An illustration of the modelling of cost and efficacy data from a clinical trial

Health care providers, purchasers and policy makers need to make informed decisions regarding the provision of cost-effective care. When a new health care intervention is to be compared with the current standard, an economic evaluation alongside an evaluation of health benefits provides useful information for the decision making process. We consider the information on cost-effectiveness which arises from an individual clinical trial comparing the two interventions. Recent methods for conducting a cost-effectiveness analysis for a clinical trial have focused on the net benefit parameter. The net benefit parameter, a function of costs and health benefits, is positive if the new intervention is cost-effective compared with the standard. In this paper we describe frequentist and Bayesian approaches to cost-effectiveness analysis which have been suggested in the literature and apply them to data from a clinical trial comparing laparoscopic surgery with open mesh surgery for the repair of inguinal hernias. We extend the Bayesian model to allow the total cost to be divided into a number of different components. The advantages and disadvantages of the different approaches are discussed. In January 2001, NICE issued guidance on the type of surgery to be used for inguinal hernia repair. We discuss our example in the light of this information. Copyright © 2003 John Wiley & Sons, Ltd.

Expert judgement in the processes of commercial property market forecasting

In this paper, we investigate the role of judgement in the formation of forecasts in commercial property markets. The investigation is based on interview surveys with the majority of UK forecast producers, who are using a range of inputs and data sets to form models to predict an array of variables for a range of locations. The findings suggest that forecasts need to be acceptable to their users (and purchasers) and consequently forecasters generally have incentives to avoid presenting contentious or conspicuous forecasts. Where extreme forecasts are generated by a model, forecasters often engage in ‘self‐censorship’ or are ‘censored’ following in‐house consultation. It is concluded that the forecasting process is significantly more complex than merely carrying out econometric modelling, forecasts are mediated and contested within organisations and that impacts can vary considerably across different organizational contexts.

Expert judgement in the processes of commercial property market forecasting

In this paper we investigate the role of judgement in the formation of forecasts in commercial real estate markets. Based on interview surveys with the majority of forecast producers, we find that real estate forecasters are using a range of inputs and data sets to form models to predict an array of variables for a range of locations. The findings suggest that forecasts need to be acceptable to their users (and purchasers) and consequently forecasters generally have incentives to avoid presenting contentious or conspicuous forecasts. Where extreme forecasts are generated by a model, forecasters often engage in ‘self-censorship’ or are ‘censored’ following in-house consultation. It is concluded that the forecasting process is more complex than merely carrying out econometric modelling and that the impact of the influences within this process vary considerably across different organizational contexts.

School effectiveness: new managerialism, quality and the Japanisation of education

School effectiveness is a microtechnology of change. It is a relay device, which transfers macro policy into everyday processes and priorities in schools. It is part of the growing apparatus of performance evaluation. Change is brought about by a focus on the school as a site-based system to be managed. There has been corporate restructuring in response to the changing political economy of education. There are now new work regimes and radical changes in organizational cultures. Education, like other public services, is now characterized by a range of structural realignments, new relationships between purchasers and providers and new coalitions between management and politics. In this article, we will argue that the school effectiveness movement is an example of new managerialism in education. It is part of an ideological and technological process to industrialize educational productivity. That is to say, the emphasis on standards and standardization is evocative of production regimes drawn from industry. There is a belief that education, like other public services can be managed to ensure optimal outputs and zero defects in the educational product.

Broker use and the cost of liquidity in commercial real estate investment

Purpose – Commercial real estate is a highly specific asset: heterogeneous, indivisible and with less information transparency than most other commonly held investment assets. These attributes encourage the use of intermediaries during asset acquisition and disposal. However, there are few attempts to explain the use of different brokerage models (with differing costs) in different markets. This study aims to address this gap. Design/methodology/approach – The study analyses 9,338 real estate transactions in London and New York City from 2001 to 2011. Data are provided by Real Capital Analytics and cover over $450 billion of investments in this period. Brokerage trends in the two cities are compared and probit regressions are used to test whether the decision to transact with broker representation varies with investor or asset characteristics. Findings – Results indicate greater use of brokerage in London, especially by purchasers. This persists when data are disaggregated by sector, time or investor type, pointing to the role of local market culture and institutions in shaping brokerage models and transaction costs. Within each city, the nature of the investors involved seems to be a more significant influence on broker use than the characteristics of the assets being traded. Originality/value – Brokerage costs are the single largest non-tax charge to an investor when trading commercial real estate, yet there is little research in this area. This study examines the role of brokers and provides empirical evidence on factors that influence the use and mode of brokerage in two major investment destinations.

