Modeling the economic losses from pressure ulcers among hospitalized patients in Australia

The objective of this study was to predict the number of cases of pressure ulcer, the bed days lost, and the economic value of these losses at Australian public hospitals. All adults (>= 18 years of age) with a minimum stay of 1 night and discharged from selected clinical units from all Australian public hospitals in 2001-02 were included in the study. The main outcome measures were the number of cases of pressure ulcer, bed days lost to pressure ulcer, and economic value of these losses. We predict a median of 95,695 cases of pressure ulcer with a median of 398,432 bed days lost, incurring median opportunity costs of AU$285 M. The number of cases, and so costs, were greatest in New South Wales and lowest in Australian Capitol Territory. We conclude that pressure ulcers represent a serious clinical and economic problem for a resource-constrained public hospital system. The most cost-effective, risk-reducing interventions should be pursued up to a point where the marginal benefit of prevention is equalized with marginal cost. By preventing pressure ulcers, public hospitals can improve efficiency and the quality of the patient's experience and health outcome.

Exploring innovation in policy-making within central government:the case of the UK's Highways Agency

The first and main contribution of this article is its access to the decision-making processes which drive innovation in policy-making within central government. The article will present a detailed case history of how the innovation came about and conclude by highlighting analytic possibilities for future research. The policy in focus is the UK’s Traffic Management Act 2004, which passed responsibility for managing incidents on major roads from the police to the Highways Agency (HA), and has been interpreted as a world first in traffic management. The article tracks the Traffic Management Act 2004 from problem identification to a preliminary evaluation. It is then suggested that future research could explain organizational change more theoretically. By taking a longitudinal and multi-level approach, the research falls into a processual account of organizational change. The second contribution of the article is to highlight two novel ways in which this approach is being applied to policy-making, through an institutional processualist research programme on public management reform and empirical investigations using complex systems to explain policy change.

The curious absence of inter-municipal co-operation in England

In Europe local authorities often work with their neighbouring municipalities, whether to address a specific task or goal or through the course of regular policy making and implementation. In England, however, inter-municipal co-operation (IMC) is less common. Councils may work with service providers from the private and non-profit sectors but less often with neighbouring local authorities. Why this is the case may be explained by a number of historical and policy factors that often encourage councils to compete, rather than to work collaboratively with each other. The present government has encouraged councils to work in partnership with other organizations but there are few examples of increased horizontal cooperation between local authorities. Instead the prevailing model remains fixed on vertical co-working predicated on a principal-agent relationship between higher and lower tiers of government.

An exploratory study of the utilisation of the UK's Prudential Borrowing Framework

This article considers the utilisation of the UK’s Prudential Borrowing Framework (PBF) and the associated Prudential Code for local government capital finance. It finds that the increased flexibility and local freedom are at the cost of less financial certainty in terms of the risks borne by local authorities and local tax payers. The PBF seems to encourage a less formal approach to risk, being considered inevitable and handled if and when adverse risk outcomes occur. Consequently capital projects may lack affordability, sustainability and prudence. The Prudential Indicators required by the Code are not easily understood by non-specialists and their calculation cannot be used to replace sound judgement or to identify the best financing option.

Audit committees in Scottish local authorities 1998-2005

During the last 15 years corporate governance has become increasingly prominent in the public sector. The Audit Commission's 1993 report on probity in local government recommended the establishment of audit committees. However, progress on this was slow, as demonstrated by a survey of Scottish local authorities by the authors in 1998. Recent major changes in government in Scotland at both a local and national level have prompted councils to improve the accountability, openness and integrity of their operations. One major aspect of this exercise was the formation of scrutiny committees to provide objective scrutiny of the process and audit committees were the most common vehicle for this. This article explores recent developments in Scottish local government and their impact on audit committees. The article also reports the results of a 2005 survey of Scottish local authorities and compares these with the 1998 survey. This indicates a significant growth in the number of audit committees in Scottish councils and although the level of their perceived effectiveness is patchy, they are a more important feature of local government than they were in 1998.

