Exploring business models to provide a foundation for enhanced eye care services in high street optometric practice

High street optometric practices are for-profit businesses. They mostly provide sight testing and eye examination services and sell optical products, such as spectacles and contact lenses. The sight testing services are often sold at a vastly reduced price and profits are generated primarily through high margin spectacle sales, in a loss leading strategy. Published literature highlights weaknesses in this strategy as it forms a barrier to widening the scope of services provided within optometric practices. This includes specialist non-refraction based services, such as shared care. In addition this business strategy discourages investment in advanced diagnostic equipment and higher professional qualifications. The aim of this thesis was to develop a greater understanding of the traditional loss-leading strategy. The thesis also aimed to assess the plausibility of alternative business models to support the development of specialist non-refraction services within high street optometric practice. This research was based on a single independent optometric practice that specialises in advanced retinal imaging and offers a broad range of shared care services. Specialist non-refraction based services were found to be poor generators of spectacle sales likely due to patient needs and presenting concerns. Alternative business strategies to support these services included charging more realistic professional fees via cost-based pricing and monthly payment plans. These strategies enabled specialist services to be more self-sustainable with less reliance on cross-subsidy from spectacle sales. Furthermore, improving operational efficiency can increase stand-alone profits for specialist services.Practice managers may be reluctant to increase professional fees due to market pressures and confidence. However, this thesis found that patients were accepting of increased professional fees. Practice managers can implement alternative business models to enhance eye care provision in high street optometric practices. These alternative business models also improve revenues and profits generated via clinical services and improve patient loyalty.

Developing the public health function of locum pharmacists under the auspices of the new pharmacy contract

Focal Point - There are reduced opportunities for locum pharmacists to access training and education that meets their needs and enables them to play a full role under the new pharmacy contract - Eighty-six per cent of locums consider themselves to be more health professional than business person, compared to just 48% of pharmacy owners - Forty per cent of locums believe that a lack of access to training is a major barrier to the development of their public health function - While locum pharmacists are arguably more likely to embrace 'professionalising', patient-care-based roles, they are also the group least likely to be able to access the necessary training to fulfill such roles Introduction It has been suggested that locum pharmacists do not want the business-based responsibilities (e.g. staff management, meeting targets, etc) that come with pharmacy management.1 Research also suggests that locums derive great satisfaction from the health-professional aspects of the pharmacists’ role (e.g. patient contact, the provision of advice, etc).1 However, upon the introduction of the new pharmacy contract (April 2005), concerns were expressed that it was becoming increasingly difficult for locum pharmacists to access training and education that would meet their needs and enable them to play a full role under the new framework.2,3 Method After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n = 1023/1998) was achieved. Respondents were asked ‘indicate how you view yourself as a pharmacist’ – in terms of their relative focus on the health-professional and business aspects of their role. Respondents were also asked ‘do you consider a lack of training opportunities to be a barrier to the development of the public health role of community pharmacists?’. Results Locums were significantly more likely than owners or employees to consider each factor a major barrier. Discussion Four in 10 locums consider a lack of training opportunities to constitute a major barrier to the development of their public health function. Pharmacy may not be able to provide the services required of it by the policy agenda if pharmacists are unable to be involved in extended role activities through a lack of training opportunities. Therefore, the paradox that needs to be addressed is that while locum pharmacists are arguably more likely to embrace ‘professionalising’, patient-care-based roles, they are also the group least likely to be able to access training to fulfil such roles. The training needs of this large subset of the pharmacist population need to be assessed and met if the whole community pharmacy workforce is going to maximise its contribution to public health under the new contractual framework. References 1 Shann P, Hassell K. An exploration of the diversity and complexity of the pharmacy locum workforce. London: Royal Pharmaceutical Society of Great Britain; 2004. 2 Almond M. Locums – key players in workforce – cast adrift as contract launched. Pharm J 2005;274:420. 3 Bishop DH. A lack of appreciation of what really happens. Pharm J 2005;274:451.

