Assessing the queuing process using data envelopment analysis:an application in health centres

Queuing is one of the very important criteria for assessing the performance and efficiency of any service industry, including healthcare. Data Envelopment Analysis (DEA) is one of the most widely-used techniques for performance measurement in healthcare. However, no queue management application has been reported in the health-related DEA literature. Most of the studies regarding patient flow systems had the objective of improving an already existing Appointment System. The current study presents a novel application of DEA for assessing the queuing process at an Outpatients’ department of a large public hospital in a developing country where appointment systems do not exist. The main aim of the current study is to demonstrate the usefulness of DEA modelling in the evaluation of a queue system. The patient flow pathway considered for this study consists of two stages; consultation with a doctor and pharmacy. The DEA results indicated that waiting times and other related queuing variables included need considerable minimisation at both stages.

A Conceptual Foresight Model to Investigate the Adoption of Radio Frequency Identification Technology in the English National Health Service

Radio Frequency Identification Technology (RFID) adoption in healthcare settings has the potential to reduce errors, improve patient safety, streamline operational processes and enable the sharing of information throughout supply chains. RFID adoption in the English NHS is limited to isolated pilot studies. Firstly, this study investigates the drivers and inhibitors to RFID adoption in the English NHS from the perspective of the GS1 Healthcare User Group (HUG) tasked with coordinating adoption across private and public sectors. Secondly a conceptual model has been developed and deployed, combining two of foresight’s most popular methods; scenario planning and technology roadmapping. The model addresses the weaknesses of each foresight technique as well as capitalizing on their individual, inherent strengths. Semi structured interviews, scenario planning workshops and a technology roadmapping exercise were conducted with the members of the HUG over an 18-month period. An action research mode of enquiry was utilized with a thematic analysis approach for the identification and discussion of the drivers and inhibitors of RFID adoption. The results of the conceptual model are analysed in comparison to other similar models. There are implications for managers responsible for RFID adoption in both the NHS and its commercial partners, and for foresight practitioners. Managers can leverage the insights gained from identifying the drivers and inhibitors to RFID adoption by making efforts to influence the removal of inhibitors and supporting the continuation of the drivers. The academic contribution of this aspect of the thesis is in the field of RFID adoption in healthcare settings. Drivers and inhibitors to RFID adoption in the English NHS are compared to those found in other settings. The implication for technology foresight practitioners is a proof of concept of a model combining scenario planning and technology roadmapping using a novel process. The academic contribution to the field of technology foresight is the conceptual development of foresight model that combines two popular techniques and then a deployment of the conceptual foresight model in a healthcare setting exploring the future of RFID technology.

A lean elvek alkalmazása az egészségügyi folyamatok fejlesztésében = Applying lean principles in healthcare process development

A fejlett társadalmak egészségügyi szolgáltató rendszerei napjainkban kettős kihívással néznek szembe: miközben a társadalom a szolgáltatási színvonal emelkedését, a hibák számának a csökkenését várja el, addig a költségvetési terhek miatt a költségcsökkentés is feltétlenül szükséges. Ez a kihívás nagyságában összevethető azzal, amellyel az USA autóipara nézett szembe az 1970-es évektől. A megoldást az autóipar esetében a konkurens „lean” menedzsment elvek és eszközök megértése és alkalmazása jelentette. A tanulmány arra keresi a választ, hogy vajon lehetséges-e ennek a megoldásnak az alkalmazása az egészségügy esetében is. A cikk az egészségügy problémájának bemutatása után tárgyalja a lean menedzsment kialakulását és hogy milyen módon került köztudatba. A tanulmány második felében a szakirodalomban fellelhető, a témával kapcsolatos tapasztalatokat foglalja össze, majd levonja a következtetéseket. = In developed societies healthcare service systems are facing double challenge; society expects service level to rise and the number of mistakes to drop, but at the same time, because of the overloaded budgets, cutting cost is also absolutely necessary. This challenge compares to the one the US automotive industry was facing in the 1970-s. In case of the automotive industry the solution was the comprehension and application of the principles and the tools of lean management. This study aims to answer the question whether it is possible to apply this solution also in the case of the healthcare system. The article first introduces the problems in the healthcare system, than describes the formation of lean management concept and its wide spread. The second half of the study summarizes the available knowledge in the literature and drives conclusions.

