Integrated approach to healthcare quality management:a case study

Purpose - The purpose of the paper is to develop an integrated quality management model, which identifies problems, suggests solutions, develops a framework for implementation and helps evaluate performance of health care services dynamically. Design/methodology/approach - This paper uses logical framework analysis (LFA), a matrix approach to project planning for managing quality. This has been applied to three acute healthcare services (Operating room utilization, Accident and emergency, and Intensive care) in order to demonstrate its effectiveness. Findings - The paper finds that LFA is an effective method of quality management of hospital-based healthcare services. Research limitations/implications - This paper shows LFA application in three service processes in one hospital. However, ideally this is required to be tested in several hospitals and other services as well. Practical implications - In the paper the proposed model can be practised in hospital-based healthcare services for improving performance. Originality/value - The paper shows that quality improvement in healthcare services is a complex and multi-dimensional task. Although various quality management tools are routinely deployed for identifying quality issues in health care delivery and corrective measures are taken for superior performance, there is an absence of an integrated approach, which can identify and analyze issues, provide solutions to resolve those issues, develop a project management framework (planning, monitoring, and evaluating) to implement those solutions in order to improve process performance. This study introduces an integrated and uniform quality management tool. It integrates operations with organizational strategies. © Emerald Group Publishing Limited.

The UK productivity gap in the service sector: do management practices matter?

Purpose – This paper aims to contribute to the debate on the drivers of the productivity gap that exists between the UK and its major international competitors. Design/methodology/approach – From the macro perspective the paper explores the quantitative evidence on the productivity differentials and how they are measured. From the micro perspective, the article explores the quantitative evidence on the role of management practices claimed to be a key determinant in promoting firm competitiveness and in bridging the UK gap. Findings – This study suggests that management practices are an ambiguous driver of firm productivity and higher firm performance. On the methodological side, qualitative and subjective measures of either management practices or firm performance are often used. This makes the results not comparable across studies, across firms or even within firms over time. Productivity and profitability are often and erroneously interchangeably used while productivity is only one element of firm performance. On the other hand, management practices are multi-dimensional constructs that generally do not demonstrate a straightforward relationship with productivity variables. To assume that they are the only driver of higher productivity may be misleading. Moreover, there is evidence of an inverse causal relationship between management practices and firm performance. This calls into question most empirical results of the extant literature based on the unidirectional assumption of direct causality between management practices and firm performance. Research limitations/implications – These and other issues suggest that more research is needed to deepen the understanding of the UK productivity gap and more quantitative evidence should be provided on the way in which management practices contribute to the UK competitiveness. Their impact is not easily measurable due to their complexity and their complementary nature and this is a fertile ground for further research. Originality/value – This paper brings together the evidence on the UK productivity gap and its main drivers, provided by the economics, management and performance measurement literature. This issue scores very highly in the agenda of policy makers and academics and has important implications for practitioners interested in evaluating the impact of managerial best practices.

Self-service technology and the service encounter

Self-service technology is affecting the service encounter. The potential reduction in personal contact through self-service technology may affect assessments of consumer satisfaction and commitment, making it necessary to investigate self-service technology usage, particularly the long-term impact on consumers' relationships with service organisations. Thus, this paper presents a framework for investigating the impact of self-service technology on consumer satisfaction and on a multi-dimensional measure of consumer commitment. Illustrative quotes from exploratory in-depth interviews support the framework and lead to a set of propositions. Future research directions for testing the framework are also discussed, and potential implications of this research are outlined.