The market for professional services in Indonesia

This paper reports the results of a study which investigates the market for professional services in Indonesia, a country which has not been investigated in the by audit fee literature prior. A well-developed research model used in the prior literature has also been applied in this study, and the empirical findings suggest broad similarities in the pricing of professional services in Indonesia and other countries previously studied. In addition to extending the results of prior research to a country not previously studied, this paper examines whether the large auditors fee premium documented in other countries exists in Indonesia, especially after the major Asian financial crisis of 1997/98, since then almost all companies in this geographical area exercise tight budget controls. The results suggest that no audit fee premium is accrued to Indonesian Big 5 auditors, in contrast to the large audit firm fee premium documented in many other countries.

The fallacy of integration:work and non-work in professional services

Many organisations are encouraging their staff to integrate work and non-work, but a qualitative study of young professionals found that many crave greater segregation rather than more integration. Most wished to build boundaries to separate the two and simplify a complex world. Where working practices render traditional boundaries of time and space ineffective, this population seems to create new idiosyncratic boundaries to segregate work from non-work. These idiosyncratic boundaries depended on age, culture and life-stage though for most of this population there was no appreciable gender difference in attitudes to segregating work and non-work. Gender differences only became noticeable for parents. A matrix defining the dimensions to these boundaries is proposed that may advance understanding of how individuals separate their work and personal lives. In turn, this may facilitate the development of policies and practices to integrate work and non-work that meet individual as well as organisational needs.

Changing career models and capacity for innovation in professional services

A number of professional sectors have recently moved away from their longstanding career model of up-or-out promotion and embraced innovative alternatives. Professional labor is a critical resource in professional service firms. Therefore, changes to these internal labor markets are likely to trigger other innovations, for example in knowledge management, incentive schemes and team composition. In this chapter we look at how new career models affect the core organizing model of professional firms and, in turn, their capacity for and processes of innovation. We consider how professional firms link the development of human capital and the division of professional labor to distinctive demands for innovation and how novel career systems help them respond to these demands.

The impact of buddying on psychological capital, work engagement and turnover intentions:an empirical study of socialization in the professional services sector

This article reports on a study investigating the impact of new employees' satisfaction with buddying on work engagement and explores the role of psychological capital in mediating this relationship. The study took place within a professional services organization wherein data were collected from 78 graduate newcomers in receipt of buddying. Satisfaction with buddying was found to have a positive relationship to both work engagement and psychological capital. The satisfaction with the buddy/work engagement relationship was fully mediated by psychological capital, providing support for Saks & Gruman's (2011) socialization resources theory. The results underscore the valuable role buddying can play as part of organizational socialization from a positive organizational behavior perspective. The research contributes to the growing evidence that positively oriented human resource practices can develop personal resources of newcomers within organizations. Recommendations are made for how the organization can improve and build upon this resource, thus developing the psychological capital of newcomers. © 2012 Wiley Periodicals, Inc.

Transfer of patients from health care centres to special care services:analysis of travel distances in Nordic countries

Objectives: This paper highlights the importance of analysing patient transportation in Nordic circumpolar areas. The research questions we asked are as follows: How many Finnish patients have been transferred to special care intra-country and inter-country in 2009? Does it make any difference to health care policymakers if patients are transferred inter-country? Study design: We analysed the differences in distances from health care centres to special care services within Finland, Sweden and Norway and considered the health care policy implica tions. Methods: An analysis of the time required to drive between service providers using the "Google distance meter" (http://maps.google.com/); conducting interviews with key Finnish stakeholders; and undertaking a quantitative analyses of referral data from the Lapland Hospital District. Results: Finnish patients are generally not transferred for health care services across national borders even if the distances are shorter. Conclusion: Finnish patients have limited access to health care services in circumpolar are as across the Nordic countries for 2 reasons. First, health professionals in Norway and Sweden do not speak Finnish, which presents a language problem. Second, The Social Insurance Institution of Finland does not cover the expenditures of travel or the costs of medicine. In addition, it seems that in circumpolar areas the density of Finnish service providers is greater than Swedish ones, causing many Swedish citizens to transfer to Finnish health care providers every year. However, future research is needed to determine the precise reasons for this.

