Toimintaprosessin kehittäminen sairaalaympäristössä teollisuustalouden menetelmin

Työn tavoitteena on tutkia reaaliaikaisen sanelunpurun vaikuttavuutta ja kannattavuutta. Reaaliaikaisen sanelunpurun vaikuttavuuden tarkastelun pohjana käytetään teollisuustalouden puolella tunnettuja ja yrityksissä laajasti käytössä olevia ajatusmalleja, kuten Leania ja Six Sigmaa. Lean –ajattelu perustuu läpimenoajan nopeuttamiseen, hukkaa ja ei lisäarvoa luovien vaiheiden eliminoimisella. Six Sigma keskittyy taas laatuun, jolloin tuote ja palveluvirheitä karsitaan. Lisäksi teoriaosassa käsitellään palveluiden ulkoistamista, tietosuojaa ja palkkakustannusten rakennetta. Empiriaosassa kuvataan kirurgianpoliklinikan ja leikkausosaston prosesseja. Prosesseissa keskitytään nykytilan sekä reaaliaikaisen sanelunpurun vaikutuksiin. Prosessien kuvaamisella saadaan tietoa toiminnan ongelmista ja kehittämiskohteista. Henkilökunnan haastatteluin selvitettiin sanelujonon vaikutuksia sekä kokemuksia ulkoistamisesta. Kustannusanalyysin avulla selvitettiin ulkoistamisen kannattavuutta reaaliaikaisessa sanelunpurussa. Työn tuloksena saatiin vaikuttavuus tarkastelu reaaliaikaisesta sanelunpurusta sekä ulkoistamisen kannattavuudesta. Prosessien kuvaaminen osoittaa, että useissa prosessin eri vaiheissa sanelujen puuttuminen aiheuttaa kustannuksia ja vaikuttaa henkilökunnan työhön. Kustannusanalyysin pohjalta sanelunpurun ulkoistaminen todettiin kannattavaksi. Jatkossa sanelunpurun ulkoistamisessa tulee kiinnittää huomiota siihen, mitkä osat sanelunpurkuprosessista halutaan ulkoistaa. Sähköisten järjestelmien kehittyminen vaikuttaa osaltaan tähän päätökseen. Lisäksi suoritepohjaisen hinnoittelun kehittäminen on tärkeä osa sanelunpurkuprosessin tehokkuutta.

Configuring Health Care Services - Service Control Improvement

The costs of health care are increasing, and at the same time, population is aging. This leads health care organizations to focus more on home based care services. This thesis focuses on the home care organization of the South Karelian District of Social and Health Services (Eksote), which was established in 2010; how its operation is organized and managed, and which problem types are faced in the daily operation of home care. This thesis examines home care services through an extensive interview study, process mapping and statistical data analysis. To be able to understand the nature of services and special environment theory models, such as service management and performance measurement, service processes and service design are introduced. This study is conducted from an external researcher‟s point of view and should be used as a discussion opener. The outcome of this thesis is an upper level development path for Eksote home care. The organization should evaluate and build a service offering, then productize home care services and modularize the products and identify similarities. Service processes should be mapped to generate efficiency for repeating tasks. Units should be reasonably sized and geographically located to facilitate management and operation. All this can be done by recognizing the different types of service products: runners repeaters and strangers. Furthermore, the organization should not hide behind medical issues and should understand the legislative, medical and operational frameworks in health care.

Globaalin taloushallinnon palvelukeskuksen perustaminen, mahdollisuudet ja haasteet

Tutkimuksen tavoitteena on tutkia globaalin taloushallinnon palvelukeskuksen perustamisprosessia ja palvelukeskusmalliin liittyviä hyötyjä. Tarkoituksena on määrittää palvelukeskuksen perustamiseen liittyvät vaiheet sekä ne kriittiset tekijät, jotka on huomioitava ennen perustamisprosessia sekä sen aikana. Empiirinen osuus on suoritettu kvalitatiivisena tutkimuksena suorittamalla neljä puolistrukturoitua teemahaastattelua globaalin taloushallinnon palvelukeskuksen perustaneissa organisaatioissa. Tutkimustulokset osoittavat, että merkittävimmät palvelukeskusmalliin liitetyt edut ovat tuottavuuden, tehokkuuden ja laadun paraneminen sekä kustannussäästöt. Kriittisimpiä menestystekijöitä ovat muutoksen suunnitteluun ja hallintaan liittyvät tekijät. Malliin liitetyt haasteet liittyvät pääasiassa globaalin toimintaympäristön monimuotoisuuteen, henkilöstöön, teknologiaan ja prosesseihin. Saadut tulokset ovat erittäin yhteneväisiä aikaisempien tutkimusten kanssa. Empiirisen tutkimuksen tulosten sekä aikaisemman tutkimustiedon perusteella on luotu viisivaiheinen malli globaalin taloushallinnon palvelukeskuksen perustamisprosessista.

