Avaliação da Performance Cirúrgica: Como Fazer?

Assessment of surgical performance is a must for every surgical practice nowadays and can be done by using scientific methods imported mostly from the Quality control tools that have been in use for long in industry. Surgical performance comprises several dimensions including clinical activity (mortality and morbidity as end points), academic activities, research and, more and more, efficiency. Stable long time results (efficacy), reducing error (safety) and meeting patient expectations (patient satisfaction) are among other performance components. This paper focus on the precise definitions of mortality and morbidity related to surgical activities and on the tools to evaluate patient complexity and assess pre operative risk. Some graphic representations are suggested to compare performance profiles of surgeons and to define individual performance profiles. Strong emphasis is put on pre operative risk assessment and its crucial role to interpret divergent surgical results. Where risk assessment is not possible or is unavailable, observed / expected ratios (O/E) for a given endpoint , be it mortality, length of stay or morbidity, must be established and routinely used to refer results and to identify performance outliers. Morbidity is being pointed out as a most valuable performance indicator in surgery because it is sensitive and comprises efficiency, safety and quality, at large.

Designing and implementing a performance: The case of Estomeo – Dental Industry

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Finance from the NOVA – School of Business and Economics

NAV Portugal's performance within the single European Sky Initiative

NAV Portugal is the Air Navigation Service Provider in Portugal, providing air traffic control services in the airspace under the country’s responsibility. Recently, the company has been included in an initiative launched by the European Commission, called the Single European Sky. This aims for a unification of the European airspace, improving it in four main pillars: safety, capacity, environment, and cost-efficiency. To each of them, Key Performance Indicators need to be computed and monitored, all having pre-defined targets. The presented work project will be analyzing how NAV Portugal is doing in the pillar of capacity, proving suggestions if needed.

Overspeed HIIT in Lower-Body Positive Pressure Treadmill Improves Running Performance.

PURPOSE: Optimal high-intensity interval training (HIIT) regimens for running performance are unknown, although most protocols result in some benefit to key performance factors (running economy (RE), anaerobic threshold (AT), or maximal oxygen uptake (V˙O2max)). Lower-body positive pressure (LBPP) treadmills offer the unique possibility to partially unload runners and reach supramaximal speeds. We studied the use of LBPP to test an overspeed HIIT protocol in trained runners. METHODS: Eleven trained runners (35 ± 8 yr, V˙O2max, 55.7 ± 6.4 mL·kg·min) were randomized to an LBPP (n = 6) or a regular treadmill (CON, n = 5), eight sessions over 4 wk of HIIT program. Four to five intervals were run at 100% of velocity at V˙O2max (vV˙O2max) during 60% of time to exhaustion at vV˙O2max (Tlim) with a 1:1 work:recovery ratio. Performance outcomes were 2-mile track time trial, V˙O2max, vV˙O2max, vAT, Tlim, and RE. LBPP sessions were carried out at 90% body weight. RESULTS: Group-time effects were present for vV˙O2max (CON, 17.5 vs. 18.3, P = 0.03; LBPP, 19.7 vs. 22.3 km·h; P < 0.001) and Tlim (CON, 307.0 vs. 404.4 s, P = 0.28; LBPP, 444.5 vs. 855.5, P < 0.001). Simple main effects for time were present for field performance (CON, -18; LBPP, -25 s; P = 0.002), V˙O2max (CON, 57.6 vs. 59.6; LBPP, 54.1 vs. 55.1 mL·kg·min; P = 0.04) and submaximal HR (157.7 vs. 154.3 and 151.4 vs. 148.5 bpm; P = 0.002). RE was unchanged. CONCLUSIONS: A 4-wk HIIT protocol at 100% vV˙O2max improves field performance, vV˙O2max, V˙O2max and submaximal HR in trained runners. Improvements are similar if intervals are run on a regular treadmill or at higher speeds on a LPBB treadmill with 10% body weight reduction. LBPP could provide an alternative for taxing HIIT sessions.