A comparative study of hospital management in Great Britain and Brazil : cost information use

In Great Britain and Brazil healthcare is free at the point of delivery and based study only on citizenship. However, the British NHS is fifty-five years old and has undergone extensive reforms. The Brazilian SUS is barely fifteen years old. This research investigated the middle management mediation role within hospitals comparing managerial planning and control using cost information in Great Britain and Brazil. This investigation was conducted in two stages entailing quantitative and qualitative techniques. The first stage was a survey involving managers of 26 NHS Trusts in Great Britain and 22 public hospitals in Brazil. The second stage consisted of interviews, 10 in Great Britain and 22 in Brazil, conducted in four selected hospitals, two in each country. This research builds on the literature by investigating the interaction of contingency theory and modes of governance in a cross-national study in terms of public hospitals. It further builds on the existing literature by measuring managerial dimensions related to cost information usefulness. The project unveils the practice involved in planning and control processes. It highlights important elements such as the use of predictive models and uncertainty reduction when planning. It uncovers the different mechanisms employed on control processes. It also depicts that planning and control within British hospitals are structured procedures and guided by overall goals. In contrast, planning and control processes in Brazilian hospitals are accidental, involving more ad hoc actions and a profusion of goals. The clinicians in British hospitals have been integrated into the management hierarchy. Their use of cost information in planning and control processes reflects this integration. However, in Brazil, clinicians have been shown to operate more independently and make little use of cost information but the potential signalled for cost information use is seen to be even greater than that of their British counterparts.

Logics, thresholds, strategic power, and the promotion of liberalisation by governments: a case study from British Higher Education

Liberalisation has become an increasingly important policy trend, both in the private and public sectors of advanced industrial economies. This article eschews deterministic accounts of liberalisation by considering why government attempts to institute competition may be successful in some cases and not others. It considers the relative strength of explanations focusing on the institutional context, and on the volume and power of sectoral actors supporting liberalisation. These approaches are applied to two attempts to liberalise, one successful and one unsuccessful, within one sector in one nation – higher education in Britain. Each explanation is seen to have some explanatory power, but none is sufficient to explain why competition was generalised in the one case and not the other. The article counsels the need for scholars of liberalisation to be open to multiple explanations which may require the marshalling of multiple sources and types of evidence.

(Can) modern local government (be) in touch with the people?

The recent White Paper, 'Modern Local Government: In Touch with the People' summarised Labour's project to modernise local government and to renew local democracy. Through the mediating concepts of accountability, responsiveness and representation, it is argued that the modernisation project will renew local authorities' political authority and legitimacy. However, a critical review of the White Paper and other Government's publications which discuss the modernisation of local government suggests that there are discrepancies between the claims to improve democratic local government and the role of councils in the provision of nationally decided andffunded welfare services.

Quality of the written information about suicide attempters

INTRODUCTION: The aim of the study was to assess the quality of the clinical records of the patients who are seen in public hospitals in Madrid after a suicide attempt in a blind observation. METHODS: Observational, descriptive cross-sectional study conducted at four general public hospitals in Madrid (Spain). Analyses of the presence of seven indicators of information quality (previous psychiatric treatment, recent suicidal ideation, recent suicide planning behaviour, medical lethality of suicide attempt, previous suicide attempts, attitude towards the attempt, and social or family support) in 993 clinical records of 907 patients (64.5% women), ages ranging from 6 to 92 years (mean 37.1±15), admitted to hospital after a suicide attempt or who committed an attempt whilst in hospital. RESULTS: Of patients who attempted suicide, 94.9% received a psychosocial assessment. All seven indicators were documented in 22.5% of the records, whilst 23.6% recorded four or less than four indicators. Previous suicide attempts and medical lethality of current attempt were the indicators most often missed in the records. The study found no difference between the records of men and women (z=0.296; p=0.767, two tailed Mann-Whitney U test), although clinical records of patients discharged after an emergency unit intervention were more incomplete than the ones from hospitalised patients (z=2.731; p=0.006), and clinical records of repeaters were also more incomplete than the ones from non-repeaters (z=3.511; p<0.001). CONCLUSIONS: Clinical records of patients who have attempted suicide are not complete. The use of semi-structured screening instruments may improve the evaluation of patients who have self- harmed.