Roadmap for Service Charging Development

Corporate support functions are increasingly being concentrated into service centers. Service Management principles guide companies in the transition. Service Financial Management is an integral part in supporting the strategic positioning of the service center. The main goal of this thesis is to create a step-by-step plan to improve and automate the service charging processes for the finance service function of the case company. Automating the service transaction data collection for reporting is expected to improve efficiency, reliability and transparency. Interviews with finance service managers are held to define current processes and areas for improvement. These create the basis for the creation of a development roadmap that takes place in two phases. The first phase is to create an environment where automation is possible, and the second phase is the automation of each finance service. Benchmarking interviews are held with the service centers in three other companies to discover best practices. The service charging processes between the studied companies are found incompatible, and suggestions for process automation cannot be inferred. Some implications of Service Financial Management decisions to the strategy of the service center are identified. The bundling of services and charging them inside or outside of the goal-setting frame of the business unit can be used to support the strategic choice and customer acceptance of the service center.

Service provider switching: a study on the switching process in retail banking

In a business environment that is characterized by intense competition, building customer loyalty has become a key area of focus for most financial institutions. The explosion of the services sector, changing customer demographics and deregulation and emergence of new technology in the financial services industry have had a critical impact on consumers’ financial services buying behaviour. The changes have forced banks to modify their service offerings to customers so as to ensure high levels of customer satisfaction and also high levels of customer retention. Banks have historically had difficulty distinguishing their products from one another because of their relative homogeneity; with increasing competition,the problem has only intensified with no coherent distinguishing theme. Rising wealth, product proliferation, regulatory changes and newer technologies are together making bank switching easier for customers. In order to remain competitive, it is important for banks to retain their customer base. The financial services sector is the foundation for any economy and plays the role of mobilization of resources and their allocation. The retail banking sector in India has emerged as one of the major drivers of the overall banking industry and has witnessed enormous growth. Switching behaviour has a negative impact on the banks’ market share and profitability as the costs of acquiring customers are much higher than the costs of retaining. When customers switch, the business loses the potential for additional profits from the customer the initial costs invested in the customer by the business get . The Objective of the thesis was to examine the relationship among triggers that customers experience, their perceptions of service quality, consumers’ commitment and behavioral intentions in the contemporary India retail banking context through the eyes of the customer. To understand customers’ perception of these aspects, data were collected from retail banking customers alone for the purpose of analysis, though the banks’ views were considered during the qualitative work carried out prior to the main study. No respondent who is an employee of a banking organization was considered for the final study to avoid the possibility of any bias that could affect the results adversely. The data for the study were collected from customers who have switched banks and from those who were non switchers. The study attempted to develop and validate a multidimensional construct of service quality for retail banking from the consumer’s perspective. A major conclusion from the empirical research was the confirmation of the multidimensional construct for perceived service quality in the banking context. Switching can be viewed as an optimization problem for customers; customers review the potential gains of switching to another service provider against the costs of leaving the service provider. As banks do not provide tangible products, their service quality is usually assessed through service provider’s relationship with customers. Thus, banks should pay attention towards their employees’ skills and knowledge; assessing customers’ needs and offering fast and efficient services.

Las TIC en la administración de la cadena de suministro y su incidencia en el desempeño operacional

Las tecnologías de la información han empezado a ser un factor importante a tener en cuenta en cada uno de los procesos que se llevan a cabo en la cadena de suministro. Su implementación y correcto uso otorgan a las empresas ventajas que favorecen el desempeño operacional a lo largo de la cadena. El desarrollo y aplicación de software han contribuido a la integración de los diferentes miembros de la cadena, de tal forma que desde los proveedores hasta el cliente final, perciben beneficios en las variables de desempeño operacional y nivel de satisfacción respectivamente. Por otra parte es importante considerar que su implementación no siempre presenta resultados positivos, por el contrario dicho proceso de implementación puede verse afectado seriamente por barreras que impiden maximizar los beneficios que otorgan las TIC.

