The impact of leadership and quality climate on hospital performance

Objective. To explore the relationship between leadership effectiveness and health-care trust performance, taking into account external quality measures and the number of patient complaints; also, to examine the role of care quality climate as a mediator. Design. We developed scales for rating leadership effectiveness and care quality climate. We then drew upon UK national indices of health-care trust performance—Commission for Health Improvement star ratings, Clinical Governance Review ratings and the number of patient complaints per thousand. We conducted statistical analysis to examine any significant relationships between predictor and outcome variables. Setting. The study is based on 86 hospital trusts run by the National Health Service (NHS) in the UK. The data collection is part of an annual staff survey commissioned by the NHS to explore the quality of working life. Participants. A total of 17 949 employees were randomly surveyed (41% of the total sample). Results. Leadership effectiveness is associated with higher Clinical Governance Review ratings and Commission for Health Improvement star ratings for our sample (ß = 0.42, P < 0.05; ß = 0.37, P < 0.05, respectively), and lower patient complaints (ß = –0.57, P < 0.05). In addition, 98% of the relationship between leadership and patient complaints is explained by care quality climate. Conclusions. Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area—patient complaints—may be a valid measure to consider when assessing leadership and quality in a health-care context.

Strategies for performance improvement in the Chinese chemical industry:evidence from case study investigations

Purpose – This paper sets out to explore the proposition that building competences is more effective than privatisation and restructuring to improve performance in the Chinese chemical industry. Design/methodology/approach – Case study research has been undertaken in the Chinese chemical industry. The two case companies provide representative data on the factors under investigation. The case investigations that are described were complemented by a survey, the results of which have been reported elsewhere. Findings – Results obtained from the research show that privatisation of Chinese state-owned enterprises is not always an effective strategy to improve performance. In the case study companies, the development of core competences was more effective in enhancing performance. Research limitations/implications – The research results are limited by the scope of the study, which was carried out in the Chinese chemical industry. They are also based on in-depth case investigations in only two companies, but are supported by a large-scale survey reported elsewhere. The results have implications for academic researchers interested in China's privatisation programme. Practical implications – The research has practical implications for companies outside China that are considering collaborative operations with Chinese companies or investing in joint ventures. It also has implications for suppliers or customers of Chinese companies. Originality/value – The paper is based on original case study investigations carried out in Chinese enterprises and is supported by a survey of representative companies in China's chemical sector. Value is derived from understanding the basis of improved performance in the companies studied.

Measurement of hospital performance

The rationale for carrying out this research was to address the clear lack of knowledge surrounding the measurement of public hospital performance in Ireland. The objectives of this research were to develop a comprehensive model for measuring hospital performance and using this model to measure the performance of public acute hospitals in Ireland in 2007. Having assessed the advantages and disadvantages of various measurement models the Data Envelopment Analysis (DEA) model was chosen for this research. DEA was initiated by Charnes, Cooper and Rhodes in 1978 and further developed by Fare et al. (1983) and Banker et al. (1984). The method used to choose relevant inputs and outputs to be included in the model followed that adopted by Casu et al. (2005) which included the use of focus groups. The main conclusions of the research are threefold. Firstly, it is clear that each stakeholder group has differing opinions on what constitutes good performance. It is therefore imperative that any performance measurement model would be designed within parameters that are clearly understood by any intended audience. Secondly, there is a lack of publicly available qualitative information in Ireland that inhibits detailed analysis of hospital performance. Thirdly, based on available qualitative and quantitative data the results indicated a high level of efficiency among the public acute hospitals in Ireland in their staffing and non pay costs, averaging 98.5%. As DEA scores are sensitive to the number of input and output variables as well as the size of the sample it should be borne in mind that a high level of efficiency could be as a result of using DEA with too many variables compared to the number of hospitals. No hospital was deemed to be scale efficient in any of the models even though the average scale efficiency for all of the hospitals was relatively high at 90.3%. Arising from this research the main recommendations would be that information on medical outcomes, survival rates and patient satisfaction should be made publicly available in Ireland; that despite a high average efficiency level that many individual hospitals need to focus on improving their technical and scale efficiencies, and that performance measurement models should be developed that would include more qualitative data.

Performance improvement of asymmetrical filtered 40GB/s RZ-DPSK receiver design-strong filtering considerations

We present a novel differential phase shift keying receiver design under strong optical filtering. The receiver design is based on asymmetrical filtering at the destructive port of the Mach Zehnder Interferometer. The asymmetrical filtered receiver design can significantly increase performance by 2 to 4.7dB in calculated "Q".

Performance improvement of asymmetrical filtered 40GB/s RZ-DPSK receiver design-strong filtering considerations

We present a novel differential phase shift keying receiver design under strong optical filtering. The receiver design is based on asymmetrical filtering at the destructive port of the Mach Zehnder Interferometer. The asymmetrical filtered receiver design can significantly increase performance by 2 to 4.7dB in calculated "Q".