Institutions and firm ownership structure:evidence from Central and Eastern Europe

FDI plays a key role in development, particularly in resource-constrained transition economies of Central and Eastern Europe with relatively low savings rates. Gains from technology transfer play a critical role in motivating FDI, yet potential for it may be hampered by a large technology gap between the source and host country. While the extent of this gap has traditionally been attributed to education, skills and capital intensity, recent literature has also emphasized the possible role of institutional environment in this respect. Despite tremendous interest among policy-makers and academics to understand the factors attracting FDI (Bevan and Estrin, 2000; Globerman and Shapiro, 2003) our knowledge about the effects of institutions on the location choice and ownership structure of foreign firms remains limited. This paper attempts to fill this gap in the literature by examining the link between institutions and foreign ownership structures. To the best of our knowledge, Javorcik (2004) is the only papers, which use firm-level data to analyse the role of institutional quality on an outward investor’s entry mode in transition countries. Our paper extends Javorcik (2004) in a number of ways: (a) rather than a cross-section, we use panel data for the period 1997-2006; (b) rather than a binary variable, we use the percentage foreign ownership as continuous variable; (c) we consider multi-dimensional institutional variables, such as corruption, intellectual property rights protection and government stability. We also use factor analysis to generate a composite index of institutional quality and see how stronger institutional environment could affect foreign ownership; (d) we explore how the distance between institutional environment in source and host countries affect foreign ownership in a host country. The firm-level data used includes both domestic and foreign firms for the period 1997-2006 and is drawn from ORBIS, a commercially available dataset provided by Bureau van Dijk. In order to examine the link between institutions and foreign ownership structures, we estimate four log-linear ownership equations/specifications augmented by institutional and other control variables. We find evidence that the decision of a foreign firm to either locate its subsidiary or acquire an existing domestic firm depends not only on factor cost differences but also on differences in institutional environment between the host and source countries.

Stakeholder performance measurement:general approaches and methods of economic evaluation

This paper begins by suggesting that when considering Corporate Social Responsibility (CSR), even CSR as justified in terms of the business case, stakeholders are of great importance to corporations. In the UK the Company Law Review (DTI, 2002) has suggested that it is appropriate for UK companies to be managed upon the basis of an enlightened shareholder approach. Within this approach the importance of stakeholders, other than shareholders, is recognised as being instrumental in succeeding in providing shareholder value. Given the importance of these other stakeholders it is then important that corporate management measure and manage stakeholder performance. In order to do this there are two general approaches that could be adopted and these are the use of monetary values to reflect stakeholder value or cost and non-monetary values. In order to consider these approaches further this paper considered the possible use of these approaches for two stakeholder groups: namely employees and the environment. It concludes that there are ethical and practical difficulties with calculating economic values for stakeholder resources and so prefers a multi-dimensional approach to stakeholder performance measurement that does not use economic valuation.

Applications of fractals to image data compression

Digital image processing is exploited in many diverse applications but the size of digital images places excessive demands on current storage and transmission technology. Image data compression is required to permit further use of digital image processing. Conventional image compression techniques based on statistical analysis have reached a saturation level so it is necessary to explore more radical methods. This thesis is concerned with novel methods, based on the use of fractals, for achieving significant compression of image data within reasonable processing time without introducing excessive distortion. Images are modelled as fractal data and this model is exploited directly by compression schemes. The validity of this is demonstrated by showing that the fractal complexity measure of fractal dimension is an excellent predictor of image compressibility. A method of fractal waveform coding is developed which has low computational demands and performs better than conventional waveform coding methods such as PCM and DPCM. Fractal techniques based on the use of space-filling curves are developed as a mechanism for hierarchical application of conventional techniques. Two particular applications are highlighted: the re-ordering of data during image scanning and the mapping of multi-dimensional data to one dimension. It is shown that there are many possible space-filling curves which may be used to scan images and that selection of an optimum curve leads to significantly improved data compression. The multi-dimensional mapping property of space-filling curves is used to speed up substantially the lookup process in vector quantisation. Iterated function systems are compared with vector quantisers and the computational complexity or iterated function system encoding is also reduced by using the efficient matching algcnithms identified for vector quantisers.