Az online-fogyasztói elégedettség mérésére alkalmas skála tesztelése és véglegesítése a vállalati döntéshozók támogatása céljából (Testing and finalizing a scale for measuring online consumer satisfaction to support the companies decision making process)

A versenyképesség, illetve a gazdaságos működés elengedhetetlen feltétele a fogyasztói elégedettség, melynek egyik meghatározó eleme az észlelt és elvárt minőség közti kapcsolat. A minőségi elvárások az internettel, mint napjaink egyik meghatározó csatornájával kapcsolatban is megfogalmazódtak már, így kapott jelentős szerepet az online szolgáltatásminőség meghatározása, illetve ezzel összekapcsolódva az online-fogyasztói elégedettségmérés. A tanulmány célja, hogy szakirodalmi áttekintést nyújtson a témában, és a szakirodalomból ismert E-S-QUAL és E-RecS-QUAL online-fogyasztói elégedettségmérésre szolgáló skálát megvizsgálja, érvényességét a magyar körülmények között letesztelje, és a szükségesnek látszó módosítások elvégzésével egy Magyarországon használható skálát hozzon létre. Az online-fogyasztók elégedettségmérésének alapjaként az online szolgáltatásminőség fogyasztói érzékelésével, illetve értékelésével kapcsolatos elméleteket járja körbe a tanulmány, és ezután kerül sor a különböző mérési módszerek bemutatására, kiemelt szerepet szánva az E-S-QUAL és E-RecS-QUAL skálának, mely az egyik leginkább alkalmazott módszernek számít. Az áttekintés középpontjában azok a honlapok állnak, melyeken vásárolni is lehet, a kutatást pedig az egyik jelentős hazai online könyvesbolt ügyfélkörében végeztem el. ______ Over the last decade the business-to-consumer online market has been growing very fast. In marketing literature a lot of studies have been created focusing on understanding and measuring e-service quality (e-sq) and online-customer satisfaction. The aim of the study is to summarize these concepts, analyse the relationship between e-sq and customer’s loyalty, which increases the competitiveness of the companies, and to create a valid and reliable scale to the Hungarian market for measuring online-customer satisfaction. The base of the empirical study is the E-S-QUAL and its second scale the E-RecS-QUAL that are widely used multiple scales measuring e-sq with seven dimensions: efficiency, system availability, fulfilment, privacy, responsiveness, compensation, and contact. The study is focusing on the websites customers use to shop online.

The effects of attribute quality information and sources of information on consumers' perceptions and behavior: A model of Pre-purchase Information Utilization in Service Physical Environments

The search-experience-credence framework from economics of information, the human-environment relations models from environmental psychology, and the consumer evaluation process from services marketing provide a conceptual basis for testing the model of "Pre-purchase Information Utilization in Service Physical Environments." The model addresses the effects of informational signs, as a dimension of the service physical environment, on consumers' perceptions (perceived veracity and perceived performance risk), emotions (pleasure) and behavior (willingness to buy). The informational signs provide attribute quality information (search and experience) through non-personal sources of information (simulated word-of-mouth and non-personal advocate sources).^ This dissertation examines: (1) the hypothesized relationships addressed in the model of "Pre-purchase Information Utilization in Service Physical Environments" among informational signs, perceived veracity, perceived performance risk, pleasure, and willingness to buy, and (2) the effects of attribute quality information and sources of information on consumers' perceived veracity and perceived performance risk.^ This research is the first in-depth study about the role and effects of information in service physical environments. Using a 2 x 2 between subjects experimental research procedure, undergraduate students were exposed to the informational signs in a simulated service physical environment. The service physical environments were simulated through color photographic slides.^ The results of the study suggest that: (1) the relationship between informational signs and willingness to buy is mediated by perceived veracity, perceived performance risk and pleasure, (2) experience attribute information shows higher perceived veracity and lower perceived performance risk when compared to search attribute information, and (3) information provided through simulated word-of-mouth shows higher perceived veracity and lower perceived performance risk when compared to information provided through non-personal advocate sources. ^

