Measuring the operational performance of intensive care units using the analytic hierarchy process approach

Purpose - The purpose of this study is to develop a performance measurement model for service operations using the analytic hierarchy process approach. Design/methodology/approach - The study reviews current relevant literature on performance measurement and develops a model for performance measurement. The model is then applied to the intensive care units (ICUs) of three different hospitals in developing nations. Six focus group discussions were undertaken, involving experts from the specific area under investigation, in order to develop an understandable performance measurement model that was both quantitative and hierarchical. Findings - A combination of outcome, structure and process-based factors were used as a foundation for the model. The analyses of the links between them were used to reveal the relative importance of each and their associated sub factors. It was considered to be an effective quantitative tool by the stakeholders. Research limitations/implications - This research only applies the model to ICUs in healthcare services. Practical implications - Performance measurement is an important area within the operations management field. Although numerous models are routinely being deployed both in practice and research, there is always room for improvement. The present study proposes a hierarchical quantitative approach, which considers both subjective and objective performance criteria. Originality/value - This paper develops a hierarchical quantitative model for service performance measurement. It considers success factors with respect to outcomes, structure and processes with the involvement of the concerned stakeholders based upon the analytic hierarchy process approach. The unique model is applied to the ICUs of hospitals in order to demonstrate its effectiveness. The unique application provides a comparative international study of service performance measurement in ICUs of hospitals in three different countries. © Emerald Group Publishing Limited.

Strategic and operational risk in an international collaboration agency: a knowledge management solution

The International Cooperation Agency (identified in this article as IDEA) working in Colombia is one of the most important in Colombian society with programs that support gender rights, human rights, justice and peace, scholarships, aboriginal population, youth, afro descendants population, economic development in communities, and environmental development. The identified problem is based on the diversified offer of services, collaboration and social intervention which requires diverse groups of people with multiple agendas, ways to support their mandates, disciplines, and professional competences. Knowledge creation and the growth and sustainability of the organization can be in danger because of a silo culture and the resulting reduced leverage of the separate group capabilities. Organizational memory is generally formed by the tacit knowledge of the organization members, given the value of accumulated experience that this kind of social work implies. Its loss is therefore a strategic and operational risk when most problem interventions rely on direct work in the socio-economic field and living real experiences with communities. The knowledge management solution presented in this article starts first, with the identification of the people and groups concerned and the creation of a knowledge map as a means to strengthen the ties between organizational members; second, by introducing a content management system designed to support the documentation process and knowledge sharing process; and third, introducing a methodology for the adaptation of a Balanced Scorecard based on the knowledge management processes. These three main steps lead to a knowledge management “solution” that has been implemented in the organization, comprising three components: a knowledge management system, training support and promotion of cultural change.

Comprehensive human urine standards for comparability and standardization in clinical proteome analysis

Urine proteomics is emerging as a powerful tool for biomarker discovery. The purpose of this study is the development of a well-characterized "real life" sample that can be used as reference standard in urine clinical proteomics studies.

An operational approach to object-oriented software development

The traditional waterfall software life cycle model has several weaknesses. One problem is that a working version of a system is unavailable until a late stage in the development; any omissions and mistakes in the specification undetected until that stage can be costly to maintain. The operational approach which emphasises the construction of executable specifications can help to remedy this problem. An operational specification may be exercised to generate the behaviours of the specified system, thereby serving as a prototype to facilitate early validation of the system's functional requirements. Recent ideas have centred on using an existing operational method such as JSD in the specification phase of object-oriented development. An explicit transformation phase following specification is necessary in this approach because differences in abstractions between the two domains need to be bridged. This research explores an alternative approach of developing an operational specification method specifically for object-oriented development. By incorporating object-oriented concepts in operational specifications, the specifications have the advantage of directly facilitating implementation in an object-oriented language without requiring further significant transformations. In addition, object-oriented concepts can help the developer manage the complexity of the problem domain specification, whilst providing the user with a specification that closely reflects the real world and so the specification and its execution can be readily understood and validated. A graphical notation has been developed for the specification method which can capture the dynamic properties of an object-oriented system. A tool has also been implemented comprising an editor to facilitate the input of specifications, and an interpreter which can execute the specifications and graphically animate the behaviours of the specified systems.