Nonlinear diffraction in sub-critical femtosecond inscription

Material processing using high-intensity femtosecond (fs) laser pulses is a fast developing technology holding potential for direct writing of multi-dimensional optical structures in transparent media. In this work we re-examine nonlinear diffraction theory in context of fs laser processing of silica in sub-critical (input power less than the critical power of self-focusing) regime. We have applied well known theory, developed by Vlasov, Petrishev and Talanov, that gives analytical description of the evolution of a root-mean-square beam (not necessarily Gaussian) width RRMS(z) in medium with the Kerr nonlinearity.

Use of computational fluid dynamics in the design of bubble column reactors

Investigations into the modelling techniques that depict the transport of discrete phases (gas bubbles or solid particles) and model biochemical reactions in a bubble column reactor are discussed here. The mixture model was used to calculate gas-liquid, solid-liquid and gasliquid-solid interactions. Multiphase flow is a difficult phenomenon to capture, particularly in bubble columns where the major driving force is caused by the injection of gas bubbles. The gas bubbles cause a large density difference to occur that results in transient multi-dimensional fluid motion. Standard design procedures do not account for the transient motion, due to the simplifying assumptions of steady plug flow. Computational fluid dynamics (CFD) can assist in expanding the understanding of complex flows in bubble columns by characterising the flow phenomena for many geometrical configurations. Therefore, CFD has a role in the education of chemical and biochemical engineers, providing the examples of flow phenomena that many engineers may not experience, even through experimentation. The performance of the mixture model was investigated for three domains (plane, rectangular and cylindrical) and three flow models (laminar, k-e turbulence and the Reynolds stresses). mThis investigation raised many questions about how gas-liquid interactions are captured numerically. To answer some of these questions the analogy between thermal convection in a cavity and gas-liquid flow in bubble columns was invoked. This involved modelling the buoyant motion of air in a narrow cavity for a number of turbulence schemes. The difference in density was caused by a temperature gradient that acted across the width of the cavity. Multiple vortices were obtained when the Reynolds stresses were utilised with the addition of a basic flow profile after each time step. To implement the three-phase models an alternative mixture model was developed and compared against a commercially available mixture model for three turbulence schemes. The scheme where just the Reynolds stresses model was employed, predicted the transient motion of the fluids quite well for both mixture models. Solid-liquid and then alternative formulations of gas-liquid-solid model were compared against one another. The alternative form of the mixture model was found to perform particularly well for both gas and solid phase transport when calculating two and three-phase flow. The improvement in the solutions obtained was a result of the inclusion of the Reynolds stresses model and differences in the mixture models employed. The differences between the alternative mixture models were found in the volume fraction equation (flux and deviatoric stress tensor terms) and the viscosity formulation for the mixture phase.

A computational model of prosody for Yorùbá text-to-speech synthesis

This work examines prosody modelling for the Standard Yorùbá (SY) language in the context of computer text-to-speech synthesis applications. The thesis of this research is that it is possible to develop a practical prosody model by using appropriate computational tools and techniques which combines acoustic data with an encoding of the phonological and phonetic knowledge provided by experts. Our prosody model is conceptualised around a modular holistic framework. The framework is implemented using the Relational Tree (R-Tree) techniques (Ehrich and Foith, 1976). R-Tree is a sophisticated data structure that provides a multi-dimensional description of a waveform. A Skeletal Tree (S-Tree) is first generated using algorithms based on the tone phonological rules of SY. Subsequent steps update the S-Tree by computing the numerical values of the prosody dimensions. To implement the intonation dimension, fuzzy control rules where developed based on data from native speakers of Yorùbá. The Classification And Regression Tree (CART) and the Fuzzy Decision Tree (FDT) techniques were tested in modelling the duration dimension. The FDT was selected based on its better performance. An important feature of our R-Tree framework is its flexibility in that it facilitates the independent implementation of the different dimensions of prosody, i.e. duration and intonation, using different techniques and their subsequent integration. Our approach provides us with a flexible and extendible model that can also be used to implement, study and explain the theory behind aspects of the phenomena observed in speech prosody.