Palveluliiketoiminta teknologiateollisuudessa

Tutkimuksen tavoitteena on palveluliiketoimintaan liittyvien hypoteesien esittäminen ja niiden todentaminen case-yrityksen avulla. Differointistrategian merkitys ja sen tuomat mahdollisuudet teknologiateollisuuden palveluliiketoiminnassa ovat työn painopisteinä. Itse palveluliiketoimintaa todennettiin tutkimuksessa erinäisin kysymyksin. Tutkimuksen keskeiset aiheet ovat palveluliiketoiminta, differointistrategia, johon myös arvoketjuajattelu kuuluu vahvasti. Tutkimus on keskittynyt myös palveluliiketoiminnan tuottavuuteen ja kannattavuuteen. Jokaista asiaa on pyritty tarkastelemaan logistiikan näkökannalta, mistä on tehty tutkimuksen viitekehys. Tutkimus perustuu kirjallisuustutkimuksiin, havaintoihin ja haastatteluihin. Casetutkimuksen avulla pyritään todentamaan kirjallisuudesta esille tulleet asiat. Palveluliiketoiminta tarkoittaa lisäarvon tuottamista asiakkaalle. Differointistrategia on olennainen osa palveluliiketoimintaa. Differointistrategia perustuu erikoistumiseen ja ainutlaatuisuuteen. Logistiikan avulle voidaan tuottaa asiakkaalle räätälöityjä palveluja ja se mahdollistaa erikoistumisen, differoitumisen. Palveluliiketoiminnan edut ovat lisäarvon tuotto asiakkaalle joko lisäämällä asiakkaan myyntiä ja/tai luomalla kustannussäästöä. Palveluliiketoiminta vaatii toimittajalta strategian ja tavoitteiden muutosta, mutta ennen kaikkea asennemuutosta ja sitoutumista. Palvelun tuottavuus ja kannattavuus mittarit/näkökulmat tulee yrityksen yleensä muuttaa, sillä perinteiset mittaustavat eivät enää välttämättä sovi palveluliiketoiminnan toiminnan mittaamiseen.

Tuotannon tunnuslukujen analysointi ja kehittäminen kourukoneilla

Sisäisen suorituskyvyn tehostaminen on yrityksille jatkuvan kehityksen prosessi. Diplomityön tarkoituksena oli selvittää Paroc Oy Ab:n kourukoneiden suorituskykymittarit sekä analysoida ja kehittää niitä. Lisäksi selvitettiin suorituskykyä kuvaavat raporttimallit eri tuotantopaikkakunnilta ja kehitettiin niitä. Teoriaosuudessa kerrotaan, mitä suorituskyvyllä tarkoitetaan sekä käydään läpi sen eri osa-alueita. Siinä esitetään myös suorituskyvyn mittaamista sekä kuinka mittareita suunnitellaan ja rakennetaan. Työn painopiste on kuitenkin empiirisessä osuudessa, jossa ensin kerrotaan työn kohteena olevien kourukoneiden tuotantoprosessi ja tämän jälkeen paneudutaan suorituskykymittareihin ja niiden analysointiin sekä raporttimalleihin. Lopuksi esitetään työn aikana esille nousseita kehitysehdotuksia. Tunnuslukujen selvittämisen tuloksena havaittiin, että kirjallisuus tukee käytössä olevia mittareita. Työssä kerättiin tuotantodataa kourukoneilta usean vuoden aikajaksolta. Datasta valmisteltiin mallit, joita käytettiin mittarien analysointiin. Analysoinnin tuloksena kävi ilmi, että mittarien tarjoama tieto oli joiltakin osin puutteellista ja näin ollen päätöksentekijälle harhaanjohtavaa. Raporttimallit eivät olleet yhtenäisiä paikkakuntien välillä, mikä toi epävarmuutta tuloksiin laskentaperiaatteiden osalta. Työn lopputuloksena tehtiin käytössä oleville suorituskykymittareille kehitysehdotuksia tarkemman ja laadukkaamman tiedon takaamiseksi. Työssä esitettiin myös uusia mittariehdotuksia. Raporttimallit yhtenäistettiin uuden tuotannonohjausjärjestelmän tuomien mahdollisuuksien myötä.