Making Energy Interventions more Effective : Situation, Interaction, and Precondition

A main purpose of this paper is to propose to policy makers, building professionals, and other non-social scientists a way to make energy interventions more culturally informed and, thereby, more effective. The case study on house purchasers gives an ample illustration of the richer results that can be achieved by paying attention to three aspects of energy efficiency initiatives: the contexts and situations of choice in each particular case, the interaction among relevant social actors, and the culture-specific preconditions for choice. Research on how purchasers of new pre-fabricated houses in Sweden choose their heating system show how such decisions tend to fall between two stools. Furthermore, the organizational structure of housing companies frames house purchasers' decision making. An important result is that energy saving or conversion measures must be promoted at an early stage amongst those who plan and construct buildings (rather than later amongst dwellers and energy end users).

Escolha de canais de venda em comércio eletrônico

The electronic commerce has become a channel of advertising, commercialization and distribution of products and services, continuously increasing it¿s importance in terms of both physical and financial volumes, but still exist many gaps in the knowledge about the choice process of sales channels in the electronic commerce. The objective of this work is to raise and quantify the relevant factors in the choice of these channels in Brazil. The identification of the relevant factors was made through depth interviews with consumers, users of electronic commerce, as well as through the existing theoretical referential on the subject. The quantification of these factors was carried out with book purchasers by electronic commerce, through quantitative research, using the methodology of conjoint analysis, where the price was the most important factor, followed by delivery time, positive experience on previous purchase, usability of the site, positive recommendation of friends and the site brand. These results indicate as important attributes: price, confidence, usability and brand.

Contratos de terceirização de manutenção industrial na modalidade risco: análise comparativa das avaliações e expectativas entre o setor industrial e as empresas fornecedoras de serviços

O objetivo principal deste trabalho é avaliar as formas de contratação de manutenção industrial praticadas nos últimos anos e identificar os elementos que devem ser considerados na elaboração de um contrato baseado em performance, com remuneração variável e cláusulas de risco, sob a óptica de quem contrata (indústrias) e de quem fornece (empresas especializadas) esse tipo de serviço. Para se chegar ao modelo sugerido, o estudo utiliza uma analogia com o "jogo da forca" (jogo infantil de salão que baseia-se no processo de tentativa e erro) para desenvolver um processo de desconstrução dos modelos atuais de contratação de manutenção, identificando os fatores determinantes (para cada forma de contrato mais utilizada) para o insucesso financeiro e operacional atualmente percebido. Após a tentativa de ordenação das causas dos problemas correntes, o trabalho passa para o objetivo principal, que é o de listar os fatores críticos de sucesso para um contrato de manutenção por performance e, finalmente, sugerir um modelo básico de atuação para que os resultados almejados sejam obtidos. Com a identificação e implementação desses elementos num novo modelo de contrato de risco de manutenção, acredita-se ser possível minimizar os problemas comerciais e operacionais que atualmente representam obstáculos ao sucesso da terceirização da manutenção em plantas industriais, particularmente no Brasil . A metodologia se baseia em análise dos resultados de pesquisa de campo através de questionário realizado junto aos principais gestores de grandes grupos industriais e com os executivos das empresas prestadoras de serviço de manutenção industrial.

A internet como ferramenta para venda de veículos: o caso Vitória Webcar

A possibilidade de interagir em tempo real com o consumidor, ao contrário dos monólogos que normalmente caracterizam os tradicionais meios de marketing, alterou drasticamente o jeito como o Customer Service pode ser oferecido, pois permite pesquisas e compras de produtos e serviços on-line, o que representa um maior conforto para o homem contemporâneo, cujo tempo é bem escasso. O mercado representa um papel central na economia de qualquer nação, facilitando a troca de informações, bens, serviços e pagamentos, além de criar valores econômicos para compradores, vendedores, intermediários e para a sociedade de modo geral. Os mercados provêem a infra-estrutura física que permite que as transações entre os compradores e os vendedores ocorram. Dessa forma, entende-se que Mercado e Negociação eletrônica são especializações dos conceitos gerais de Mercado e Negociação. O uso de meios eletrônicos e, mais especificamente, o uso da Internet como recurso para promover o comércio, tem revolucionado todas as formas de comercialização existentes, promovendo o surgimento de novos tipos de mercados eletrônicos, os mercados baseados em Internet. Com tais vantagens, os mercados eletrônicos geram novas oportunidades de negócios, proporcionam novas estratégias para se atingir o consumidor, o fornecedor e os intermediários que estejam dispostos a somar valores na integração cliente/fornecedor. Mercados eletrônicos melhoram as informações compartilhadas entre compradores e fornecedores e ajudam a reduzir o custo de logística permitindo promoções rápidas, entregas imediatas e inventários reduzidos. É a infra-estrutura da informação substituindo sistemas de distribuição física. Foi, portanto, sobre esta temática que buscou-se desenvolver todo o trabalho de pesquisa, enfocando-se um caso real: Vitória Web Car, por ser uma organização que direcionou o seu foco para a qualidade dos serviços, como base para o seu crescimento e diferenciação no mercado do varejo virtual brasileiro.

