorithms based on radial basis function (RBF) neural network and weighted recursive median (WRM) filters are explored for denoising simulated time series. The RBF neural network filter is developed using a K-means clustering algorithm and is much less computationally expensive to develop than feedforward neural networks trained using backpropagation. The nonlinear multimodal integer-programming problem of selecting optimal integer weights of the WRM filter is solved using genetic algorithm. Numerical results are obtained for helicopter rotor structural damage indicators based on simulated frequencies. Test signals consider low order polynomial growth of damage indicators with time to simulate gradual or incipient faults and step changes in the signal to simulate abrupt faults. Noise and outliers are added to the test signals. The WRM and RBF filters result in a noise reduction of 54 - 71 and 59 - 73% for the test signals considered in this study, respectively. Their performance is much better than the moving average FIR filter, which causes significant feature distortion and has poor outlier removal capabilities and shows the potential of soft computing methods for specific signal-processing applications.