Therapeutic Project at Extra-Hospital Mental Health Services: a critical reflection on the elaboration and management of services' therapeutic projects

Based on a study conducted in Ribeirao Preto, SP, Brazil in extra-hospital mental health services that addressed the organization of these services, therapeutic projects and the inclusion of psychosocial rehabilitation in health actions available, a theoretical-critical reflection concerning the development process of the therapeutic projects by the services' teams is presented. The qualitative study was conducted in an outpatient clinic and a Psychosocial Care Center. Data were collected through semi-structured interviews and focal groups. Data analysis was based on the hermeneutic dialectic philosophy of Jurgen Habermas according to the techniques of reconstruction and interpretation. Data analysis revealed that professionals have difficulty developing and managing therapeutic projects. Health actions are made available without being concretely supported by a proposal guiding the service's practical activities. The therapeutic projects are referred by professionals as the result of guidelines provided by management levels or technical orientations inherent to each profession but not as an activity that represents a philosophy of work of the health team. When the therapeutic project is focused on as a type of consensus that results from a communicative action directed to a mutual and intersubjective understanding among the members of the mental health extra-hospital team, the difficulties of the services' team dialogically organizing themselves to collectively construct the therapeutic project is evidenced.

Propuesta de un modelo de sistema de información interorganizacional: aplicación en el sector de la domótica para la gestión de servicios del hogar digital