An interdisciplinary approach to designing and evaluating a hybrid solar-biomass power plant

Purpose: Energy security is a major concern for India and many rural areas remain un-electrified. Thus, innovations in sustainable technologies to provide energy services are required. Biomass and solar energy in particular are resources that are widely available and underutilised in India. This paper aims to provide an overview of a methodology that was developed for designing and assessing the feasibility of a hybrid solar-biomass power plant in Gujarat. Design/methodology/approach: The methodology described is a combination of engineering and business management studies used to evaluate and design solar thermal collectors for specific applications and locations. For the scenario of a hybrid plant, the methodology involved: the analytical hierarchy process, for solar thermal technology selection; a cost-exergy approach, for design optimisation; quality function deployment, for designing and evaluating a novel collector - termed the elevation linear Fresnel reflector (ELFR); and case study simulations, for analysing alternative hybrid plant configurations. Findings: The paper recommended that for a hybrid plant in Gujarat, a linear Fresnel reflector of 14,000 m2 aperture is integrated with a 3 tonne per hour biomass boiler, generating 815 MWh per annum of electricity for nearby villages and 12,450 tonnes of ice per annum for local fisheries and food industries. However, at the expense of a 0.3 ¢/kWh increase in levelised energy costs, the ELFR can increase savings of biomass (100 t/a) and land (9 ha/a). Research limitations/implications: The research reviewed in this paper is primarily theoretical and further work will need to be undertaken to specify plant details such as piping layout, pump sizing and structure, and assess plant performance during real operational conditions. Originality/value: The paper considers the methodology adopted proved to be a powerful tool for integrating technology selection, optimisation, design and evaluation and promotes interdisciplinary methods for improving sustainable engineering design and energy management. © Emerald Group Publishing Limited.

A collagen IV matrix is required for guinea pig gastric epithelial cell monolayers to provide an optimal model of the stomach surface for biopharmaceutical screening

The surface epithelial cells of the stomach represent a major component of the gastric barrier. A cell culture model of the gastric epithelial cell surface would prove useful for biopharmaceutical screening of new chemical entities and dosage forms. Primary cultures of guinea pig gastric mucous epithelial cells were grown on filter inserts (Transwells®) for 3 days. Tight-junction formation, assessed by transepithelial electrical resistance (TEER) and permeability of mannitol and fluorescein, was enhanced when collagen IV rather than collagen I was used to coat the polycarbonate filter. TEER for cells grown on collagen IV was close to that obtained with intact guinea pig gastric epithelium in vitro. Differentiation was assessed by incorporation of [ 3H]glucosamine into glycoprotein and by activity of NADPH oxidase, which produces superoxide. Both of these measures were greater for cells grown on filters coated with collagen I than for cells grown on plastic culture plates, but no major difference was found between cells grown on collagens I and IV. The proportion of cells, which stained positively for mucin with periodic acid Schiff reagent, was greater than 95% for all culture conditions. Monolayers grown on membranes coated with collagen IV exhibited apically polarized secretion of mucin and superoxide, and were resistant to acidification of the apical medium to pH 3.0 for 30 min. A screen of nonsteroidal anti-inflammatory drugs revealed a novel effect of diclofenac and niflumic acid in reversibly reducing permeability by the paracellular route. In conclusion, the mucous cell preparation grown on collagen IV represents a good model of the gastric surface epithelium suitable for screening procedures. © 2005 The Society for Biomolecular Screening.

Professional Services in the EU Internal Market: Quality Regulation and Self-Regulation, by T. Heremans (Oxford: Oxford University Press, 2012, ISBN 9781849462402); xxii+366pp., £75.00 hb.