Hospital performance:efficiency or quality? Can we have both with IT?

The influence of IT investment on hospital efficiency and quality are of great interest to healthcare executives as well as insurers. Few studies have examined how IT investments influence both efficiency and quality or whether there is an optimal IT investment level that influences both in the desired direction. Decision makers in healthcare wonder if there are tradeoffs between their pursuit of hospital operational efficiency and quality. Our study involving a 2-stage double bootstrap DEA analysis of 187 US hospitals over 2. years found direct effects of IT investment upon service quality and a moderating effect of quality upon operational efficiency. Further, our findings indicate a U-shaped relationship between IT investments and operational efficiency suggesting that IT investments have diminishing returns beyond a certain point.

Introduction to performance improvement management software (PIM-DEA)

This chapter provides information on the use of Performance Improvement Management Software (PIMDEA). This advanced DEA software enables users to make the best possible analysis of the data, using the latest theoretical developments in Data Envelopment Analysis (DEA). PIM-DEA software gives full capacity to assess efficiency and productivity, set targets, identify benchmarks, and much more, allowing users to truly manage the performance of organizational units. PIM-DEA is easy to use and powerful, and it has an extensive range of the most up-to-date DEA models and which can handle large sets of data.

Transmission performance improvement using random DFB laser based Raman amplification and bidirectional second-order pumping

We demonstrate that a distributed Raman amplification scheme based on random distributed feedback (DFB) fiber laser enables bidirectional second-order Raman pumping without increasing relative intensity noise (RIN) of the signal. This extends the reach of 10 × 116 Gb/s DP-QPSK WDM transmission up to 7915 km, compared with conventional Raman amplification schemes. Moreover, this scheme gives the longest maximum transmission distance among all the Raman amplification schemes presented in this paper, whilst maintaining relatively uniform and symmetric signal power distribution, and is also adjustable in order to be highly compatible with different nonlinearity compensation techniques, including mid-link optical phase conjugation (OPC) and nonlinear Fourier transform (NFT).

Performance improvement of broadband distributed Raman amplifier using bidirectional pumping with first and dual order forward pumps

In this paper, a new bidirectional pumping scheme with dual order forward pumps is proposed. Performance is compared numerically with conventional bidirectional and backward only pumping schemes for a 70 nm bandwidth, 61.5 km distributed Raman amplifier. We demonstrate that it is possible to design a flat gain spectrum with improved noise figure and OSNR, as well as a low gain ripple (<1 dB).

Improving performance? The adoption and implementation of quality systems in U.K. nonprofits

There are increasing and multiple pressures on nonprofit organizations to demonstrate excellence in performance. Although there is a growing literature on the various approaches to performance improvement taken by nonprofits, little is known about the processes involved in the adoption and implementation of specific approaches. This article is about the adoption and use of one approach to performance improvement, quality systems, in the U.K. nonprofit sector. We report findings about factors that encourage nonprofits to adopt quality systems. We also analyze the distinctive challenges of implementing quality approaches in a nonprofit sector context and suggest critical success factors. The article concludes with a discussion of the organizational and policy implications of applying the management concepts of quality and performance to the nonprofit sector.

The influence of tool geometry on the performance of drilling tools

The main objective of the work presented in this thesis is to investigate the two sides of the flute, the face and the heel of a twist drill. The flute face was designed to yield straight diametral lips which could be extended to eliminate the chisel edge, and consequently a single cutting edge will be obtained. Since drill rigidity and space for chip conveyance have to be a compromise a theoretical expression is deduced which enables optimum chip disposal capacity to be described in terms of drill parameters. This expression is used to describe the flute heel side. Another main objective is to study the effect on drill performance of changing the conventional drill flute. Drills were manufactured according to the new flute design. Tests were run in order to compare the performance of a conventional flute drill and non conventional design put forward. The results showed that 50% reduction in thrust force and approximately 18% reduction in torque were attained for the new design. The flank wear was measured at the outer corner and found to be less for the new design drill than for the conventional one in the majority of cases. Hole quality, roundness, size and roughness were also considered as a further aspect of drill performance. Improvement in hole quality is shown to arise under certain cutting conditions. Accordingly it might be possible to use a hole which is produced in one pass of the new drill which previously would have required a drilled and reamed hole. A subsidiary objective is to design the form milling cutter that should be employed for milling the foregoing special flute from drill blank allowing for the interference effect. A mathematical analysis in conjunction with computing technique and computers is used. To control the grinding parameter, a prototype drill grinder was designed and built upon the framework of an existing cincinnati cutter grinder. The design and build of the new grinder is based on a computer aided drill point geometry analysis. In addition to the conical grinding concept, the new grinder is also used to produce spherical point utilizing a computer aided drill point geometry analysis.

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.