Practical Framework for Monitoring the Performance of Agile IT Projects in an Output-Based Outsourcing Context

Over the past decade, organizations worldwide have begun to widely adopt agile software development practices, which offer greater flexibility to frequently changing business requirements, better cost effectiveness due to minimization of waste, faster time-to-market, and closer collaboration between business and IT. At the same time, IT services are continuing to be increasingly outsourced to third parties providing the organizations with the ability to focus on their core capabilities as well as to take advantage of better demand scalability, access to specialized skills, and cost benefits. An output-based pricing model, where the customers pay directly for the functionality that was delivered rather than the effort spent, is quickly becoming a new trend in IT outsourcing allowing to transfer the risk away from the customer while at the same time offering much better incentives for the supplier to optimize processes and improve efficiency, and consequently producing a true win-win outcome. Despite the widespread adoption of both agile practices and output-based outsourcing, there is little formal research available on how the two can be effectively combined in practice. Moreover, little practical guidance exists on how companies can measure the performance of their agile projects, which are being delivered in an output-based outsourced environment. This research attempted to shed light on this issue by developing a practical project monitoring framework which may be readily applied by organizations to monitor the performance of agile projects in an output-based outsourcing context, thus taking advantage of the combined benefits of such an arrangement Modified from action research approach, this research was divided into two cycles, each consisting of the Identification, Analysis, Verification, and Conclusion phases. During Cycle 1, a list of six Key Performance Indicators (KPIs) was proposed and accepted by the professionals in the studied multinational organization, which formed the core of the proposed framework and answered the first research sub-question of what needs to be measured. In Cycle 2, a more in-depth analysis was provided for each of the suggested Key Performance Indicators including the techniques for capturing, calculating, and evaluating the information provided by each KPI. In the course of Cycle 2, the second research sub-question was answered, clarifying how the data for each KPI needed to be measured, interpreted, and acted upon. Consequently, after two incremental research cycles, the primary research question was answered describing the practical framework that may be used for monitoring the performance of agile IT projects delivered in an output-based outsourcing context. This framework was evaluated by the professionals within the context of the studied organization and received positive feedback across all four evaluation criteria set forth in this research, including the low overhead of data collection, high value of provided information, ease of understandability of the metric dashboard, and high generalizability of the proposed framework.

Corporate social performance and stock returns: UK evidence from disaggregate measures

This study examines the relation between corporate social performance and stock returns in the UK. We closely evaluate the interactions between social and financial performance with a set of disaggregated social performance indicators for environment, employment, and community activities instead of using an aggregate measure. While scores on a composite social performance indicator are negatively related to stock returns, we find the poor financial reward offered by such firms is attributable to their good social performance on the environment and, to a lesser extent, the community aspects. Considerable abnormal returns are available from holding a portfolio of the socially least desirable stocks. These relationships between social and financial performance can be rationalized by multi-factor models for explaining the cross-sectional variation in returns, but not by industry effects.

Indicadores de performance na cadeia de suprimentos

Esta dissertação procura explorar dentro do conceito de Cadeia de Suprimentos, como sendo um conjunto de atividades relacionadas à gestão do fluxo de materiais e de Logística Empresarial; não só a importância dos processos correlacionados tais como: planejamento, implementação e controle do fluxo de materiais, mas principalmente, a importância de medir e monitorar o desempenho destes processos, como forma de manter a empresa competitiva e atualizada em suas práticas. Expor alguns conceitos sobre indicadores de performance, suas funções, implicações e aplicabilidades, a fim de que não sejam mal interpretados ou mal utilizados uma vez que, da correta interpretação e utilização, depende a superioridade das empresas. Para muitas empresas hoje, o diferencial competitivo está no quanto o processo de logística é bem administrado. Para alcançar excelência em logística deve-se assegurar que os processos-chave correlacionados estejam alinhados com a estratégia central do negócio, e que sejam constantemente medidos contra objetivos de performance pré-definidos. Podendo ainda, estes objetivos, serem estabelecidos conjuntamente a cada um de seus parceiros e integrantes da cadeia (clientes / fornecedores / sub-contratados) a fim de criar-se um entendimento comum de expectativas e resultados.

Performance measurement review: a comparison between English and Italian companies

