Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.

Dynamic Covariance Models for Multivariate Financial Time Series

The accurate prediction of time-changing covariances is an important problem in the modeling of multivariate financial data. However, some of the most popular models suffer from a) overfitting problems and multiple local optima, b) failure to capture shifts in market conditions and c) large computational costs. To address these problems we introduce a novel dynamic model for time-changing covariances. Over-fitting and local optima are avoided by following a Bayesian approach instead of computing point estimates. Changes in market conditions are captured by assuming a diffusion process in parameter values, and finally computationally efficient and scalable inference is performed using particle filters. Experiments with financial data show excellent performance of the proposed method with respect to current standard models.

The user-value of rural electrification: An analysis and adoption of existing models and theories

User-value is a determining factor for product acceptance in product design. Research on rural electrification to date, however, does not draw sufficient attention to the importance of user-value with regard to the overall success of a project. This is evident from the analysis of project reports and applicable indicators from agencies active in the sector. Learning from the design, psychology and sociology literatures, it is important that rural electrification projects incorporate the value perception of the end-user and extend their success beyond the commonly used criteria of financial value, the appropriateness of the technology, capacity building and technology uptake. Creating value for the end-user is particularly important for project acceptance and the sustainability of a scheme once it has been handed over to the local community. In this research paper, existing theories and models of value-theory are transposed and applied to community operated rural electrification schemes and a user-value framework is developed. Furthermore, the importance of value to the end-user is clarified. Current literature on product design reveals that user-value has different properties, many of which are applicable to rural electrification. Five value pillars and their sub-categories important for the users of rural electrification projects are identified, namely: functional; social significance; epistemic; emotional; and cultural values. These pillars provide the main structure for the conceptual framework developed in this research paper. It is proposed that by targeting the values of the end-user, the key factors of user-value applicable to rural electrification projects will be identified and the sustainability of the project will be better ensured. © 2014 The Authors.