Alternative service organizations: Funding environment, strategies, and patterns of adaptation

This study explored the strategies that community-based, consumer-focused advocacy, alternative service organizations (ASOs), implemented to adapt to the changes in the nonprofit funding environment (Oliver & McShane, 1979; Perlmutter, 1988a, 1994). It is not clear as to the extent to which current funding trends have influenced ASOs as little empirical research has been conducted in this area (Magnus, 2001; Marquez, 2003; Powell, 1986). ^ This study used a qualitative research design to investigate strategies implemented by these organizations to adapt to changes such as decreasing government, foundation, and corporate funding and an increasing number of nonprofit organizations. More than 20 community informants helped to identify, locate, and provide information about ASOs. Semi-structured interviews were conducted with a sample of 30 ASO executive directors from diverse organizations in Miami-bade and Broward Counties, in South Florida. ^ Data analysis was facilitated by the use of ATLAS.ti, version 5, a qualitative data analysis computer software program designed for grounded theory research. This process generated five major themes: Funding Environment; Internal Structure; Strategies for Survival; Sustainability; and Committing to the Cause, Mission, and Vision. ^ The results indicate that ASOs are struggling to survive financially by cutting programs, decreasing staff, and limiting service to consumers. They are also exploring ways to develop fundraising strategies; for example, increasing the number of proposals written for grants, focusing on fund development, and establishing for-profit ventures. Even organizations that state that they are currently financially stable are concerned about their financial vulnerability. There is little flexibility or cushioning to adjust to "funding jolts." The fear of losing current funding levels and being placed in a tenuous financial situation is a constant concern for these ASOs. ^ Further data collected from the self-administered Funding Checklist and demographic forms were coded and analyzed using Statistical Package for the Social Sciences (SPSS). Descriptive information and frequencies generated findings regarding the revenue, staff compliment, use of volunteers and fundraising consultants, and fundraising practices. The study proposes a model of funding relationships and presents implications for social work practice, and policy, along with recommendations for future research. ^

Spatial-temporal mining of archived automatic vehicle location (AVL) data for transit service planning applications

An Automatic Vehicle Location (AVL) system is a computer-based vehicle tracking system that is capable of determining a vehicle's location in real time. As a major technology of the Advanced Public Transportation System (APTS), AVL systems have been widely deployed by transit agencies for purposes such as real-time operation monitoring, computer-aided dispatching, and arrival time prediction. AVL systems make a large amount of transit performance data available that are valuable for transit performance management and planning purposes. However, the difficulties of extracting useful information from the huge spatial-temporal database have hindered off-line applications of the AVL data. ^ In this study, a data mining process, including data integration, cluster analysis, and multiple regression, is proposed. The AVL-generated data are first integrated into a Geographic Information System (GIS) platform. The model-based cluster method is employed to investigate the spatial and temporal patterns of transit travel speeds, which may be easily translated into travel time. The transit speed variations along the route segments are identified. Transit service periods such as morning peak, mid-day, afternoon peak, and evening periods are determined based on analyses of transit travel speed variations for different times of day. The seasonal patterns of transit performance are investigated by using the analysis of variance (ANOVA). Travel speed models based on the clustered time-of-day intervals are developed using important factors identified as having significant effects on speed for different time-of-day periods. ^ It has been found that transit performance varied from different seasons and different time-of-day periods. The geographic location of a transit route segment also plays a role in the variation of the transit performance. The results of this research indicate that advanced data mining techniques have good potential in providing automated techniques of assisting transit agencies in service planning, scheduling, and operations control. ^