Il sistema di misurazione delle performance (PMS) ha ricevuto particolare attenzione dalla ricerca in ambito accademico e dalle aziende che ogni anno investono risorse nell’implementazione e nel miglioramento di questo strumento. I ruoli assegnati al PMS possono essere: misurazione della performance, implementazione della strategia, comunicazione, allineamento dei comportamenti, apprendimento e miglioramento. Queste differenti finalità sottolineano quanto sia strategica un’efficace implementazione di tale strumento. Negli ultimi anni le aziende si trovano a dover competere in ambienti sempre più turbolenti e mutevoli. La capacità di adattarsi al cambiamento è fondamentale, pertanto anche il PMS deve essere aggiornato per garantire un’implementazione di Key Performance Indicators (KPIs) che siano appropriati e rilevanti, considerando le nuove priorità aziendali e le condizioni al contorno. Questa tesi ha come obiettivo quello di analizzare la revisione del PMS, in quanto un inappropriato set di KPIs implementati possono causare un indebolimento del potenziale di tale strumento ed ancor peggio un fallimento degli investimenti riguardanti tale strumento. L’approccio metodologico di questa tesi è un multiple case-study. Per avere una visione più ampia di come viene sviluppata la revisione del PMS nella pratica si è deciso di inserire nel campione aziende di grandi dimensioni operanti in differenti settori industriali. Le informazioni raccolte attraverso le interviste, hanno permesso di fornire un contributo non presente in letteratura: una categorizzazione delle revisioni svolte dalle aziende e riflessioni su di esse. La limitazione di questo studio è legata ad un basso numero interviste svolte.

Quantificazione del rischio occupazionale: Indicatori, indici e metodologia fuzzy

La tesi affronta il concetto di esposizione al rischio occupazionale e il suo scopo è quello di indagare l’ambiente di lavoro e il comportamento dei lavoratori, con l'obiettivo di ridurre il tasso di incidenza degli infortuni sul lavoro ed eseguire la riduzione dei rischi. In primo luogo, è proposta una nuova metodologia denominata MIMOSA (Methodology for the Implementation and Monitoring of Occupational SAfety), che quantifica il livello di "salute e sicurezza" di una qualsiasi impresa. Al fine di raggiungere l’obiettivo si è reso necessario un approccio multidisciplinare in cui concetti d’ingegneria e di psicologia sono stati combinati per sviluppare una metodologia di previsione degli incidenti e di miglioramento della sicurezza sul lavoro. I risultati della sperimentazione di MIMOSA hanno spinto all'uso della Logica Fuzzy nel settore della sicurezza occupazionale per migliorare la metodologia stessa e per superare i problemi riscontrati nell’incertezza della raccolta dei dati. La letteratura mostra che i fattori umani, la percezione del rischio e il comportamento dei lavoratori in relazione al rischio percepito, hanno un ruolo molto importante nella comparsa degli incidenti. Questa considerazione ha portato ad un nuovo approccio e ad una seconda metodologia che consiste nella prevenzione di incidenti, non solo sulla base dell'analisi delle loro dinamiche passate. Infatti la metodologia considera la valutazione di un indice basato sui comportamenti proattivi dei lavoratori e sui danni potenziali degli eventi incidentali evitati. L'innovazione consiste nell'applicazione della Logica Fuzzy per tener conto dell’"indeterminatezza" del comportamento umano e del suo linguaggio naturale. In particolare l’applicazione è incentrata sulla proattività dei lavoratori e si prefigge di impedire l'evento "infortunio", grazie alla generazione di una sorta d’indicatore di anticipo. Questa procedura è stata testata su un’azienda petrolchimica italiana.

Performance evaluation of a miniature laser ablation time-of-flight mass spectrometer designed for in situ investigations in planetary space research

Key performance features of a miniature laser ablation time-of-flight mass spectrometer designed for in situ investigations of the chemical composition of planetary surfaces are presented. This mass spectrometer is well suited for elemental and isotopic analysis of raw solid materials with high sensitivity and high spatial resolution. In this study, ultraviolet laser radiation with irradiances suitable for ablation (< 1 GW/cm2) is used to achieve stable ion formation and low sample consumption. In comparison to our previous laser ablation studies at infrared wavelengths, several improvements to the experimental setup have been made, which allow accurate control over the experimental conditions and good reproducibility of measurements. Current performance evaluations indicate significant improvements to several instrumental figures of merit. Calibration of the mass scale is performed within a mass accuracy (Δm/m) in the range of 100 ppm, and a typical mass resolution (m/Δm) ~600 is achieved at the lead mass peaks. At lower laser irradiances, the mass resolution is better, about (m/Δm) ~900 for lead, and limited by the laser pulse duration of 3 ns. The effective dynamic range of the instrument was enhanced from about 6 decades determined in previous study up to more than 8 decades at present. Current studies show high sensitivity in detection of both metallic and non-metallic elements. Their abundance down to tens of ppb can be measured together with their isotopic patterns. Due to strict control of the experimental parameters, e.g. laser characteristics, ion-optical parameters and sample position, by computer control, measurements can be performed with high reproducibility. Copyright © 2012 John Wiley & Sons, Ltd.