El sector de la edificación es uno de los principales sectores económicos en España y, además, es un componente básico de la actividad económica y social, debido a su importante papel como generador de empleo, proveedor de bienes e incentivador del crecimiento. Curiosamente, es uno de los sectores con menos regulación y organización y que, además, está formado mayoritariamente por empresas de pequeña y mediana dimensión (pymes) que, por su menor capacidad, a menudo, se quedan detrás de las grandes empresas en términos de adopción de soluciones innovadoras. La complejidad en la gestión de toda la información relacionada con un proyecto de edificación ha puesto de manifiesto claras ineficiencias que se traducen en un gasto innecesario bastante representativo. La información y los conocimientos aprendidos rara vez son transmitidos de una fase a otra dentro del proyecto de edificación y, mucho menos, reutilizados en otros proyectos similares. De este modo, no sólo se produce un gasto innecesario, sino que incluso podemos encontrar información contradictoria y obsoleta y, por tanto, inútil para la toma de decisiones. A lo largo de los años, esta situación ha sido motivada por la propia configuración del sector, poniendo de manifiesto la necesidad de una solución que pudiera solventar este reto de gestión interorganizacional. Así, la cooperación interorganizacional se ha convertido en un factor clave para mejorar la competitividad de las organizaciones, típicamente pymes, que componen el sector de la edificación. La información es la piedra angular de cualquier proceso de negocio. Durante la última década, una amplia gama de industrias han experimentado importantes mejoras de productividad con la aplicación eficiente de las TIC, asociadas, principalmente, a incrementos en la velocidad de proceso de información y una mayor coherencia en la generación de datos, accesibilidad e intercambio de información. La aplicación eficaz de las TIC en el sector de la edificación requiere una combinación de aspectos estratégicos y tácticos, puesto que no sólo se trata de utilizar soluciones puntuales importadas de otros sectores para su aplicación en diferentes áreas, sino que se buscaría que la información multi-agente estuviera integrada y sea coherente para los proyectos de edificación. El sector de la construcción ha experimentado un descenso significativo en los últimos años en España y en Europa como resultado de la crisis financiera que comenzó en 2007. Esta disminución está acompañada de una baja penetración de las TIC en la interorganizacionales orientadas a los procesos de negocio. El descenso del mercado ha provocado una desaceleración en el sector de la construcción, donde sólo las pymes flexibles han sido capaces de mantener el ritmo a pesar de la especialización y la innovación en los servicios adaptados a las nuevas demandas del mercado. La industria de la edificación está muy fragmentada en comparación con otras industrias manufactureras. El alto grado de esta fragmentación está íntimamente relacionado con un impacto significativo en la productividad y el rendimiento. Muchos estudios de investigación han desarrollado y propuesto una serie de modelos de procesos integrados. Por desgracia, en la actualidad todavía no se está en condiciones para la formalización de cómo debe ser la comunicación y el intercambio de información durante el proceso de construcción. El paso del proceso secuencial tradicional a los procesos de interdependencia recíproca sin lugar a duda son una gran demanda asociada a la comunicación y el flujo de información en un proyecto de edificación. Recientemente se está poniendo mucho énfasis en los servicios para el hogar como un primer paso hacia esta mejora en innovación ya que la industria de los servicios digitales interactivos tiene un alto potencial para generar innovación y la ventaja estratégica para las empresas existentes. La multiplicidad de servicios para el hogar digital (HD) y los proveedores de servicios demandan, cada vez más, la aparición de una plataforma capaz de coordinar a todos los agentes del sector con el usuario final. En consecuencia, las estructuras organizacionales tienden a descentralizarse en busca de esa coordinación y, como respuesta a esta demanda, se plantea, también en este ámbito, el concepto de cooperación interorganizacional. Por lo tanto, ambos procesos de negocio -el asociado a la construcción y el asociado a la provisión de servicios del hogar digital, también considerado como la propia gestión de ese hogar digital o edificio, inteligente o no- deben de ser vistos en su conjunto mediante una plataforma tecnológica que les dé soporte y que pueda garantizar la agregación e integración de los diversos procesos, relacionados con la construcción y gestión, que se suceden durante el ciclo de vida de un edificio. Sobre esta idea y atendiendo a la evolución permanente de los sistemas de información en un entorno de interrelación y cooperación daría lugar a una aplicación del concepto de sistema de información interorganizacional (SIIO). El SIIO proporciona a las organizaciones la capacidad para mejorar los vínculos entre los socios comerciales a lo largo de la cadena de suministro, por lo que su importancia ha sido reconocida por organizaciones de diversos sectores. Sin embargo, la adopción de un SIIO en diferentes ámbitos ha demostrado ser complicada y con una alta dependencia de las características particulares de cada sector, siendo, en este momento, una línea de investigación abierta. Para contribuir a esta línea de investigación, este trabajo pretende recoger, partiendo de una revisión de la literatura relacionada, un enfoque en un modelo de adopción de un SIIO para el objeto concreto de esta investigación. El diseño de un SIIO está basado principalmente, en la identificación de las necesidades de información de cada uno de sus agentes participantes, de ahí la importancia en concretar un modelo de SIIO en el ámbito de este trabajo. Esta tesis doctoral presenta el modelo de plataforma virtual de la asociación entre diferentes agentes del sector de la edificación, el marco de las relaciones, los flujos de información correspondientes a diferentes procesos y la metodología que subyace tras el propio modelo, todo ello, con el objeto de contribuir a un modelo unificado que dé soporte tanto a los procesos relacionados con la construcción como con la gestión de servicios en el hogar digital y permitiendo cubrir los requisitos importantes que caracterizan este tipo de proyectos: flexibilidad, escalabilidad y robustez. El SIIO se ha convertido en una fuente de innovación y una herramienta estratégica que permite a las pymes obtener ventajas competitivas. Debido a la complejidad inherente de la adopción de un SIIO, esta investigación extiende el modelo teórico