Enabling adaptability in service aggregates using transparent shaping techniques

Distributed applications are exposed as reusable components that are dynamically discovered and integrated to create new applications. These new applications, in the form of aggregate services, are vulnerable to failure due to the autonomous and distributed nature of their integrated components. This vulnerability creates the need for adaptability in aggregate services. The need for adaptation is accentuated for complex long-running applications as is found in scientific Grid computing, where distributed computing nodes may participate to solve computation and data-intensive problems. Such applications integrate services for coordinated problem solving in areas such as Bioinformatics. For such applications, when a constituent service fails, the application fails, even though there are other nodes that can substitute for the failed service. This concern is not addressed in the specification of high-level composition languages such as that of the Business Process Execution Language (BPEL). We propose an approach to transparently autonomizing existing BPEL processes in order to make them modifiable at runtime and more resilient to the failures in their execution environment. By transparent introduction of adaptive behavior, adaptation preserves the original business logic of the aggregate service and does not tangle the code for adaptive behavior with that of the aggregate service. The major contributions of this dissertation are: first, we assessed the effectiveness of BPEL language support in developing adaptive mechanisms. As a result, we identified the strengths and limitations of BPEL and came up with strategies to address those limitations. Second, we developed a technique to enhance existing BPEL processes transparently in order to support dynamic adaptation. We proposed a framework which uses transparent shaping and generative programming to make BPEL processes adaptive. Third, we developed a technique to dynamically discover and bind to substitute services. Our technique was evaluated and the result showed that dynamic utilization of components improves the flexibility of adaptive BPEL processes. Fourth, we developed an extensible policy-based technique to specify how to handle exceptional behavior. We developed a generic component that introduces adaptive behavior for multiple BPEL processes. Fifth, we identify ways to apply our work to facilitate adaptability in composite Grid services.

A theory of constraints service systems improvement method: Case of the airline turnaround problem

This dissertation develops a process improvement method for service operations based on the Theory of Constraints (TOC), a management philosophy that has been shown to be effective in manufacturing for decreasing WIP and improving throughput. While TOC has enjoyed much attention and success in the manufacturing arena, its application to services in general has been limited. The contribution to industry and knowledge is a method for improving global performance measures based on TOC principles. The method proposed in this dissertation will be tested using discrete event simulation based on the scenario of the service factory of airline turnaround operations. To evaluate the method, a simulation model of aircraft turn operations of a U.S. based carrier was made and validated using actual data from airline operations. The model was then adjusted to reflect an application of the Theory of Constraints for determining how to deploy the scarce resource of ramp workers. The results indicate that, given slight modifications to TOC terminology and the development of a method for constraint identification, the Theory of Constraints can be applied with success to services. Bottlenecks in services must be defined as those processes for which the process rates and amount of work remaining are such that completing the process will not be possible without an increase in the process rate. The bottleneck ratio is used to determine to what degree a process is a constraint. Simulation results also suggest that redefining performance measures to reflect a global business perspective of reducing costs related to specific flights versus the operational local optimum approach of turning all aircraft quickly results in significant savings to the company. Savings to the annual operating costs of the airline were simulated to equal 30% of possible current expenses for misconnecting passengers with a modest increase in utilization of the workers through a more efficient heuristic of deploying them to the highest priority tasks. This dissertation contributes to the literature on service operations by describing a dynamic, adaptive dispatch approach to manage service factory operations similar to airline turnaround operations using the management philosophy of the Theory of Constraints.

Contracted School Food Service: Advantages, Disadvantages, and Political Concerns

Schools have evolved to be providers of education as well as suppliers of ancillary services to the population that they serve. This article examines one of these ancillary services, food service, in order to provide some awareness of the political aspects of the decision-making process in choosing whether or not to contract this service, as well as the pros and cons of the situation.

Manager-Customer Relationship in Food Service Commissary Operations

Documented reports of day-to-day decision-making in food service tend to emphasize technical aspects. However, this view does not represent completely the decision-making process managers go through. The author reports on the effect of the manager-customer relationship in decision-making by managers.

Evaluating Applicability of E-Service Quality in Online Hotel Bookings

This study evaluates applicability of E-service quality measurements in the context of online hotel bookings. Data was collected from an online survey of undergraduate college students at two universities in the United States. The Transaction Process-based Framework (eTransQual) conceptualized by Bauer et al. (2006) was adapted, and the dimensionality of e-service quality was identified. The study identified process/reliability as the most important factor influencing overall quality of booking websites.

