Measurement for improvement: a survey of current practice in Australian public hospitals

Objective:
To identify patient safety measurement tools in use in Australian public hospitals and to determine barriers to their use.

Design:
Structured survey, conducted between 4 March and 19 May 2005, designed to identify tools, and to assess current use of, levels of satisfaction with, and barriers to use of tools for measuring the domains and subdomains of: organisational capacity to provide safe health care; patient safety incidents; and clinical performance.

Participants and setting:
Hospital executives, managers and clinicians from a nationwide random sample of Australian public hospitals stratified by state and hospital peer grouping.

Main outcome measures:
Tools used by hospitals within the three domains and their subdomains; patient safety tools and processes identified by individuals at these hospitals; satisfaction with the tools; and barriers to their use.

Results:
Eighty-two of 167 invited hospitals (49%) responded. The survey ascertained a comprehensive list of patient safety measurement tools that are in current use for measuring all patient safety domains. Overall, there was a focus on use of processes rather than quantitative measurement tools. Approximately half the 182 individual respondents from participating hospitals reported satisfaction with existing tools. The main reported barriers were lack of integrated supportive systems, resource constraints and inadequate access to robust measurement tools validated in the Australian context. Measurement of organisational capacity was reported by 50 (61%), of patient safety incidents by 81 (99%) and of clinical performance by 81 (99%).

Conclusion:
Australian public hospitals are measuring the safety of their health care, with some variation in measurement of patient safety domains and their subdomains. Improved access to robust tools may support future standardisation of measurement for improvement.

Extending robust industrial optimisation using simulation and reinforcement learning

Traditional optimisation methods are incapable of capturing the complexity of today's dynamic manufacturing systems. A new methodology, integrating simulation models and intelligent learning agents, was successfully applied to identify solutions to a fundamental scheduling problem. The robustness of this approach was then demonstrated through a series of real-world industrial applications.

Self-assembled monolayers into the 21st century : recent advances and applications

The modification of an interface on a molecular level with more than one molecular ‘building block' is essentially an example of the ‘bottom–up' fabrication principle of nanotechnology. The fabrication of such integrated molecular systems in electrochemistry has seen rapid progress in recent years via the development of sensing interfaces fabricated using self-assembled monolayers (SAMs). This review outlines recent advances and applications of self-assembled monolayers for modifying electrodes with an emphasis on the development of integrated molecular systems. First, some basic issues regarding fabricating integrated molecular systems, such as the role of the surface topography of the electrode and patterning surfaces, are discussed. Subsequently an overview of recent developments in pH, inorganic and bio sensing involving the use of SAMs is given. Finally emerging trends in using molecular building blocks in the fabrication of integrated molecular systems, such as nanotubes, dendrimers and nanoparticles, are reviewed.

Defence mechanisms of a resistant monocot model to phytophthora cinnamomi

The plant pathogen Phytophthora cinnamomi causes devastating disease in natural and agricultural systems worldwide. While some plants can survive, little is known about the underlying mechanisms of resistance. This research used histochemical and genome-wide analysis to identify key cellular and molecular defence mechanisms within the resistant plant Zea mays.

Integrating agriculture and food policy to achieve sustainable peri-urban fruit and vegetable production in Victoria, Australia

Efforts to increase fruit and vegetable consump­tion are a significant aspect of national approaches to preventive health. However, policy frameworks for increasing fruit and vegetable consumption rarely take an integrated food-systems approach that includes a focus on production. In this policy analysis and commentary we examine fruit and vegetable production in peri-urban areas of Melbourne in Victoria, Australia, and highlight the significance of emerging environmental and eco­nomic pressures on fruit and vegetable production. This examination will be of interest to other locations around the world also experiencing pressure on their peri-urban agriculture. These pressures suggest that the availability and afforda­bility of fruit and vegetable supplies cannot be taken for granted, and that future initiatives to increase fruit and vegetable consumption should include a focus on sustainable production. Threats to production that include environmental pressures, together with the loss and cost of peri-urban agri­cultural land and a cost-price squeeze due to rising input costs and low farm-gate prices, act in combi­nation to threaten the viability of the Victorian fruit and vegetable industries. We pro­pose that policy initiatives to increase fruit and vegetable consumption should include measures to address the pressures facing production, and that the most effective policy responses are likely to be integrated approaches that aim to increase fruit and vegetable availability and affordability through innovative solutions to problems of production and distribu­tion. Some brief examples of potential integrated policy solutions are identified to illu­strate the possibilities and stimulate discussion.

