An evaluation of physician predictions of discharge on a general medicine service.

The goal of this study was to evaluate general medicine physicians' ability to predict hospital discharge. We prospectively asked study subjects to predict whether each patient under their care would be discharged on the next day, on the same day, or neither. Discharge predictions were recorded at 3 time points: mornings (7-9 am), midday (12-2 pm), or afternoons (5-7 pm), for a total of 2641 predictions. For predictions of next-day discharge, the sensitivity (SN) and positive predictive value (PPV) were lowest in the morning (27% and 33%, respectively), but increased by the afternoon (SN 67%, PPV 69%). Similarly, for same-day discharge predictions, SN and PPV were highest at midday (88% and 79%, respectively). We found that although physicians have difficulty predicting next-day discharges in the morning prior to the day of expected discharge, their ability to correctly predict discharges continually improved as the time to actual discharge decreased. Journal of Hospital Medicine 2015;10:808-810. © 2015 Society of Hospital Medicine.

China in Global Value Chains: Implications for Industrial Policy and Development

Rapid technological advances and liberal trade regimes permit functional reintegration of dispersed activities into new border-spanning business networks variously referred to as global value chains (GVCs). Given that the gains of a country from GVCs depend on the activities taking place in its jurisdiction and their linkages to global markets, this study starts by providing a descriptive overview of China’s economic structure and trade profile. The first two chapters of this paper demonstrate what significant role GVCs have played in China’s economic growth, evident in enhanced productivity, diversification, and sophistication of China’s exports, and how these economic benefits have propelled China’s emergence as the world’s manufacturing hub in the past two decades. However, benefits from GVC participation – in particular technological learning, knowledge building, and industrial upgrading – are not automatic. What strategies would help Chinese industries engage with GVCs in ways that are deemed sustainable in the long run? What challenges and related opportunities China would face throughout the implementation process? The last two chapters of this paper focus on implications of GVCs for China’s industrial policy and development. Chapter Three examines how China is reorienting its manufacturing sector toward the production of higher value-added goods and expanding its service sector, both domestically and internationally; while Chapter Four provides illustrative policy recommendations on dealing with the positive and negative outcomes triggered by GVCs, within China and beyond the country’s borders. To the end, this study also hopes to shed some light on the lessons and complexities that arise from GVC participation for other developing countries.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

The value of military oath in civil wars in Rome: The example of conflict 49-45 BC

During the civil war between Caesar and Pompey, the military oath which binds the soldier to his army is often openly violated. Yet despite this offense, commanders of armed struggle require recursively the oath to their men. Admittedly, this ritual act seems ineffective given the many desertions and mutinies identified, but military leaders use its symbolic and sacred meaning to legitimize one hand their “anti-republican” actions, on the other armies fighting in a context deemed impius.

Palliative Medicine:Scoping the level and extent of service provision to people with intellectual disability at end of life Poster Presentation

Background: Concerns exist about the end of life care
that people with intellectual disabilities receive. This population
are seldom referred to palliative care services and
inadequate data sets exist about their place of death.
Aim: To scope the extent of service provision to people
with intellectual disabilities at the end of life by specialist
palliative care and intellectual disability services in one
region of the United Kingdom.
Methods: As part of a larger doctoral study a regional survey
took place of a total sample (n=66) of specialist palliative
care and intellectual disability services using a postal
questionnaire containing forty items. The questionnaire
was informed by the literature and consultation with an
expert reference group. Data were analysed using SPSS to
obtain descriptive statistics.
Results: A total response rate from services of 71.2%
(n=47) was generated. Findings showed a range of experience
among services in providing end of life care to people
with intellectual disabilities in the previous five years, but
general hospitals were reported the most common place of
death. A lack of accessible information on end of life care
for people with learning disabilities was apparent. A few
services (n=14) had a policy to support this population to
make decisions about their care or had used adapted Breaking
Bad News guidelines (n=5) to meet their additional
needs. Both services recognised the value of partnership
working in assessing and meeting the holistic needs of
people with intellectual disabilities at end of life.
Conclusions: A range of experience in caring for people
with intellectual disabilities was present across services,
but more emphasis is required on adapting communication
for this population to facilitate them to participate in their
care. These findings could have international significance
given that studies in other countries have highlighted a
need to widen access to palliative care for this group of
people.

