The variability and predictors of quality of AIDS care services in Brazil

Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery.Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality.Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities.Conclusion: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).

Self-perception, complaints and vocal quality among undergraduate students enrolled in a Pedagogy course

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Service Innovation: the state of the art and a proposal of a research agenda

The service sector has acquired a growing importance in every country economy, which has stimulated research in the field of service innovation, a new field in management studies. This text aimed to state a research agenda upon service innovation, based on an articulated discussion of the results of several articles that compose the state of the art of this concept. 73 empirical articles were analyzed, 33% of them exploring the innovation strategies and technology; 18% of the articles describe research on economic performance and enterprise productivity; 16% are related to antecedents and determinants of innovation; another 16% about network capacity development, alliances and collaboration among organizations; 9% of the articles explore service quality, innovation taxonomy, flexible systems and regional systems of innovation; and another 8% are related to themes such as intensive knowledge, research and development. The researches were concentrated in the Engineering & Technology and Hospitality Industries, which accounted for 31% and 24% of the texts, respectively. The remaining 45% of the articles referred to sectors such as Telecommunications, Health, Retail, Financial & Insurance and Public Services. The main gaps identified in these texts refer to the difficulties on measuring service innovation, besides the small number of researches on the public sector. At the end, a research agenda in the subject is presented, including the development of a scale for orientating the innovation and identifying the determining factors of the innovation in the public environment.

Gauging food and nutritional care quality in hospitals

Background: Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods: Investigation of the Hospital Food and Nutrition Service (HFNS) of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ) and hospital food service quality (FSQ). HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results: Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02) and per dietitian (p < 0.01). The mean compliance with NCQ criteria in public and private institutions was 51.8% and 41.6%, respectively. The percentage of public and private health institutions in conformity with FSQ criteria was 42.4% and 49.1%, respectively. Most of the actions comprising each corpus, NCQ and FSQ, varied considerably between the two types of institution. NCQ was positively influenced by hospital type (general) and presence of a clinical dietitian. FSQ was affected by institution size: large and medium-sized hospitals were significantly better than small ones. Conclusions: Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

A novel monetary incentive for commercial P2P streaming

Today P2P faces two important challenges: design of mechanisms to encourage users’ collaboration in multimedia live streaming services; design of reliable algorithms with QoS provision, to encourage multimedia providers employ the P2P topology in commercial streaming services. We believe that these two challenges are tightly-related and there is much to be done with respect. This paper proposes a novel monetary incentive for P2P multimedia streaming. The incentive model classifies the users in groups according to the perceived video quality. We apply the model to a streaming system’s billing model in order to evaluate its feasibility and visualize its quantitative effect on the users’ motivation and the provider’s profit. We conclude that monetary incentive can boost up users’ cooperation, loyalty and enhance the overall system integrity and performance. Moreover the model defines the constraints for the provider’s cost and profit when the system is leveraged on the cloud. Considering those constraints, a multimedia content provider can adapt the billing model of his streaming service and achieve desirable discount-profit trade-off. This will moreover contribute to better promotion of the service, across the users on the Internet.

Quality cost in bus operations based on activity-based costing

The study of service quality and its implication for transport contracts has several approaches in research and practical applications, where the main emphasis is the consideration of quality from the user's point of view, thus obtaining a customer satisfaction index as a measurement of the overall quality with no further implications for service providers. The main aim of this paper is to estimate the real economic impact of improving quality attributes for a bus operator. An application of the activity-based costing methodology is developed for a bus contract in Madrid, using quality data from surveys together with economic and performance information, and focusing on headway as a quality variable. Results show the consistency and practicality of this methodology, overcoming simplifications from traditional procedures. This method is a powerful tool in quality-based contracting as well as for effective investment in transport quality under poverty funding constraints

Caracterización y análisis del coste de mejora de la calidad de servicio en transporte urbano en autobús, basado en la metodología ABC (activity based costing)