The occupiers' burden: tackling food shortage and related health problems in post-war Germany 1945-47

The end of the Second World War brought much relief to its combatants, but a range of problems remained that would plague post-war Europe for years to come. Chief among them was food shortage. The breakdown of agricultural systems, essential services, and the state itself laid fertile ground for food shortage to develop in parts of post-war Germany occupied by the victorious powers. There is much to be gained from comparing the occupiers’ responses to this Horseman of the Apocalypse. The most fruitful comparison lies between the Soviets and British. Unlike the Americans whose economic might in the post-war period allowed them to better feed and supply Germans living in their occupation zone, domestic economic weaknesses hamstrung both Soviet and British responses to the more severe advent of food shortage which confronted them. Their responses were very different—some successful, others not—but all instructive for understanding the impacts of natural and policy factors on the development of food shortage and the consequences to the health of the population. The variety of these impacts have been obscured by the absence of this comparison in the literature, which is now made more feasible by the greater availability of the extensive resources that each occupier devoted to recording food and health data, particularly in the Soviet case. The data is not only relevant to the occupation period from 1945 to 1949, as it suggests long-term health impacts on those most exposed to the risk of food shortage then, and most at risk to the consequences of malnutrition decades later. In fact, as the available data defines regional differences in food rations and, accordingly, comparative food shortages in Soviet and British occupation zones, the situation in post-war Germany provides an excellent platform for future research linking differences in early nutrition to adult health outcomes.

Adaptation to climate change in regional Australia : a decision-making framework for modelling policy for rural production

A decision-making framework was developed and applied in regional Australia to identify adaptation issues arising in agricultural systems and rural production as a consequence of climate change. Australian agriculture is very susceptible to the adverse impacts of climate change, with major shifts in temperature and rainfall projected. An advantage of the framework is that it provides a suite of tools to aid in the formulation of strategies for sustainable regional development and adaptation. The decision-making framework uses a participatory approach that integrates land suitability analysis with uncertainty analysis and spatial optimisation to determine optimal agricultural land use (at a regional scale) for current and possible future climatic conditions. It thus provides a robust analytic approach to (i) recognise regions under threat of productivity declines, (ii) identify alternative cropping systems better adapted to likely future climatic conditions and (iii) investigate policy actions to improve the sub-optimal situations created by climate change. The decision-making framework and its methods were applied in a case study of the South West Region of Victoria.

Visões das gerências da auditoriainterna da Petrobras sobre a sua estratégia de atuação em facedas práticas de mercado e da nova modelagem organizacional da companhia

The purpose of this study is to identify the strategic vision of the Internal Audit Department of Petrel Brasileiro S.A. PETROBRAS, in comparison with the audit function's proposals and practices in competitive organizations and their reality. It also aims at the verification of the possible solutions, within Petrobras itself, so as to constantly add value to the business and to the shareholders. With this in mind, a research was carried out, contemplating the conceptual proposals and market practices related to auditing and to the current diagnosis and the organizational model of Petrobras, so as to choose elements for comparison and analysis of such vision. The results of this research pointed in the direction of questioning the organizational value of the internal audit action, concluding that it will only be possible to continuously attain such value by means of a permanent coordination with the organization's strategic level. This is especially true if the audit action participates effectively in the process of Corporate Governance, in defining the risks, the internal control system and the measurement of corporate performance, as related to the development of the strategic plan. However, any action along these lines is still heavily impacted and limited by several aspects of culture and relationship of the organizational power as well as by the beliefs of the organization and of the body of auditors. The involvement of the auditors as employees was also considered relevant in the auditing process, by means of the participation of the audited entities in self assessment2. This procedure is still not sufficiently guaranteed by successful experiments in major organizations, considering that there is not a clear demonstration of the effective benefits of adopting this practice, as ompared to the central control, seldom shared but strongly monitored by integrated information systems. Finally, this research points to the need to renew the concept of the formation and role of the auditors in modern competitive organizations, in the face of information technology and of automation of the instrument controls of the business. Therefore, one may conclude that the trend will be toward an action aiming at the revision of formal internal control matrixes, as they are established in such systems. On the other hand, the majority of audit human resources will be increasingly deployed to the evaluation of risk and control, as related to relevant events of a more abstract nature, as in the case of those connected with the uncontrollable factors of the external environment.