Osmotic dehydration in plant tissues

The primary aim of the thesis is to provide a comprehensive investigation of the osmotic dehydration processes in plant tissue. Effort has been concentrated on the modelling for simulating the processes. Two mathematical models for simulating the mass transfer during osmotic dehydration processes in plant tissues are developed and verified using existing experimental data. Both models are based on the mechanism of diffusion and convection of any mobile material that can transport in plant tissues. The mass balance equation for the transport of each constituent is established separately for intracellular and extra-cellular volumes with taking into account the mass transfer across the cell membrane the intracellular and extra-cellular volumes and the shrinkage of the whole tissue. The contribution from turgor pressure is considered in both models. Model two uses Darcy’s law to build the relation between shrinkage velocity and hydrostatic pressure in each volume because the plant tissue can be considered as the porous medium. Moreover, it has been extended to solve the multi-dimensional problems. A lot of efforts have been made to the parameter study and the sensitivity analyses. The parameters investigated including the concentration of the osmotic solution, diffusion coefficient, permeability of the cell membrane, elastic modulus of the cell wall, critical cell volume etc. The models allow us to quantitatively simulate the time evolution of intracellular and extra-cellular volumes as well as the time evolution of concentrations in each cross-section.

Minimizing nasty surprises with better informed decision-making in self-adaptive systems

Designers of self-adaptive systems often formulate adaptive design decisions, making unrealistic or myopic assumptions about the system's requirements and environment. The decisions taken during this formulation are crucial for satisfying requirements. In environments which are characterized by uncertainty and dynamism, deviation from these assumptions is the norm and may trigger 'surprises'. Our method allows designers to make explicit links between the possible emergence of surprises, risks and design trade-offs. The method can be used to explore the design decisions for self-adaptive systems and choose among decisions that better fulfil (or rather partially fulfil) non-functional requirements and address their trade-offs. The analysis can also provide designers with valuable input for refining the adaptation decisions to balance, for example, resilience (i.e. Satisfiability of non-functional requirements and their trade-offs) and stability (i.e. Minimizing the frequency of adaptation). The objective is to provide designers of self adaptive systems with a basis for multi-dimensional what-if analysis to revise and improve the understanding of the environment and its effect on non-functional requirements and thereafter decision-making. We have applied the method to a wireless sensor network for flood prediction. The application shows that the method gives rise to questions that were not explicitly asked before at design-time and assists designers in the process of risk-aware, what-if and trade-off analysis.

A modular holistic approach to prosody modelling for Standard Yorùbá speech synthesis

This paper presents a novel prosody model in the context of computer text-to-speech synthesis applications for tone languages. We have demonstrated its applicability using the Standard Yorùbá (SY) language. Our approach is motivated by the theory that abstract and realised forms of various prosody dimensions should be modelled within a modular and unified framework [Coleman, J.S., 1994. Polysyllabic words in the YorkTalk synthesis system. In: Keating, P.A. (Ed.), Phonological Structure and Forms: Papers in Laboratory Phonology III, Cambridge University Press, Cambridge, pp. 293–324]. We have implemented this framework using the Relational Tree (R-Tree) technique. R-Tree is a sophisticated data structure for representing a multi-dimensional waveform in the form of a tree. The underlying assumption of this research is that it is possible to develop a practical prosody model by using appropriate computational tools and techniques which combine acoustic data with an encoding of the phonological and phonetic knowledge provided by experts. To implement the intonation dimension, fuzzy logic based rules were developed using speech data from native speakers of Yorùbá. The Fuzzy Decision Tree (FDT) and the Classification and Regression Tree (CART) techniques were tested in modelling the duration dimension. For practical reasons, we have selected the FDT for implementing the duration dimension of our prosody model. To establish the effectiveness of our prosody model, we have also developed a Stem-ML prosody model for SY. We have performed both quantitative and qualitative evaluations on our implemented prosody models. The results suggest that, although the R-Tree model does not predict the numerical speech prosody data as accurately as the Stem-ML model, it produces synthetic speech prosody with better intelligibility and naturalness. The R-Tree model is particularly suitable for speech prosody modelling for languages with limited language resources and expertise, e.g. African languages. Furthermore, the R-Tree model is easy to implement, interpret and analyse.