El estudio de la calidad de servicio en transporte público ha tenido distintos enfoques, tanto en la investigación como en sus aplicaciones prácticas, tales como el desarrollo del método SERVQUAL, los proyectos QUATTRO y EQUIP de la Comisión Europea, el Transit Capacity and Quality of Service Manual y finalmente el estándar EN 13816, siendo la consideración principal la calidad desde el punto de vista del usuario, es decir, la calidad percibida, cuyo objetivo en la práctica trata de obtener un Índice de Satisfacción del Cliente como medida de la calidad global. Esta aproximación deja de lado aspectos tanto sobre calidad suministrada como sobre los suministradores del servicio, las administraciones y los operadores, particularmente en cuanto a las implicaciones económicas. El objetivo principal de la presente tesis es la estimación del impacto económico real de la mejora de atributos de calidad para un operador de autobús urbano. En el capítulo 2, se lleva a cabo un análisis del estado del arte sobre el estudio de la calidad, tanto de los métodos de estudio, como de su aplicación al campo de transporte público, y, específicamente, del estudio de costes. En los capítulos 3 y 4 se propone la aplicación de la metodología ABC (Activity Based Costing) para el caso de un contrato de servicio de transporte público en autobús en la Comunidad de Madrid, concretamente la conexión de Tres Cantos. Para ello se utilizan datos de encuestas de calidad esperada y percibida por los usuarios, junto con información económica y de actividad, así como entrevistas a personal de la empresa, conformando todo ello una metodología compacta de investigación y análisis. Los resultados de las encuestas y los análisis posteriores identificaron la frecuencia de servicio, la puntualidad de los autobuses y la seguridad de la conducción como las tres variables mas importantes desde el punto de vista del usuario, y ha sido en referencia a estas tres variables sobre las que se ha desarrollado la aplicación del método ABC contenida en el capítulo 5. Los resultados descritos en el capítulo 6 muestran la consistencia y la aplicabilidad de esta metodología, superando las simplificaciones de los procedimientos tradicionales contables. En cuanto a los resultados obtenidos, se ha comprobado que una aproximación tradicional basada en costes por kilometro puede llegar a sobrevalorar los costes asociados a mejoras de calidad hasta tres veces los costes calculados según el método ABC. Finalmente en el capítulo 7 se recogen las principales conclusiones y se apuntan algunas líneas futuras de investigación basadas en mejoras sobre la aplicación y transferibilidad de los resultados. The study of service quality and its implication for transport contracts has several approaches in research and practical applications, such as the development of the SERVQUAL method, the UE QUATTRO and EQUIP research projects, the Transit Capacity and Quality of Service Manual and finally the EN 13816 standard. In all cases the main stream is the consideration of quality from the user’s point of view, thus obtaining a Customer Satisfaction Index as a measurement of the overall service quality. This approach ignores quality consequences for transport providers, authorities and operators, particularly economic implications. The main target of this thesis is to estimate the real economic impact of improving quality attributes for a bus operator. Chapter 2 includes a thorough analysis of the state of the art of general methodologies on service quality, their applications for public transport, and particularly for quality costing. In chapters 3 and 4, the Activity Based Costing (ABC) methodology is proposed for a suburban bus contract in Madrid, Tres Cantos. Perceived and expected quality surveys are used together with economic and performance information, as well as interviews with key staff from the operator. The whole set of surveys, interviews and ABC methodology puts together a comprehensive approach for analysis and research. Surveys and subsequent analysis shows service headway, punctuality and safety as the three most important service attributes from the user’s point of view. The proposed methodology has been applied to these three variables, as described in chapter 5. Results obtained in chapter 6 show the consistency and practicality of this methodology, overcoming simplifications from traditional accounting procedures. According to the latter, a calculation of costs based on mileage can overvalue quality improvements up to three times the results following ABC methodology. Finally, in chapter 7, the main conclusions are highlighted and some future research is suggested in terms of application improvements as well as results transferability.

Modelo multivariante de evolución en el tiempo de la calidad percibida en la educación superior