Implementação de sistemas de gestão integrados no setor de construção: estudo de casos brasileiros

As pressões de mercado, os programas de abertura financeira, a desregulamentação da atividade produtiva e a diminuição de barreiras protecionistas afetam significativamente a competitividade da indústria nacional. Outras mudanças, não apenas econômicas, mas sociais, políticas e tecnológicas, também pressionam as organizações a adotar novas estratégias empresariais e deixam claro que modelos de gestão tradicionais já não são mais suficientes para enfrentar estes novos desafios. Na busca de diferenciais competitivos, as empresas têm adotado sistemas de gestão da qualidade, de gestão ambiental e de gestão da saúde e segurança do trabalhador. Como forma de evidenciar a terceiros sua preocupação simultânea com estas três disciplinas, as empresas têm buscado a certificação integrada destes sistemas por meio das normas ISO 9001, ISO 14001 e OHSAS 18001. Surgem, assim, os Sistemas de Gestão Integrados (SGIs), objetos de pesquisa deste estudo. O recorte é setorial, sendo que o setor de construção foi escolhido devido a características como singularidade de seus produtos, alto impacto ambiental e alto índice de acidentes de trabalho. Com o objetivo de investigar como os SGIs foram implementados no setor de construção, foram escolhidos três casos de empresas sabidamente adotantes deste modelo de gestão. Foram analisadas as motivações, o processo de implementação e certificação do sistema, os fatores críticos de sucesso, as dificuldades encontradas e os benefícios colhidos com a adoção de SGIs. A pesquisa confirmou estudos anteriores que demonstram que a motivação, dependendo do contexto em que as empresas se inserem, pode ser por necessidade de maior competitividade, de legitimação, ou ainda, por responsabilidade ambiental de sua liderança. Os fatores críticos de sucesso são, dentre outros, comprometimento da alta administração, comunicação eficiente com as partes interessadas, disponibilidade de recursos e maturidade das equipes. As dificuldades encontradas foram a valorização excessiva de resultados econômico-financeiros, a complexidade do modelo adotado, a utilização burocrática do sistema, a falta de maturidade e preparo dos profissionais, o porte dos projetos, o perfil de competências dos profissionais e variados tipos de resistências. A adoção do SGI nas empresas estudadas esteve condicionada a situações do cenário econômico, do alto índice de terceirização verificado no setor e às dificuldades com a qualificação da mão-de-obra. Não obstante as dificuldades e os condicionantes, o SGI trouxe vários benefícios para as organizações e, um dado relevante, é que ele pode desencadear reações positivas ao longo da cadeia de valor, uma vez que as empresas adotantes de SGI passam a ser mais exigentes em relação a seus fornecedores.

Essays on the general equilibrium effects of barriers to trade on economic growth, foreign trade and the location of economic activity in Brazil

This work presents a fully operational interstate CGE model implemented for the Brazilian economy that tries to quantify both the role of barriers to trade on economic growth and foreign trade performance and how the distribution of the economic activity may change as the country opens up to foreign trade. Among the distinctive features embedded in the model, modeling of external scale economies, port efficiency and land-maritime transport costs provides an innovative way of dealing explicitly with theoretical issues related to integrated regional systems. In order to illustrate the role played by the quality of infrastructure and geography on the country‟s foreign and interregional trade performance, a set of simulations is presented where barriers to trade are significantly reduced. The relative importance of trade policy, port efficiency and land-maritime transport costs for the country trade relations and regional growth is then detailed and quantified, considering both short run as well as long run scenarios. A final set of simulations shed some light on the effects of liberal trade policies on regional inequality, where the manufacturing sector in the state of São Paulo, taken as the core of industrial activity in the country, is subjected to different levels of external economies of scale. Short-run core-periphery effects are then traced out suggesting the prevalence of agglomeration forces over diversion forces could rather exacerbate regional inequality as import barriers are removed up to a certain level. Further removals can reverse this balance in favor of diversion forces, implying de-concentration of economic activity. In the long run, factor mobility allows a better characterization of the balance between agglomeration and diversion forces among regions. Regional dispersion effects are then clearly traced-out, suggesting horizontal liberal trade policies to benefit both the poorest regions in the country as well as the state of São Paulo. This long run dispersion pattern, on one hand seems to unravel the fragility of simple theoretical results from recent New Economic Geography models, once they get confronted with more complex spatially heterogeneous (real) systems. On the other hand, it seems to capture the literature‟s main insight: the possible role of horizontal liberal trade policies as diversion forces leading to a more homogeneous pattern of interregional economic growth.

Fatores de sucesso na implementação de sistemas integrados de gestão empresarial (ERP): estudo de caso em uma média empresa

RAMOS, A. S. M.; OLIVEIRA, M. A. Fatores de sucesso na implementação de sistemas integrados de gestão empresarial (ERP): estudo de caso em uma média empresa. In: ENCONTRO NACIONAL DE ENGENHARIA DE PRODUÇÂO, 22., 2002, Curitiba-PR. Anais... Porto Alegre-RS: ABEPRO, 2002. v. 1.