Service Loyalty: An Integrative Model and Examination across Service Contexts

Marketing academics and practitioners generally agree that customer loyalty is vital to business success. There is less agreement on the factors that determine customer loyalty, particularly in service contexts. Research on the determinants of service loyalty has taken three distinct paths: 1) quality/value/satisfaction; 2) relationship quality; and, 3) relational benefits. In this research, the authors coalesce these paths to derive a model that links dimensions of customer loyalty (cognitive, affective, intention, and behavioral) with a system of determinants. The model is tested with data from varied services (airlines, banks, beauty salons, hospitals, hotels, and mobile telephone) and 3,500 customers in China. Results are consistent across contexts and support a multidimensional view of customer loyalty. Key loyalty determinants are customer satisfaction, commitment, service fairness, service quality, trust, and a construct new to service loyalty models—commercial friendship. The research contributes to the literature by providing a more complete, integrated view of customer loyalty and its determinants in services contexts.

It’s Cheaper than Acquiring New Ones: Retaining Members to Your Service

The benefits of retention are well known: it’s cheaper and easier to retain existing customers than it is to try to acquire new ones. Secondly, retained customers play a vital role in the acquisition of new customers through word-of-mouth. Thirdly, retained customers have a higher monetary value, due to being more susceptible to cross-selling initiatives. So, retention is important. But, it’s difficult to achieve, especially for membership organisations. Numerous organisations work on a membership-based business model, such as health clubs, trade unions, charities and even professional associations. Often, recruiting and retaining members is fundamental to the success of these enterprises which rely on membership fees as their primary revenue stream.

Aplicação de um value stream map nos serviços após venda automóvel

O projeto desenvolvido tem como objetivo principal a melhoria da eficiência na prestação de serviços de reparação de chapa e pintura na Caetano Auto Colisão, através da aplicação de ferramentas associadas à filosofia Lean. Apesar das ferramentas e técnicas lean estarem bem exploradas nas empresas de produção e manufatura, o mesmo não se verifica em relação às empresas da área dos serviços. O Value Stream Mapping é uma ferramenta lean que consiste no mapeamento do fluxo de materiais e informação necessários para a realização das atividades (que acrescentam e não acrescentam valor), desempenhadas pelos colaboradores, fornecedores e distribuidores, desde a obtenção do pedido do cliente até à entrega final do serviço. Através desta ferramenta é possível identificar as atividades que não acrescentam valor para o processo e propor medidas de melhoria que resultem na eliminação ou redução das mesmas. Com base neste conceito, foi realizado o mapeamento do processo de prestação de serviços de chapa e pintura e identificados os focos de ineficiência. A partir desta análise foram sugeridas melhorias que têm como objetivo atingir o estado futuro proposto assim como tornar o processo mais eficiente. Duas destas melhorias passaram pela implementação dos 5S na sala das tintas e pela elaboração de um relatório A3 para o centro de lavagens. O projeto realizado permitiu o estudo de um problema real numa empresa de serviços, bem como a proposta de um conjunto de melhorias que a médio prazo se espera virem a contribuir para a melhoria da eficiência na prestação de serviços de chapa e pintura.

Having a strategy for new service development : does it really matter?

Purpose – The aim of this study is to investigate the role of key strategic factors in new service development (NSD). In particular, the role of service development strategy, a formalised development process, integrated development teams and customer co-creation were investigated and the results were compared with managers' beliefs. Design/methodology/approach – The study used a sample of more than 500 service development projects to test a NSD conceptual model. Regression analysis was used to test the relative importance of the key strategic factors, and the results were compared with managers' beliefs. Findings – The results show that managers believe that customer co-creation is most important in order to succeed with NSD. However, contrary to management belief, a service development strategy is the “missing link” in improving NSD performance. In addition, the research highlighted an interaction effect between integrated development teams and customer co-creation, which means that project managers should focus on individual competencies on the development team and how they interact with customers throughout the NSD process. Originality/value – For a long time, NSD has failed to receive the attention it deserves, not just in practice but also in service research. This study shows that the number of new services put on the market and then withdrawn because of low sales remains as high as 43 per cent. This paper contributes knowledge on how to reduce the number of failures in NSD by pointing out the key strategic factors that influence NSD performance.