Las instituciones de educación superior deben gestionar eficaz y eficientemente sus procesos de captación de nuevos estudiantes, y con este objetivo necesitan mejorar su comprensión sobre los antecedentes que inciden en la intención de recomendarlas. Por lo que esta Tesis Doctoral se centra en el estudio y análisis de las componentes de la calidad del servicio de la educación superior, como antecedentes de la intención de recomendación de una institución universitaria. El enfoque que se adopta en esta investigación integra las dimensiones de calidad docente y de calidad de servicio e incorpora en el análisis la valoración global de la carrera. Paralelamente se contempla la moderación de la experiencia y el desempeño académico del estudiante. En esta Tesis Doctoral se hace uso de la Encuesta de Calidad de la Universidad ORT Uruguay cedida a los autores para su explotación con fines de investigación. Los estudiantes cumplimentan la encuesta semestralmente con carácter obligatorio en una plataforma en línea autoadministrada, que permite identificar las valoraciones realizadas por los estudiantes a lo largo de su paso por la universidad. Por lo que la base de datos es un panel no balanceado que consta de 195.058 registros obtenidos, a partir de 7.077 estudiantes en 17 semestres (marzo de 2003 a 2011). La metodología se concreta en los Modelos de Ecuaciones Estructurales, que proporciona una serie de ventajas con respecto a otras aproximaciones. Una de las más importantes es que permite al investigador introducir información a priori y valorar su inclusión, además de reformular las modelizaciones propuestas desde una perspectiva multi-muestra. En esta investigación se estiman los modelos con MPLUS 7. Entre las principales conclusiones de esta Tesis Doctoral cabe señalar que las percepciones de calidad, servicio, docencia y carrera, inciden positivamente en la intención de recomendar la universidad, y que la variable experiencia del estudiante modera dichas relaciones. Los resultados señalan, en general, que a medida que los estudiantes avanzan en su carrera, los efectos totales de la percepción de la calidad del servicio en la calidad global de la carrera y en la intención de recomendar la universidad son mayores que los efectos que tiene la percepción de calidad de la docencia. Estos hallazgos señalan la necesidad que tienen estas instituciones de educación superior de incorporar en su planificación estratégica la segmentación de los estudiantes según su experiencia. ABSTRACT For institutions of higher education to effectively and efficiently manage their processes for attracting new students, they need to understand the influences that activate student intentions to recommend a program and/or college. This Thesis describes research identifying the quality components of a university that serve as antecedents of student intentions to recommend. The research design integrates teaching and service dimensions of higher education, as well as measures of student perceptions of the overall quality of a program. And introduces the student quality and student experience during the program as moderators of these relationships. This Thesis makes use of the Quality Survey of the Universidad ORT Uruguay ceded to the authors for their exploitation for research purposes. The students complete the survey each semester in a self-administered online platform, which allows to identify the assessments conducted by the students throughout its passage by the university. So that the database is an unbalanced panel consisting of 195.058 records obtained from 7.077 students in 17 semesters (march 2003 to 2011). The methodology of analysis incorporated Simultaneous Equation Models, which provides a number of advantages with respect to other approaches. One of the most important is that it allows the researcher to introduce a priori information and assess its inclusion, in addition to reformulate the modellings proposals with a multi-sample approach. In this research the models are estimated with MPLUS 7. Based on the findings, student perceptions of quality, service, teaching and program, impact positively the intent to recommend the university, but the student’s experience during the program moderates these relationships. Overall, the results indicate that as students advance in the program, the full effects of the perception of service quality in the overall quality of the program and in the intention to recommend the university, outweigh the effects of the perceived teaching quality. The results indicate the need for institutions of higher education to incorporate in its strategic planning the segmentation of the students according to their experience during the program.

Service Science

Service Science is an emerging interdisciplinary field to systematically improve the design and innovation of service. Although many of the concepts used in service science have been around for some decades, this term is usually associated with an initiative called Service Science, Management, and Engineering (SSME), led by IBM in the first half of the 2000s to advance service research and education (in this entry, Service Science and SSME are considered synonymous, but the shorter term will be used here). Service Science is receiving growing attention due to the rising importance of service industries in world economies. The relevance of this topic is also justified because it helps organizations improve service performance, including service quality. This entry describes the key drivers, analyzes the evolution, examines the theoretical underpinnings, and defines Service Science. It concludes with a brief discussion of the challenges facing Service Science.

Understanding service experience in non-profit performing arts: Implications for operations and service management

Recent research in the non-profit performing arts has shown that marketing efforts designed to increase revenue from ticket sales are not achieving the results required to sustain the performing arts. This paper applies operations management analytical techniques to the non-profit performing arts to increase understanding of operational issues and inform service management strategy. The paper takes a two-study idiographic approach. Implementing a modified version of service transaction analysis (STA), Study One describes a performing arts service from provider and customer perspectives, identifies service gaps and develops an elaborated service description incorporating both perspectives. In Study Two, building on the elaborated service description and extant research, in-depth interviews are conducted to gather thick descriptions of predictors of satisfaction, value and service quality as they relate to repurchase intention (RI). Technical, functional and critical factors required to improve organizational performance are identified. Implications for operational strategy, service design and service management theory for this context are discussed. (c) 2005 Published by Elsevier B.V.

Human resource management and organizational performance:evidence from the retail banking sector

Underpinned by the resource-based view (RBV), social exchange theory (SET), and a theory of intrinsic motivation (empowerment), I proposed and tested a multi-level model that simultaneously examines the intermediate linkages or mechanisms through which HPWS impact individual and organizational performance. First and underpinned by RBV, I examined at the unit level, collective human capital and competitive advantage as path-ways through which the use of HPWS influences – branch market performance. Second and-, underpinned by social exchange (perceived organizational support) and intrinsic motivation (psychological empowerment) theories, I examined cross and individual level mechanisms through which experienced HPWS may influence employee performance. I tested the propositions of this study with multisource data obtained from junior and senior customer contact employees, and managers of 37 branches of two banks in Ghana. Results of the Structural Equation Modeling (SEM) analysis revealed that (i) collective human capital partially mediated the relationship between management-rated HPWS and competitive advantage, while competitive advantage completely mediated the influence of human capital on branch market performance. Consequently, management-rated HPWS influenced branch market performance indirectly through collective human capital and competitive advantage. Additionally, results of hierarchical linear modeling (HLM) tests of the cross-level influences on the motivational implications of HPWS revealed that (i) management-rated HPWS influenced experienced HPWS; (ii) perceived organizational support (POS) and psychological empowerment fully mediated the influence of experienced HPWS on service-oriented organizational citizenship behaviour (OCB), and; (iii) service-oriented OCB mediated the influence of psychological empowerment and POS on service quality and task performance. I discuss the theoretical and practical implications of these findings.