Interactive semantics

Much research pursues machine intelligence through better representation of semantics. What is semantics? People in different areas view semantics from different facets although it accompanies interaction through civilization. Some researchers believe that humans have some innate structure in mind for processing semantics. Then, what the structure is like? Some argue that humans evolve a structure for processing semantics through constant learning. Then, how the process is like? Humans have invented various symbol systems to represent semantics. Can semantics be accurately represented? Turing machines are good at processing symbols according to algorithms designed by humans, but they are limited in ability to process semantics and to do active interaction. Super computers and high-speed networks do not help solve this issue as they do not have any semantic worldview and cannot reflect themselves. Can future cyber-society have some semantic images that enable machines and individuals (humans and agents) to reflect themselves and interact with each other with knowing social situation through time? This paper concerns these issues in the context of studying an interactive semantics for the future cyber-society. It firstly distinguishes social semantics from natural semantics, and then explores the interactive semantics in the category of social semantics. Interactive semantics consists of an interactive system and its semantic image, which co-evolve and influence each other. The semantic worldview and interactive semantic base are proposed as the semantic basis of interaction. The process of building and explaining semantic image can be based on an evolving structure incorporating adaptive multi-dimensional classification space and self-organized semantic link network. A semantic lens is proposed to enhance the potential of the structure and help individuals build and retrieve semantic images from different facets, abstraction levels and scales through time.

Municipal benchmarking:organisational learning and network performance in the public sector

The main purpose of this dissertation is to assess the relation between municipal benchmarking and organisational learning with a specific emphasis on benchlearning and performance within municipalities and between groups of municipalities in the building and housing sector in the Netherlands. The first and main conclusion is that this relation exists, but that the relative success of different approaches to dimensions of change and organisational learning are a key explanatory factor for differences in the success of benchlearning. Seven other important conclusions could be derived from the empirical research. First, a combination of interpretative approaches at the group level with a mixture of hierarchical and network strategies, positively influences benchlearning. Second, interaction among professionals at the inter-organisational level strengthens benchlearning. Third, stimulating supporting factors can be seen as a more important strategy to strengthen benchlearning than pulling down barriers. Fourth, in order to facilitate benchlearning, intrinsic motivation and communication skills matter, and are supported by a high level of cooperation (i.e., team work), a flat organisational structure and interactions between individuals. Fifth, benchlearning is facilitated by a strategy that is based on a balanced use of episodic (emergent) and systemic (deliberate) forms of power. Sixth, high levels of benchlearning will be facilitated by an analyser or prospector strategic stance. Prospectors and analysers reach a different learning outcome than defenders and reactors. Whereas analysers and prospectors are willing to change policies when it is perceived as necessary, the strategic stances of defenders and reactors result in narrow process improvements (i.e., single-loop learning). Seventh, performance improvement is influenced by functional perceptions towards performance, and these perceptions ultimately influence the elements adopted. This research shows that efforts aimed at benchlearning and ultimately improved service delivery, should be directed to a multi-level and multi-dimensional approach addressing the context, content and process of dimensions of change and organisational learning.

Nonlinear diffraction in sub-critical femtosecond inscription

Material processing using high-intensity femtosecond (fs) laser pulses is a fast developing technology holding potential for direct writing of multi-dimensional optical structures in transparent media. In this work we re-examine nonlinear diffraction theory in context of fs laser processing of silica in sub-critical (input power less than the critical power of self-focusing) regime. We have applied well known theory, developed by Vlasov, Petrishev and Talanov, that gives analytical description of the evolution of a root-mean-square beam (not necessarily Gaussian) width RRMS(z) in medium with the Kerr nonlinearity.