Un dispositif multimédia au service de la révision de texte au 2e cycle du primaire

Cette recherche s'inscrit dans un cadre théorique de la didactique de l'écriture et des sciences cognitives. Elle présente la mise à l'essai d'un dispositif multimédia pour soutenir la révision de textes. Cette étude évalue les avantages et les limites du commentaire oral formulé par l'enseignant et formaté en MP3, qui vise à communiquer à l'élève du 2e cycle du primaire une rétroaction portant sur la révision qu'il a lui-même réalisé au regard de son texte.

The role of emotions in value creation for families in pediatric health care

The purpose of this study was to analyze emotions related to a child’s critical illness from the perspective of the family and discuss the link those emotions might form with value creation. High quality service is of paramount importance in hospital care, especially when a child is diagnosed with critical illness. Through the analysis of patient family emotions and their triggers, the study was aiming to deepen the understanding of value creation for customer. Therefore, the research sought to find answers to the following three sub-questions: 1. What are the emotions experienced? 2. What triggers them? 3. How are the emotions linked to amelioration or aggravation of value for patient and family? The theoretical background of this research is built on two core concepts: emotions and value creation. As both concepts are wide and multifaceted, the research concentrates on viewing emotions from the applicable cognitive angle, identifying and categorizing emotions in a general level. Value creation is studied from the service perspective, discussing the possible relations between emotions and value creation. Moreover, the suitability of views regarding customer value co-creation to health care encounters is analyzed. Qualitative approach was selected as the most appropriate methodology for conducting the empirical research. The empirical data was collected from public blogs, for which a total of 18 blogs were reviewed. Five blogs were selected for the analysis, which had the intent of identifying the emotions experienced by patient families and deepening the knowledge of their role in value creation during health care service encounters. The empirical study of this research discovered a wide range of positive and negative emotions, which denotes that a severe life situation does not prevent the feeling of positive emotions. Furthermore, by combining the empirical findings to the theoretical background, this study concludes that recognizing and treating the patient family as a partner and value creator is essential. The high quality technical aspect of care is vital, but it is not the sole attribute for service quality, as the interpersonal communication plays a large role in the customer’s overall assessment of the health care performance. The patients and their families largely evaluate the service encounter based on their perceptions, thus emotions play a significant role. Depending on the service experience, value maybe created or destructed. Hence, this study posits emotion at the core of the service encounter, indicating towards the importance of active assessment of customer perceptions and the recognition of the emotional states

Professional service productization and its implications to knowledge transfer in internationalization processes –Case: Company X in Finnish, Swedish and Norwegian markets

As a result of globalization, two thirds of the world’s business takes place nowadays in the service sector. In line, professional service firms are growing their share of the global service production. However, saturation of the professional service sector has forced professional service firms to search for more heuristic ways to conduct business in the international markets. By leveraging effectively the firm’s professionals, a professional service firm can lower its costs to clients and simultaneously generate additional value for the company and thus gain competitive advantage. Even though the academic field has shown growing interest towards services for decades, the fields of service productization and service internationalization are heavily understudied even today. Hence, the objective of this study was to contribute to the research on professional service internationalization and productization. The study concentrated on examining the impact that productization has on knowledge sharing and leveraging in professional service firms operating internationally. The research question focused on examining what implications productization has on knowledge transfer and leveraging during professional service internationalization by leaning on the existing research and on an empirical research. The empirical research was conducted as a single case study within a professional service firm operating in debt-related administrative service business. The case company is one of the leading operators in its field of business and therefore offered a fruitful environment to observe and analyze the topics in question. Additionally, the case company has a strong international presence and a large scale of operations in the selected markets, Finland, Norway and Sweden. Based on the previous literature and on the empirical research, this study found that for professional service firms to efficiently utilize individual, tacit knowledge, in its internationalization processes, it must be shared with the whole organization. By exploiting productization as a knowledge leveraging mechanism, a PSF can apply and transfer knowledge profoundly during its internationalization processes that would otherwise be difficult to tap into. Productization might not be sufficient alone, but by complementing it with a favorable organizational structure and culture, and by encouraging open communication, a PSF may take advantage of the whole potential that productization has to offer.