Does land fragmentation affect farm performance? A case study from Brittany. Factor Markets Working Paper No. 40, April 2013

Agricultural land fragmentation is widespread and may affect farmers’ decisions and impact farm performance, either negatively or positively. The authors investigated this impact for the western region of Brittany, France, in 2007, regressing a set of performance indicators on a set of fragmentation descriptors. The performance indicators (production costs, yields, revenue, profitability, technical and scale efficiency) were calculated at the farm level using Farm Accountancy Data Network (FADN) data, while the fragmentation descriptors were calculated at the municipality level using data from the cartographic field pattern registry (RPG). The various fragmentation descriptors enabled the authors to account for not only the traditional number and average size of plots, but also their geographical scattering. They found that farms experienced higher costs of production, lower crop yields and lower profitability where land fragmentation (LF) was more pronounced. Total technical efficiency was not found to be significantly related to any of the municipality LF descriptors used, while scale efficiency was lower where the average distance to the nearest neighbouring plot was greater. Pure technical efficiency was found to be negatively related to the average number of plots in the municipality, with the unexpected result that it was also positively related to the average distance to the nearest neighbouring plot. By simulating the impact of hypothetical consolidation programmes on average pre-tax profits and wheat yield, the study also showed that the marginal benefits of reducing fragmentation may differ with respect to the improved LF dimension and the performance indicator considered. The analysis therefore shows that the measures of land fragmentation usually used in the literature do not reveal the full set of significant relationships with farm performance and that, in particular, measures accounting for distance should be considered more systematically.

The impact of supply chain performance measurement systems on dynamic behaviour in supply chains

The amplification of demand variation up a supply chain widely termed ‘the Bullwhip Effect’ is disruptive, costly and something that supply chain management generally seeks to minimise. Originally attributed to poor system design; deficiencies in policies, organisation structure and delays in material and information flow all lead to sub-optimal reorder point calculation. It has since been attributed to exogenous random factors such as: uncertainties in demand, supply and distribution lead time but these causes are not exclusive as academic and operational studies since have shown that orders and/or inventories can exhibit significant variability even if customer demand and lead time are deterministic. This increase in the range of possible causes of dynamic behaviour indicates that our understanding of the phenomenon is far from complete. One possible, yet previously unexplored, factor that may influence dynamic behaviour in supply chains is the application and operation of supply chain performance measures. Organisations monitoring and responding to their adopted key performance metrics will make operational changes and this action may influence the level of dynamics within the supply chain, possibly degrading the performance of the very system they were intended to measure. In order to explore this a plausible abstraction of the operational responses to the Supply Chain Council’s SCOR® (Supply Chain Operations Reference) model was incorporated into a classic Beer Game distribution representation, using the dynamic discrete event simulation software Simul8. During the simulation the five SCOR Supply Chain Performance Attributes: Reliability, Responsiveness, Flexibility, Cost and Utilisation were continuously monitored and compared to established targets. Operational adjustments to the; reorder point, transportation modes and production capacity (where appropriate) for three independent supply chain roles were made and the degree of dynamic behaviour in the Supply Chain measured, using the ratio of the standard deviation of upstream demand relative to the standard deviation of the downstream demand. Factors employed to build the detailed model include: variable retail demand, order transmission, transportation delays, production delays, capacity constraints demand multipliers and demand averaging periods. Five dimensions of supply chain performance were monitored independently in three autonomous supply chain roles and operational settings adjusted accordingly. Uniqueness of this research stems from the application of the five SCOR performance attributes with modelled operational responses in a dynamic discrete event simulation model. This project makes its primary contribution to knowledge by measuring the impact, on supply chain dynamics, of applying a representative performance measurement system.

Emergent strategy and the measurement of performance:the formulation of performance indicators at the microlevel

This article presents some evidence on an aspect of the design of a strategic control system, at the microlevel, within a single organization. The research we report used an ethnographic approach to provide an understanding of strategy formulation. Our aim is to contribute to an area of literature which is of increasing significance, but relatively underdeveloped in terms of the application of in-depth, field-research techniques. We take an intensive look at the manner in which performance measures are formulated, at the microlevel, within a single organization. The article presents, as an in-depth case analysis, the experience of a fisheries holding company in New Zealand. The article recounts the experiences of managers within the organization of the process of identification of such things as critical success factors and key performance indicators (KPIs) and, more broadly, the formulation of a strategic performance measurement system.