Fearonomics and the Role of Nigeria's Private Sector in the Nigerian Ebola Response

Background: Outbreaks of infectious diseases such as Ebola have dramatic economic impacts on affected nations due to significant direct costs and indirect costs, as well as increased expenditure by the government to meet the health and security crisis. Despite its dense population, Nigeria was able to contain the outbreak swiftly and was declared Ebola free on 13th October 2014. Although Nigeria’s Ebola containment success was multifaceted, the private sector played a key role in Nigeria’s fight against Ebola. An epidemic of a disease like Ebola, not only consumes health resources but also detrimentally disrupts trade and travel to impact both public and private sector resulting in the ‘fearonomic’ effect of the contagion. In this thesis, I have defined ‘fearonomics’ or the ‘fearonomic effects’ of a disease as the intangible and intangible economic effects of both informed and misinformed aversion behavior exhibited by individuals, organizations, or countries during an outbreak. During an infectious disease outbreak, there is a significant potential for public-private sector collaborations that can help offset some of the government’s cost of controlling the epidemic.

Objective: The main objective of this study is to understand the ‘fearonomics’ of Ebola in Nigeria and to evaluate the role of the key private sector stakeholders in Nigeria’s Ebola response.

Methods: This retrospective qualitative study was conducted in Nigeria and utilizes grounded theory to look across different economic sectors in Nigeria to understand the impact of Ebola on Nigeria’s private sector and how it dealt with the various challenges posed by the disease and its ‘fearonomic effects'.

Results: Due to swift containment of Ebola in Nigeria, the economic impact of the disease was limited especially in comparison to the other Ebola-infected countries such as Liberia, Sierra Leone, and Guinea. However, the 2014 Ebola outbreak had more than a just direct impact on the country’s economy and despite the swift containment, no economic sector was immune to the disease’s fearonomic impact. The potential scale of the fearonomic impact of a disease like Ebola was one of the key motivators for the private sector engagement in the Ebola response.

The private sector in Nigeria played an essential role in facilitating the country’s response to Ebola. The private sector not only provided in-cash donations but significant in-kind support to both the Federal and State governments during the outbreak. Swift establishment of an Ebola Emergency Operation Centre (EEOC) was essential to the country’s response and was greatly facilitated by the private sector, showcasing the crucial role of private sector in the initial phase of an outbreak. The private sector contributed to Nigeria’s fight against Ebola not only by donating material assets but by continuing operations and partaking in knowledge sharing and advocacy. Some sector such as the private health sector, telecom sector, financial sector, oil and gas sector played a unique role in orchestrating the Nigerian Ebola response and were among the first movers during the outbreak.

This paper utilizes the lessons from Nigeria’s containment of Ebola to highlight the potential of public-private partnerships in preparedness, response, and recovery during an outbreak.

Utilizing “Big Data” to Improve the Hotel Sector’s Energy Efficiency: Lessons from Recent Economics Research

Hotel chains have access to a treasure trove of “big data” on individual hotels’ monthly electricity and water consumption. Benchmarked comparisons of hotels within a specific chain create the opportunity to cost-effectively improve the environmental performance of specific hotels. This paper describes a simple approach for using such data to achieve the joint goals of reducing operating expenditure and achieving broad sustainability goals. In recent years, energy economists have used such “big data” to generate insights about the energy consumption of the residential, commercial, and industrial sectors. Lessons from these studies are directly applicable for the hotel sector. A hotel’s administrative data provide a “laboratory” for conducting random control trials to establish what works in enhancing hotel energy efficiency.