Negociações de ganhos mútuos: um estudo de caso na empresa pública delta

A negociação é a ferramenta mais eficiente de conseguir algo que se deseja, ela ocorre quando existem conflitos e alternativas a serem selecionadas que podem envolver toda a empresa. As diversas alternativas apresentam interesses comuns e conflitantes, expressando a complexidade das relações. Com a crescente demanda por agilidade na resposta aos novos perfis de procura, as organizações precisam ser mais versáteis nos processos e mais rápidas para reagir às mudanças do mercado, e as Negociações de Ganhos Mútuos (NGM) são uma forma atual de condução de criação de valor. Esta dissertação tem como objetivo propor a utilização das ferramentas da teoria de NGM como instrumento apoiador aos gestores de compras públicas adquirentes de produtos e serviços de TI a atingir os resultados esperados. Para isso, foi realizada uma pesquisa de natureza descritiva-exploratória por meio de abordagem qualitativa. Para atingir este objetivo, foram feitos estudos teóricos das temáticas: Flexibilidade Organizacional, Gestão de Compras Públicas, Sistemas de Informação, Alinhamento Estratégico e Teoria da Negociação, de forma a se obter um melhor entendimento da pesquisa. Foi elaborado um questionário não estruturado, sendo este o instrumento de pesquisa que foi utilizado neste estudo. Aplicado o questionário diretamente aos participantes, obteve-se uma participação de 10 respondentes, sendo todos participantes dos processos licitatórios na empresa pública Delta. Uma vez efetuada a coleta de dados, foram analisadas as respostas utilizando uma modalidade da técnica de análise de conteúdo, chamada pattern-matching, com o propósito de comparar os resultados com o referencial teórico utilizado no estudo. Como resultado do estudo, identificou-se a utilização da abordagem distributiva nos processos licitatórios.

Sistemas de controle de vendas no setor têxtil: um estudo exploratório

Esta dissertação estuda os sistemas de controle de vendas praticados pela indústria têxtil brasileira diante das mudanças ambientais ocorridas nas últimas duas décadas. O pressuposto básico para a utilização de sistemas de controle para a equipe de vendas é que através deles é possível dirigir e influenciar as atitudes e os comportamentos dos empregados para conseguir atingir seus objetivos, havendo uma estreita relação entre a forma como a gerência comercial monitora, dirige, avalia e recompensa as atividades dos seus vendedores e a efetividade da área comercial, sendo diferenciais decisivos para atender a pressão por competitividade e as exigências do mercado quanto ao posicionamento da equipe comercial frente ao novo cenário de negócios. Da revisão teórica foram levantados os oito principais modelos de sistemas de controle e aspectos importantes que devem ser considerados para a composição do sistema de cada empresa. A pesquisa foi conduzida entre os responsáveis por equipes de vendas no segmento têxtil nos elos onde vendas industriais são realizadas. Empregaram-se técnicas empíricas para o levantamento das freqüências de incidência dos aspectos estudados e foi possível constatar que os elos de fibras e filamentos, fiação, tecelagem, malharia e beneficiamento do segmento têxtil possuem sistemas de controle pertinentes com as características de venda industrial. Os controles formais estão ligados a resultados e os controles informais estão relacionados com o acompanhamento das atividades e capacidades do vendedor. Adicionalmente buscou-se captar a percepção dos responsáveis por equipes comerciais sobre sua efetividade nos aspectos de volume de vendas, lucratividade, participação de mercado e também satisfação do cliente.

Is what you say what you do? Analyzing and comparing the effect of buyer-supplier relationship in the Brazilian and Chinese supplier selection criteria