New insights on measuring bank branches efficiency through DEA:transactional, operational, and profit assessments

This thesis presents a number of methodological developments that were raised by a real life application to measuring the efficiency of bank branches. The advent of internet banking and phone banking is changing the role of bank branches from a predominantly transaction-based one to a sales-oriented role. This fact requires the development of new forms of assessing and comparing branches of a bank. In addition, performance assessment models must also take into account the fact that bank branches are service and for-profit organisations to which providing adequate service quality as well as being profitable are crucial objectives. This study analyses bank branches performance in their new roles in three different areas: their effectiveness in fostering the use of new transaction channels such as the internet and the telephone (transactional efficiency); their effectiveness in increasing sales and their customer base (operational efficiency); and their effectiveness in generating profits without compromising the quality of service (profit efficiency). The chosen methodology for the overall analysis is Data Envelopment Analysis (DEA). The application attempted here required some adaptations to existing DEA models and indeed some new models so that some specialities of our data could be handled. These concern the development of models that can account for negative data, the development of models to measure profit efficiency, and the development of models that yield production units with targets that are nearer to their observed levels than targets yielded by traditional DEA models. The application of the developed models to a sample of Portuguese bank branches allowed their classification according to the three performance dimensions (transactional, operational and profit efficiency). It also provided useful insights to bank managers regarding how bank branches compare between themselves in terms of their performance, and how, in general, the three performance dimensions are connected between themselves.

Differences between theoretical predictions and operational performance in a stock control application

Over the past decade, several experienced Operational Researchers have advanced the view that the theoretical aspects of model building have raced ahead of the ability of people to use them. Consequently, the impact of Operational Research on commercial organisations and the public sector is limited, and many systems fail to achieve their anticipated benefits in full. The primary objective of this study is to examine a complex interactive Stock Control system, and identify the reasons for the differences between the theoretical expectations and the operational performance. The methodology used is to hypothesise all the possible factors which could cause a divergence between theory and practice, and to evaluate numerically the effect each of these factors has on two main control indices - Service Level and Average Stock Value. Both analytical and empirical methods are used, and simulation is employed extensively. The factors are divided into two main categories for analysis - theoretical imperfections in the model, and the usage of the system by Buyers. No evidence could be found in the literature of any previous attempts to place the differences between theory and practice in a system in quantitative perspective nor, more specifically, to study the effects of Buyer/computer interaction in a Stock Control system. The study reveals that, in general, the human factors influencing performance are of a much higher order of magnitude than the theoretical factors, thus providing objective evidence to support the original premise. The most important finding is that, by judicious intervention into an automatic stock control algorithm, it is possible for Buyers to produce results which not only attain but surpass the algorithmic predictions. However, the complexity and behavioural recalcitrance of these systems are such that an innately numerate, enquiring type of Buyer needs to be inducted to realise the performance potential of the overall man/computer system.

Professionals' awareness of operational antibiotic prescribing controls in UK NHS hospitals

In recent years, there have been increasing recommendations for multidisciplinary collaboration between clinical pharmacists and medical microbiologists in an attempt to control the quality (and quantity) of antibiotic prescribing. A questionnaire addressing the utilization of antibiotic prescribing controls was sent to the chief pharmacist and medical microbiologist in UK NHS hospitals. Responses were received from both the chief pharmacist and the medical microbiologist employed in the same hospital from 83 hospitals (a 30% response rate from two independent studies). A high level of disagreement and poor awareness was identified between the interprofessional staff groups regarding the existence of antibiotic formulary (with disagreement between the two groups, or not known by one or both respondents, in 46% of the paired hospitals, N=38) and guideline documents (13%, N=11), performance of antibiotic prescribing audits (40%, N=33), and whether pharmacists (52%, N=43) and medical microbiologists (77%, N=64) monitored physician compliance with antibiotic prescribing control documents. This study has identified poor knowledge of the existence of basic antibiotic prescribing control mechanisms and the role of professional colleagues. It is suggested that there is some way to go before 'Agenda for Change' principles of flexible and collaborative roles are met. © 2004 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.

The micro-politics of operational adjustment:veto players and the consolidation of demand in the NHS

Recent reports about procurement within the NHS have been highly critical. One problem identified in the reports is the fragmentation of NHS demand across an unnecessarily large number of suppliers. This fragmentation is said to increase transaction costs, reduce opportunities for scale economies and reduce NHS leverage over suppliers. It has been suggested, therefore, that an important way of improving procurement in the NHS is the better consolidation of demand with a lower number of preferred suppliers. However, such a policy, because it will create ‘winners’ and ‘losers’ within NHS organisations, has political as well as technical and practical ramifications. In this article, the authors present a model, the Veto Players Model, in order to assist managers to address these political ramifications. In the article, the authors not only demonstrate the utility of this model with regard to demand consolidation policies, but also argue that the model provides useful lessons for change management initiatives more generally.