de adopción de un SIIO de Kurnia y Johnston (2000) con un modelo empírico para la caracterización de un SIIO. El modelo resultante tiene como objetivo fomentar la innovación de servicios en el sector mediante la identificación de los factores que influyen en la adopción de un SIIO por las pymes en el sector de la edificación como fuente de ventaja competitiva y de colaboración. Por tanto, esta tesis doctoral, proyectada sobre una investigación empírica, proporciona un enfoque para caracterizar un modelo de SIIO que permita dar soporte a la gestión integrada de los procesos de construcción y gestión de servicios para el hogar digital. La validez del modelo de SIIO propuesto, como fuente y soporte de ventajas competitivas, está íntimamente relacionada con la necesidad de intercambio de información rápido y fiable que demandan los agentes del sector para mejorar la gestión de su interrelación y cooperación con el fin de abordar proyectos más complejos en el sector de la edificación, relacionados con la implantación del hogar digital, y contribuyendo, así a favorecer el desarrollo de la sociedad de la información en el segmento residencial. ABSTRACT The building industry is the largest industry in the world. Land purchase, building design, construction, furnishing, building equipment, operations maintenance and the disposition of real estate have an unquestionable prominence not only at economic but also at social level. In Spain, the building sector is one of the main drivers of economy and also a basic component of economic activity and its role in generating employment, supply of goods or incentive for growth is crucial in the evolution of the economy. Surprisingly, it is one of the sectors with less regulation and organization. Another consistent problem is that, in this sector, the majority of companies are small and medium (SMEs), and often behind large firms in terms of their adoption of innovative solutions. The complexity of managing all information related to this industry has lead to a waste of money and time. The information and knowledge gathered is frequently stored in multiple locations, involving the work of thousands of people, and is rarely transferred on to the next phase. This approach is inconsistent and makes that incorrect information is used for decisions. This situation needs a viable solution for interorganizational information management. So, interorganizational co-operation has become a key factor for organization competitiveness within the building sector. Information is the cornerstone of any business process. Therefore, information and communication technologies (ICT) offer a means to change the way business is conducted. During the last decade, significant productivity improvements were experienced by a wide range of industries with ICT implementation. ICT has provided great advantages in speed of operation, consistency of data generation, accessibility and exchange of information. The wasted money resulting from reentering information, errors and omissions caused through poor decisions and actions, and the delays caused while waiting for information, represent a significant percentage of the global benefits. The effective application of ICT in building construction sector requires a combination of strategic and tactical developments. The building sector has experienced a significant decline in recent years in Spain and in Europe as a result of the financial crisis that began in 2007. This drop goes hand in hand with a low penetration of ICT in inter-organizational-oriented business processes. The market decrease has caused a slowdown in the building sector, where only flexible SMEs have been able to keep the pace though specialization and innovation in services adapted to new market demands. The building industry is highly fragmented compared with other manufacturing industries. This fragmentation has a significant negative impact on productivity and performance. Many research studies have developed and proposed a number of integrated process models. Unfortunately, these studies do not suggest how communication and information exchange within the construction process can be achieved, without duplication or lost in quality. A change from the traditional sequential process to reciprocal interdependency processes would increase the demand on communication and information flow over the edification project. Focusing on home services, the digital interactive service industry has the potential to generate innovation and strategic advantage for existing business. Multiplicity of broadband home services (BHS) and suppliers suggest the need for a figure able to coordinate all the agents in sector with the final user. Consequently, organizational structures tend to be decentralized. Responding to this fact, the concept of interorganizational co-operation also is raising in the residential market. Therefore, both of these business processes, building and home service supply, must be complemented with a technological platform that supports these processes and guarantees the aggregation and integration of the several services over building lifecycle. In this context of a technological platform and the permanent evolution of information systems is where the relevance of the concept of inter-organizational information system (IOIS) emerges. IOIS improves linkages between trading partners along the supply chain. However, IOIS adoption has proved to be difficult and not fully accomplished yet. This research reviews the literature in order to focus a model of IOIS adoption. This PhD Thesis presents a model of virtual association, a framework of the relationships, an identification of the information requirements and the corresponding information flows, using the multi-agent system approach. IOIS has become a source of innovation and a strategic tool for SMEs to obtain competitive advantage. Because of the inherent complexity of IOIS adoption, this research extends Kurnia and Johnston’s (2000) theoretical model of IOIS adoption with an empirical model of IOIS characterization. The resultant model aims to foster further service innovation in the sector by identifying the factors influencing IOIS adoption by the SMEs in the building sector as a source of competitive and collaborative advantage. Therefore, this PhD Thesis characterizes an IOIS model to support integrated management of building processes and home services. IOIS validity, as source and holder of competitive advantages, is related to the need for reliable information interchanges to improve interrelationship management. The final goal is to favor tracking of more complex projects in building sector and to contribute to consolidation of the information society through the provision of broadband home services and home automation.