Identifying New Business Opportunities and Customer Value Creation: Case Vuosaari

Previously conducted research projects in the field of logistics services have emphasized the importance of value added services in customer value creation. Through value added services companies can extend their service portfolio and gain higher customer satisfaction and loyalty. In more general level service marketing has been recognized to be challenging due the intangible nature of services. This has caused issues in pricing and value perceptions. To tackle these issues scholars have suggested well–managed customer reference marketing practices. The main goal of this research work is to identify shortages in the current service offering. Additionally, the focus is on, how these shortages can be fixed. Due the low capacity utilization of warehouse premises, there is a need to find the main factors, which are causing or affecting on the current situation. The research aims to offer a set of alternatives how to come over these issues. All the potential business opportunities are evaluated and the promising prospects are discussed. The focus is on logistics value added services and how those effect on route decisions in logistics. Simultaneously the aim is to create a holistic understanding of how added value and offered services effect on logistics centralization. Moreover, customer value creation and customer references’ effectiveness in logistics service marketing are emphasized in this project. Logistics value added services have a minor effect on logistics decision. Routes are chosen on a low–cost basis. However, it is challenging to track down logistics costs and break those down into different phases. Customer value as such is a difficult concept. This causes challenges when services are sold with value–based principles. Customer references are useful for logistics service providers and this should be exploited in marketing. Those reduce the perceived risk and give credibility to the service provider.

Creating and measuring customer value in digital businesses

Most economic transactions nowadays are due to the effective exchange of information in which digital resources play a huge role. New actors are coming into existence all the time, so organizations are facing difficulties in keeping their current customers and attracting new customer segments and markets. Companies are trying to find the key to their success and creating superior customer value seems to be one solution. Digital technologies can be used to deliver value to customers in ways that extend customers’ normal conscious experiences in the context of time and space. By creating customer value, companies can gain the increased loyalty of existing customers and better ways to serve new customers effectively. Based on these assumptions, the objective of this study was to design a framework to enable organizations to create customer value in digital business. The research was carried out as a literature review and an empirical study, which consisted of a web-based survey and semi-structured interviews. The data from the empirical study was analyzed as mixed research with qualitative and quantitative methods. These methods were used since the object of the study was to gain deeper understanding about an existing phenomena. Therefore, the study used statistical procedures and value creation is described as a phenomenon. The framework was designed first based on the literature and updated based on the findings from the empirical study. As a result, relationship, understanding the customer, focusing on the core product or service, the product or service quality, incremental innovations, service range, corporate identity, and networks were chosen as the top elements of customer value creation. Measures for these elements were identified. With the measures, companies can manage the elements in value creation when dealing with present and future customers and also manage the operations of the company. In conclusion, creating customer value requires understanding the customer and a lot of information sharing, which can be eased by digital resources. Understanding the customer helps to produce products and services that fulfill customers’ needs and desires. This could result in increased sales and make it easier to establish efficient processes.

Customer involvement in new service development

This case study aims at filling the research gap in the literature, by researching how customers experience customer involvement in new service development, in addition to giving insight on what are the organisational customers’ motivations to become involved in service development. These subjects are studied by conducting three interviews. The thesis gives a review of previous findings regarding customer-driven new service development, customer involvement, customer roles, modes of involvement, communication in the involvement process, what is the role of customer engagement and what are the motivational drivers for customers. The thesis also explains what new service development is and makes a distinction between new service development and new service design. The results revealed that organisational customers want to be involved throughout the development process, with active involvement in the beginning and end phases. Moreover, customers prefer face-to-face methods and active and bidirectional communication throughout the process. The findings propose seven motivational factors, a new framework for customer-driven new service development and communication process map. The managerial implications list five themes for service providers to take into consideration when involving customers to the service development process.