Book review

Canadian province-building : the state as educator and entrepreneur in Alberta

This study provides an account and analysis of the development of systems of educational provision In capitalist democracies, especially in connection with the social origin and relative autonony of those systems. Using the case study of Athabasca University, a Canadian distance-education institution in the province of Alberta, the study is a critical work of historical sociology, in which the shifting social role of a system of educational provision during two transitions of a regional political economy is analyzed. Comparative observations are made in reference to other systems of educational provision and organizations, in particular the training department of a large Company based In the same region as the Unversity. The study explores the social origin and relative autonomy of systems of educational provision In relation to educational ideologies, which are themselves associated with social ideologies. Pierre Bourdieu's theoretical construction of "fields of power'' allows for a consideration of power as a relational phenomenon in the study. In other words, power is understood as being exercised in a way that simultaneously takes account of the power of other actors and groups. Fields of power also allow for an analysis of power as it is exercised at various levels of organizations and within society. The study is organized in two phases. First, an account is developed of the historical period in which the Unlversity and the Company were created, but especially the period of establishment for the Unlversity, 1970 - 75. Conclusions are offered concerning the causal associations between the historical antecedents that gave rise to the two organlzations. It is argued that both the University and the Company were established In part to enact the AIberta government's efforts to enhance Its powers within the Canadian federation (a process called province-building), The second phase is concerned with a more recent period of three years, 1993 - 95. By this time, province-building was not as significant a concern for policy-makers, and the organizational responses of the University and the Company reflected this shift. A divergence of practice is observed at the University and the Company, with actors at the Company encouraging the development of collectivist values for employees, while at the University no such overt strategy was followed, The study concludes that a consumerist model of education developed by the University in 1970 - 75 and expanded In 1993 - 95 contributed significantly to the institution's social origin and relative autonomy. The model was used as an Ideology in the earlier period and as a strategy In the later one, serving to forestall the institution's closure during both periods of crisis, though Ieading to ambiguous social outcomes. A consumerist model may on the one hand be progressive in that expanded access to educational opportunities is made possible. On the other hand, the consumerist model will tend increasingly to provide educational services to those social segments that already have access to educational opportunities.

Congestion pricing by priority auction

This paper analyzes a communication network facing users with a continuous distribution of delay cost per unit time. Priority queueing is often used as a way to provide differential services for users with different delay sensitivities. Delay is a key dimension of network service quality, so priority is a valuable resource which is limited and should to be optimally allocated. We investigate the allocation of priority in queues via a simple bidding mechanism. In our mechanism, arriving users can decide not to enter the network at all or submit an announced delay sensitive value. User entering the network obtains priority over all users who make lower bids, and is charged by a payment function which is designed following an exclusion compensation principle. The payment function is proved to be incentive compatible, so the equilibrium bidding behavior leads to the implementation of "cµ-rule". Social warfare or revenue maximizing by appropriately setting the reserve payment is also analyzed.

A wearable device for recording of biopotentials and body movements

Long term recording of biomedical signals such as ECG, EMG, respiration and other information (e.g. body motion) can improve diagnosis and potentially monitor the evolution of many widespread diseases. However, long term monitoring requires specific solutions, portable and wearable equipment that should be particularly comfortable for patients. The key-issues of portable biomedical instrumentation are: power consumption, long-term sensor stability, comfortable wearing and wireless connectivity. In this scenario, it would be valuable to realize prototypes using available technologies to assess long-term personal monitoring and foster new ways to provide healthcare services. The aim of this work is to discuss the advantages and the drawbacks in long term monitoring of biopotentials and body movements using textile electrodes embedded in clothes. The textile electrodes were embedded into garments; tiny shirt and short were used to acquire electrocardiographic and electromyographic signals. The garment was equipped with low power electronics for signal acquisition and data wireless transmission via Bluetooth. A small, battery powered, biopotential amplifier and three-axes acceleration body monitor was realized. Patient monitor incorporates a microcontroller, analog-to-digital signal conversion at programmable sampling frequencies. The system was able to acquire and to transmit real-time signals, within 10 m range, to any Bluetooth device (including PDA or cellular phone). The electronics were embedded in the shirt resulting comfortable to wear for patients. Small size MEMS 3-axes accelerometers were also integrated. © 2011 IEEE.

Impact of electric vehicles on GB electricity demand and associated benefits for system control

This paper investigates the impact that electric vehicle uptake will have on the national electricity demand of Great Britain. Data from the National Travel Survey, and the Coventry and Birmingham Low Emissions Demonstration (CABLED) are used to model an electrical demand profile in a future scenario of significant electric vehicle market penetration. These two methods allow comparison of how conventional cars are currently used, and the resulting electrical demand with simple substitution of energy source, with data showing how electric vehicles are actually being used at present. The report finds that electric vehicles are unlikely to significantly impact electricity demand in GB. The paper also aims to determine whether electric vehicles have the potential to provide ancillary services to the grid operator, and if so, the capacity for such services that would be available. Demand side management, frequency response and Short term Operating Reserve (STOR) are the services considered. The report finds that electric cars are unlikely to provide enough moveable demand peak shedding to be worthwhile. However, it is found that controlling vehicle charging would provide sufficient power control to viably act as frequency response for dispatch by the transmission system operator. This paper concludes that electric vehicles have technical potential to aid management of the transmission network without adding a significant demand burden. © 2013 IEEE.