Development of a web-service-agents-based family wealth management system

The roiling financial markets, constantly changing tax law and increasing complexity of planning transaction increase the demand of aggregated family wealth management (FWM) services. However, current trend of developing such advisory systems is mainly focusing on financial or investment side. In addition, these existing systems lack of flexibility and are hard to be integrated with other organizational information systems, such as CRM systems. In this paper, a novel architecture of Web-service-agents-based FWM systems has been proposed. Multiple intelligent agents are wrapped as Web services and can communicate with each other via Web service protocols. On the one hand, these agents can collaborate with each other and provide comprehensive FWM advices. On the other hand, each service can work independently to achieve its own tasks. A prototype system for supporting financial advice is also presented to demonstrate the advances of the proposed Webservice- agents-based FWM system architecture.

A total quality management methodology for universities

This research document is motivated by the need for a systemic, efficient quality improvement methodology at universities. There exists no methodology designed for a total quality management (TQM) program in a university. The main objective of this study is to develop a TQM Methodology that enables a university to efficiently develop an integral total quality improvement (TQM) Plan. ^ Current research focuses on the need of improving the quality of universities, the study of the perceived best quality universities, and the measurement of the quality of universities through rankings. There is no evidence of research on how to plan for an integral quality improvement initiative for the university as a whole, which is the main contribution of this study. ^ This research is built on various reference TQM models and criteria provided by ISO 9000, Baldrige and Six Sigma; and educational accreditation criteria found in ABET and SACS. The TQM methodology is proposed by following a seven-step metamethodology. The proposed methodology guides the user to develop a TQM plan in five sequential phases: initiation, assessment, analysis, preparation and acceptance. Each phase defines for the user its purpose, key activities, input requirements, controls, deliverables, and tools to use. The application of quality concepts in education and higher education is particular; since there are unique factors in education which ought to be considered. These factors shape the quality dimensions in a university and are the main inputs to the methodology. ^ The proposed TQM Methodology is used to guide the user to collect and transform appropriate inputs to a holistic TQM Plan, ready to be implemented by the university. Different input data will lead to a unique TQM plan for the specific university at the time. It may not necessarily transform the university into a world-class institution, but aims to strive for stakeholder-oriented improvements, leading to a better alignment with its mission and total quality advancement. ^ The proposed TQM methodology is validated in three steps. First, it is verified by going through a test activity as part of the meta-methodology. Secondly, the methodology is applied to a case university to develop a TQM plan. Lastly, the methodology and the TQM plan both are verified by an expert group consisting of TQM specialists and university administrators. The proposed TQM methodology is applicable to any university at all levels of advancement, regardless of changes in its long-term vision and short-term needs. It helps to assure the quality of a TQM plan, while making the process more systemic, efficient, and cost effective. This research establishes a framework with a solid foundation for extending the proposed TQM methodology into other industries. ^

Service Management Concepts: Implications for Hospitality Management

In - Service Management Concepts: Implications for Hospitality Management – a study by K. Michael Haywood, Associate Professor, School of Hotel and Food Administration, University of Guelph, Ontario, Canada, Associate Professor Haywood initially proffers: “The study and application of hospitality management has progressed on its own for many years; however, managers are not immune to the knowledge gained from study of other service industries. The author synthesizes what is happening in the area of service management, looks at its relevance to hospitality management, and identifies a few important implications of service management for hospitality managers.” The author draws a distinction between non-denominated service management, and service management as it applies to the hospitality industry. This is done to make an apparent comparison, as many people would assume the two are one in the same. They are not, and the contrast works well here. “While much of what we already know about effective management applies to service industries, some of the traditional concepts of management are inadequate in solving the problems faced by service businesses,” Haywood points out. “If a body of knowledge to be known as service management already exists, or is being developed, where does it fit relative to hospitality management,” Haywood asks. According to John Bateson, Testing a Conceptual Framework for Consumer Service Marketing, there are four criteria used to judge service management. Haywood details these for you, the reader, by way of citation. Haywood points to the difficulty in pin-pointing the intangibles that underpin the service industry. Since service is a concept rather than a touchable good, such as inventory, problems arise for both the organization and the client. Haywood points to a classic study of four service industries in France to illustrate the problems, although no realistic suggestions address the issues. “Over the past few years a variety of system models have been developed to explain the service process, that is, how the service is designed, produced, delivered, and consumed,” Haywood offers. These models are depicted in Appendices A-E. In offering perspectives on how the hospitality industry can gain from the experiences of service management, Haywood observes: “Service management places particular emphasis on a strategic outlook. Hospitality firms would be wise to carefully examine how they are perceived in the marketplace vis-a-vis their service concept, position, competitive situation, and management’s leadership abilities.” “Learning from the experiences of other service firms can help keep a company on track, that is, providing needed and valued services,” he closes the thought.