Fatores de longevidade do programa Central do Cidadão no Rio Grande do Norte

The public management reform in Brazil, since 1995, provoked new experiences in public administration. Among the new models of public service the one-stop shopping has distinguished and was adopted at Rio Grande do Norte with the Citizens Center Program. The one-stop shopping assembles in the same place many public services with appropriate structure, enabled human resources and citizens focus processes. The goal of this research was understand how citizens focus processes help to explain Citizens Center Program s longevity. It was made a case study and the research tools were applied with Citizen Center Programs workers and citizen-users at South Unit of Citizen Center Program placed at Via Direta Mall, Natal. The major contributions for Citizen Center Program s longevity were imputed to Basic Operation Processes. The most spoken features in Citizen Center Program mentioned were quality, efficiency, celerity e personal appearance, what demonstrate concern and care with citizen-users. Worker s personal appearance, accommodation, celerity, politeness and attending capacity planning were high evaluated by citizen-users revealing the wisely choice of use a large quality concept and citizenship concept in public administration. Citizen-users also pointed the necessity of refine and enlarge the communication ways that form an essential mechanism to public citizen focus administration. Not ignoring the policy aspect citizen focus processes were noticed like especial management actions that make easier citizen s activities and public service access, what generate satisfaction to citizen-users. It s possible to conclude that the high level approving evaluation of Citizen Center Program consolidates it an especial public policy that serves citizen s necessities e create appropriate legitimacy conditions of the public policy making harder the choice of ending the policy even in more fragile moments strongly contributing for its longevity

Production planning, pricing and market coordination for news vendor problem with price dependent demand

Thesis (Ph.D.)--University of Washington, 2016-08

Qualidade de vida no trabalho: o caso de enfermeiros dos Hospitais Públicos Walfredo Gurgel e Santa Catarina

The theoretical foundation of this study addresses the construct Quality of Worklife involving pro-active reading organizations in face to social developments of the working class, which is a challenge to the people s management. In this sense, as a contribution to the studies of quality of worklife (QOWL), this study addresses the quality of lifework of nurses at Walfredo Gurgel and Santa Catarina public hospitals. The goal is to make a diagnosis about the quality of lifework of these employees taking as a basis dimensions and performance indicators shown in the model by Fernandes (1996). The research is characterized by field, in a descriptive way. This survey comprised 75 nurses, with 49 by Walfredo Gurgel hospital and 26 by Santa Catarina one. The data collection was carried out through structured questionnaire. The questions were processed in the software Statistic 6.0, with factor analysis and multiple regressions, after the systematization of data. As a result, the most nurses in hospitals are dissatisfied with the quality of lifework, with the highest incidence in Santa Catarina hospital. The variable occupational health assessment was more negative in the hospital Santa Catarina one, whereas in Walfredo Gurgel, was family assistance. The variable guarantee of employment was more positive assessment in two hospitals without, though, implying in high importance on QOWL of nurses. The factor structure and decision showed greater sensitivity to explain the QOWL of nurses, joining 17 variables from 40 of the model. The factor working conditions, joining 6 variables, showed the second highest sensitivity. The compensation factor, gathering 5 variables, showed the third highest sensitivity while image and health factors showed minor importance

Breves consideraciones sobre la mistanasia y el caso del Hospital Universitario Evangélico de Curitiba, estado de Paraná, Brasil

Con frecuencia, los profesionales de la salud se encuentran limitados a continuar con el tratamiento de sus pacientes, debido a las condiciones estructurales de los hospitales públicos, como la cantidad de camas, la calidad del material hospitalario, la calificación de los propios profesionales públicos, entre otras. En este sentido el artículo tiene como objetivo presentar la negligencia con los derechos de la personalidad y principios fundamentales en el sistema de salud público brasileño, señalando la necesidad de políticas públicas para la mejora del Sistema Único de Salud (SUS, Sistema Único de Saúde en portugués), precisamente en las fallas de su sistema, tomando como ejemplo la banalización de la vida por un médico del Hospital Evangélico de Curitiba, Estado de Paraná. Con este ejemplo se buscó presentar también el verdadero sentido de la eutanasia, y su evolución en la historia de la humanidad, distinguiendo la práctica que se llevó acabo en el Hospital Evangélico de Curitiba, que fue presentado por los medios de comunicación de todo el mundo como el caso de la eutanasia en Brasil. El enfoque del tema es de suma importancia para la bioética, porque tiene como objeto permitir una mejor reflexión sobre el problema y sus posibles soluciones.