Choosing properly and efficiently a supplier has been challenging practitioners and academics since 1960’s. Since then, countless studies had been performed and relevant changes in the business scenario were considered such as global sourcing, quality-orientation, just-in-time practices. It is almost consensus that quality should be the selection driver, however, some polemical findings questioned this general agreement. Therefore, one of the objectives of the study was to identify the supplier selection criteria and bring this discussion back again. Moreover, Dickson (1966) suggested existing business relationship as selection criterion, then it was reviewed the importance of business relationship for the company and noted a set of potential negative effects that could rise from it. By considering these side effects of relationship, this research aimed to investigate how the relationship could influence the supplier selection and how its harmful effects could affect the selection process. The impact of this phenomenon was investigated cross-nationally. The research strategy adopted was a controlled experiment via vignette combined with discrete choice analysis. The data collections were performed in China and Brazil. By examining the results, it could be drawn five major findings. First, when purchasers were asked to declare their supplier selection priorities, quality was stated as the most important independently of country and relationship. This result was consistent with diverse studies since 60’s. However, when purchasers were exposed to a multi-criteria trade-off situation, their actual selection priorities deviate from what they had declared. In the actual decision-making without influence of buyer-supplier relationship, Brazilian purchasers focused on price and Chinese buyers prioritized delivery then price. This observation reinforced some controversial prior studies of Verma & Pullman (1998) and Hirakubo & Kublin (1998). Second, through the introduction of the buyer-supplier relationship (operationalized via relational capital) in the supplier selection process, this research extended the existing studies and found that Brazilian buyers still focused on price. The relationship became just another criterion for supplier selection such as quality and delivery. However, from the Chinese sample, the results suggested that quality was totally discarded and the decision was majorly made through price and relationship. The third finding suggested that relational capital could legitimate the quality and sustainability of the supplier and replaces these selection criteria and made the decisional task less complex. Additionally, with the relational capital, the decision-makings were associated to few biases such as availability cognition, commitment, confirmatory and perceived biases. By analyzing the purchasers’ behavior, relational capital inducted buyers of both countries to relax in their purchasing requirements (quality, delivery and sustainability) leading to potential negative effects. In the Brazilian sample, the phenomenon of willing to pay a higher price for a lower quality offer demonstrated to be a potential counterproductive and suboptimal decision. Finally, the last finding was associated to the cultural effect on the buyers’ decisions. From the outcome, it is possible to observe that if a purchaser’s cultural background is more relation-oriented, the more he will tend to use relational capital as a decision heuristic, thus, the purchaser will be more susceptible to the potential relationship’s side effects

Un Mediolaniensis mos in epigrafia: l'officina epigrafica di Mediolanum

Si compie un'indagine al fine di determinare se all'interno dell'epigrafia romana fossero presenti precise specificità locali e quale livello di consapevolezza ne avessero i fruitori del mezzo epigrafico. Campione di indagine è l'orizzonte epigrafico di Mediolanum, di cui si definiscono le specificità - monumentali, impaginative, sintattiche, ma anche relative a maestranze e committenza - per confronto con le produzioni epigrafiche circostanti. Il quadro finale è quello di una produzione ben inserita negli orizzonti cisalpino e transpadano, ma che allo stesso tempo se ne differenzia per una serie di peculiarità, che in taluni casi sembrerebbero volutamente ricercate dai committenti.

Comparing expectations and experiences of care for sexually transmitted infections in general practice: a qualitative study

Background A key aim of England's National Strategy for Sexual Health is to extend high-quality sexual health services in primary care. Objectives To explore the expectations and experiences of men and women who initially presented at their general practice with a suspected sexually transmitted infection in order to identify areas where change could improve service delivery. Methods Semi-structured interviews were carried out in six general practices and two genitourinary medicine (GUM) clinics in Brent primary care trust (London) and Bristol (southwest England). Patients within general practice, and GUM patients who had initially attended general practice were eligible to participate. Interview transcripts were analysed using thematic analysis. Results 49 patients (29 women, 20 men) were interviewed. Patients approaching their GP practice typically expected written referral or in-house care, but this expectation was often not met. Absence of formal referral, lack of information and perceived avoidance of sexual health matters by practitioners were commonly cited as reasons for disappointment. However, a dedicated service within general practice met expectations well. Conclusion Purchasers and providers of all general practice services should ensure that any patient consulting in primary care with a suspected sexually transmitted infection can either receive appropriate care there, or a formal and supported referral to a specialised GUM clinic or primary care service.

Clinical decision support capabilities of commercially-available clinical information systems.

BACKGROUND: The most effective decision support systems are integrated with clinical information systems, such as inpatient and outpatient electronic health records (EHRs) and computerized provider order entry (CPOE) systems. Purpose The goal of this project was to describe and quantify the results of a study of decision support capabilities in Certification Commission for Health Information Technology (CCHIT) certified electronic health record systems. METHODS: The authors conducted a series of interviews with representatives of nine commercially available clinical information systems, evaluating their capabilities against 42 different clinical decision support features. RESULTS: Six of the nine reviewed systems offered all the applicable event-driven, action-oriented, real-time clinical decision support triggers required for initiating clinical decision support interventions. Five of the nine systems could access all the patient-specific data items identified as necessary. Six of the nine systems supported all the intervention types identified as necessary to allow clinical information systems to tailor their interventions based on the severity of the clinical situation and the user's workflow. Only one system supported all the offered choices identified as key to allowing physicians to take action directly from within the alert. Discussion The principal finding relates to system-by-system variability. The best system in our analysis had only a single missing feature (from 42 total) while the worst had eighteen.This dramatic variability in CDS capability among commercially available systems was unexpected and is a cause for concern. CONCLUSIONS: These findings have implications for four distinct constituencies: purchasers of clinical information systems, developers of clinical decision support, vendors of clinical information systems and certification bodies.