Process of privatization: Benefits of *reform in management of public housing

The study of the private management of public housing is an important topic to be critically analyzed as the government search for ways to increase efficiency in providing housing for the poor. Public Housing Authorities must address the cost for repairing or replacing the deteriorating housing stock, the increase in the need for affordable housing, and the lack of supply. There is growing pressure on efficient use of public funds that has heightened the need for profound structural reform. An important strategy for carrying out such reform is through privatization. Although privatization does not work in every case, the majority position in the traditional privatization literature is that reliance on private organizations normally, but not always, results in cost savings. ^ The primary purpose of this dissertation is to determine whether a consensus exist among decision-makers on the efficiency of privatizing the management of public housing. A secondary purpose is to review the techniques (best practices) used by the private sector that results in cost-efficiencies in the management of public housing. The study employs the use of a triangulated research design utilizing cross-sectional survey methodology that included use of a survey instrument to solicit responses from the private managers. The study consists of qualitative methods using interviews from key informants of private-sector management firms and public housing agencies, case studies, focus groups, archival records and housing authorities documents. ^ Results indicated that important decision-makers perceive that private managers made a positive contribution to cost-efficiencies in the management of public housing. The performance of private contractors served as a yardstick for comparison of efficiency of services that are produced in-house. The study concluded that private managers made the benefits of their management techniques well known creating a sense of competition between public and private managers. Competition from private contractors spurred municipal worker and management productivity improvements creating better management results for the public housing authorities. The study results are in concert with a review of recent research and studies that also concluded private managers have some distinct advantages to controlling costs in the management of public housing. ^

UNDERSTANDING CUSTOMER CHOICES IN SERVICE OUTSOURCING AND REVENUE MANAGEMENT

This dissertation investigates customer behavior modeling in service outsourcing and revenue management in the service sector (i.e., airline and hotel industries). In particular, it focuses on a common theme of improving firms’ strategic decisions through the understanding of customer preferences. Decisions concerning degrees of outsourcing, such as firms’ capacity choices, are important to performance outcomes. These choices are especially important in high-customer-contact services (e.g., airline industry) because of the characteristics of services: simultaneity of consumption and production, and intangibility and perishability of the offering. Essay 1 estimates how outsourcing affects customer choices and market share in the airline industry, and consequently the revenue implications from outsourcing. However, outsourcing decisions are typically endogenous. A firm may choose whether to outsource or not based on what a firm expects to be the best outcome. Essay 2 contributes to the literature by proposing a structural model which could capture a firm’s profit-maximizing decision-making behavior in a market. This makes possible the prediction of consequences (i.e., performance outcomes) of future strategic moves. Another emerging area in service operations management is revenue management. Choice-based revenue systems incorporate discrete choice models into traditional revenue management algorithms. To successfully implement a choice-based revenue system, it is necessary to estimate customer preferences as a valid input to optimization algorithms. The third essay investigates how to estimate customer preferences when part of the market is consistently unobserved. This issue is especially prominent in choice-based revenue management systems. Normally a firm only has its own observed purchases, while those customers who purchase from competitors or do not make purchases are unobserved. Most current estimation procedures depend on unrealistic assumptions about customer arriving. This study proposes a new estimation methodology, which does not require any prior knowledge about the customer arrival process and allows for arbitrary demand distributions. Compared with previous methods, this model performs superior when the true demand is highly variable.

Working in public health services in Brazil: The relationship between different rationalities

Success in a public health system is related to its ability to change its production process and to deal with general principles of the health system, such as universality and equity. The frameworks proposed by service marketing scholars have been developed primarily for private services; they focus on acceptance by the targeted client-users, and on the technical specifications of the new service delivery processes. Little attention has been given to the employees` point of view and their activities to maintain service operations modulated by innovation. In a public health system, workers make decisions in real time related to users` needs and the technical specifications of the process; therefore, it is very important to understand how the changes impact on employees` activities and on the quality delivered for citizens. This article discusses how changes implemented in Sao Paulo, Brazil impact the organizational parameters and working activities for front-line workers. (C) 2008 Elsevier Ltd. All rights reserved.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders

Background: The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. Method: A comprehensive literature review (1990-2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. Treatment recommendations: This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3-5 years following diagnosis since course of illness is strongly influenced by what occurs in this 'critical period'. Patients should not have to 'prove chronicity' before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at least two antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no special Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.