An Ethnographic Approach to Understanding Service Quality

The ethnographic research process, which explores human behavior as it relates to its situation, is outlined and illustrated through a hospitality case that explores the ways in which employees come to understand the meaning of service quality The challenges of ethnographic research are reviewed and implications for future research are provided

From Clerk and Cashier to Guest Service Agent

In their study - From Clerk and Cashier to Guest Service Agent - by Nancy J. Allin, Director of Quality Assurance and Training and Kelly Halpine, Assistant Director of Quality Assurance and Training, The Waldorf-Astoria, New York, the authors state at the outset: “The Waldorf-Astoria has taken the positions of registration clerk and cashier and combined them to provide excellent guest service and efficient systems operation. The authors tell how and why the combination works. That thesis statement defines the article, and puts it squarely in the crosshairs of the service category. Allin and Halpine use their positions at the Waldorf-Astoria in New York City to frame their observations “The allocation of staff hours has been a challenge to many front office managers who try their hardest to schedule for the norm but provide excellent, efficient service throughout the peaks,” Allin and Halpine allude. “…the decision [to combine the positions of registration clerk and cashier] was driven by a desire to improve guest service where its impact is most obvious, at the front desk. Cross-trained employees speed the check-in and check-out process by performing both functions, as the traffic at the desk dictates,” the authors say. Making such a move has resulted in positive benefits for both the guests and the hotel. “Benefits to the hotel, in addition to those brought to bear by increased guest satisfaction, include greater flexibility in weekly scheduling and in granting vacations while maintaining adequate staffing at the desk,” say Allin and Halpine . “Another expected outcome, net payroll savings, should also be realized as a consequence of the ability to schedule more efficiently.” The authors point to communication as the key to designing a successful combination such as this, with the least amount of service disruption. They bullet-point what that communication should entail. Issues of seniority, wage and salary rates, organizational charting, filing, scheduling, possible probationary periods, position titles, and physical layouts are all discussed. “It is critical that each of the management issues be addressed and resolved before any training is begun,” Allin and Halpine suggest. “Unresolved issues project confusion and lack of conviction to line employees and the result is frustration and a lack of commitment to the combination process,” they push the thought Allin and Halpine insist: “Once begun, training must be ongoing and consistent.” In the practical sense, the authors provide that authorizing overtime is helpful in accomplishing training. “Training must address the fact that employees will be faced with guest situations which are new to them, for example: an employee previously functioning as a cashier will be faced with walking guests. Specific exercises should be included to address these needs,” say the authors.

An interview study of community college student perspectives on service -learning

Over the past two decades, the community college in the United States has boasted a leadership role in the movement to make education community-based and performance-oriented. This has led to an intensification in attempts to search for more innovative means to make education more experiential and relevant to students' lived experiences. ^ One such innovative program that holds promise to meet this challenge is service-learning. This paradigm attempts to relate the academic education in the classroom to community-based problems, which fits in neatly with the community-based characteristics of the community college. It promises to link ideas developed in the classroom and their practical application within the community through guided reflection. It is designed to enhance and enrich student learning of course material by combining citizenship, academic subjects, skills, and values. ^ Though many studies have been carried out in regard to the outcomes of service-learning through quantitative means, relatively few qualitative studies are available, and those available have primarily studied traditional students at four-year residential colleges or universities. Therefore, there is an urgent need to study non-traditional students' perspectives at the community college level. ^ The purpose of this study was to describe and explain the perspectives of five students at Broward Community College, Central Campus, Ft. Lauderdale, Florida. The following exploratory questions guided this study: (1) What elements constitute these students' perspectives? (2) What variables influence their perspectives? (3) What beliefs do these students hold about their service-learning experience which support or are contrary to their perspectives? ^ This ethnographic interview study was conducted over a period of twelve months and consisted of three interviews for each of the five participants. The analysis of the data was conducted following the stringent principles of ethnographic research which included constant comparative analysis. The interviews were tape recorded with the participants' permission, transcribed verbatim, and organized into categories for in-depth understanding. Furthermore, these categories were developed from the data collected and an organizational scheme for understanding and interpreting of these perspectives emerged. The researcher, as well, kept a reflective journal of the research process as part of the data set. ^ The results of this study show the need for a better grasp of the concepts of service-learning on the part of all involved with its implementation. In spite of this, all of the participants displayed gains to a greater or lesser degree in personal growth, academic skills, and citizenship skills. ^