Managing healthcare quality using logical framework analysis

Purpose - The purpose of this paper is to develop an integrated quality management model that identifies problems, suggests solutions, develops a framework for implementation and helps to evaluate dynamically healthcare service performance. Design/methodology/approach - This study used the logical framework analysis (LFA) to improve the performance of healthcare service processes. LFA has three major steps - problems identification, solution derivation, and formation of a planning matrix for implementation. LFA has been applied in a case-study environment to three acute healthcare services (Operating Room utilisation, 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 study shows LFA application in three service processes in one hospital. This very limited population sample needs to be extended. Practical implications - The proposed model can be implemented in hospital-based healthcare services in order to improve performance. It may also be applied to other services. Originality/value - 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 healthcare delivery, they are not without flaws. There is an absence of an integrated approach, which can identify and analyse issues, provide solutions to resolve those issues, develop a project management framework to implement those solutions. This study introduces an integrated and uniform quality management tool for healthcare services. © Emerald Group Publishing Limited.

Exploring value through integrated service solutions:the case of e-grocery shopping

Purpose – The purpose of this paper is to demonstrate the need for an improved understanding of consumer value for online grocery purchases and to propose the notion of “integrated service solution” packages as a strategy for growing and successfully sustaining the channel to guide both marketing strategy and policy. Design/methodology/approach – This paper integrates and synthesises research from retailing, consumer behaviour and service quality literatures in order to develop a conceptual framework for understanding the value of e-grocery shopping to aid practitioners to address the critical needs, expectations and concerns of consumers for the development of grocery shopping within the online environment. Findings – This paper offers an alternative approach to allow e-grocery to become a mainstream retail channel in its own right and not to compete with the in-store offerings. The research demonstrates the need for a progressive approach that follows contemporary consumer needs and habits at the household level. The conjecture is that shopping for fast-moving consumer goods follows a learning path that needs to be replicated in the online context. Moreover, it is suggested that consumer resistance to the adoption of the new channel should be addressed not only from a technological perspective but also from the social aspects of online shopping. Originality/value – The research provides a practical framework for both retailers and policy makers on how the “next generation” of online services can be developed using a “bottom up” consumer perspective. This paper also advocates a non-technological bias to e-grocery retailing strategy.

An investigation into the antecedents of prosocial service behaviours : a travel service context

Frontline employee (FLE) attitudes and behaviours during service encounters influence customers’ perceptions of service quality and customer satisfaction. The identification of variables that influence FLEs service behaviours is, therefore, important. Much remains unknown about the factors affecting prosocial service behaviours (PSBs). This thesis answers the following questions: What are the antecedents of PSBs in a travel service setting? It is argued that managerial strategies indirectly influence PSBs via their direct influence on job attitudes. This thesis represents an attempt towards an increased knowledge about the antecedents of PSBs by seeking answers to the question. A conceptual model was developed from the literature. Briefly stated, the hypothesised model proposed that job attitudes mediate the relationship between managerial strategies and the PSBs. In-depth interviews provided initial support for the conceptual model. Structural equation modelling techniques were then used to test these relationships on data from 179 travel service employees. Partial support for the mediational role of job attitudes was found. More specifically, the relationship between professional development and extra-role customer service is mediated by job satisfaction and organisational commitment, but not in-role customer service and cooperation. The managerial strategies influence PSBs directly. Internal communication influences extra- and in-role customer service behaviours positively. The relationship between professional development and the three PSBs constructs is negative. Empowerment influences in-role customer service and cooperative behaviours positively.

The antecedents of prosocial service behaviours:an empirical investigation

Frontline employee attitudes and behaviours during service encounters influence customers' perceptions of service quality. For this reason, the identification of variables that influence service behaviours is important. Much remains unknown about the factors affecting service behaviours in service settings. This study investigates service employees' attitudinal (job satisfaction and organisational commitment) and behavioural (prosocial service behaviours) responses to management strategies (internal communication, professional development and empowerment). One hundred and eighty-eight service employees contributed data, which were analysed using a structural modelling methodology. The authors found that management strategies influence service behaviours directly but the mediating role of job attitudes is not supported.