Europe's exports superstar - it's the organisation! Bruegel Working Paper 2015/05, 15 July 2015

What explains Germany’s superb export performance? Is Germany’s export behaviour very distinct compared to other European countries? The authors explore the organisational responses to competition of 14,000 exporting firms in seven European countries. The paper examines the export business model of the median exporter and of the top one percent exporters in each country, accounting for 20 percent to 55 percent of total exports. What do these firms do to become superstars? The authors find, first, that the export market share of the median exporter in each of the countries to the world more than tripled (in some cases the export market share increases tenfold) for firms that combine decentralised management with offshoring of production to low-wage countries. Exporters which abstain from any organisational adjustment do very badly. Decentralised management provides incentives for workers for product improvements allowing exporters to compete on quality. Offshoring production to low-wage countries reduces costs allowing exporters to compete on price. Second, we find that Germany is the leading quality exporter in Europe followed by Austria and Spain. Among the top 10 percent of exporters there is no single firm with low quality in Germany and Austria, which suggest that decentralised management has provided incentives for quality in these countries. Third, Germany’s exports are less vulnerable to price increases, while exports from France and Italy respond strongly to price changes, and thus costs reductions via offshoring benefits these countries most.

Disruptive Marketing Strategy - ribaltare i classici modelli di approccio al mercato

Viviamo in un epoca di cambiamenti. Continuamente, giorno dopo giorno, il vecchio scompare per fare spazio al nuovo. La tecnologia permea sempre più in ogni aspetto della vita, conquistando le nostre abitudini, cambiando il nostro modo di vedere il mondo, e, in maniera inevitabile, il nostro modo di agire. L’essere umano ha da sempre cercato di concepire cose che ancora non ci sono, per cambiare la realtà e modellarla a suo piacimento. Si parte, quindi, da qualcosa che fin dalla nascita è dentro ognuno di noi, un desiderio che arde nell'animo umano, che si alimenta grazie al soffio dell’immaginazione e che non c’è modo di spegnere. L’innovazione porta novità. Resistere al cambiamento non è sempre facile, e se si cerca di ostacolarlo esso ti travolgerà. “Affrontare il cambiamento è come scalare una colata di fango giù per una collina” - esordisce in “The Innovator Dilemma”, Clayton M. Christensen - “Bisogna affrontare qualsiasi cosa per rimanere su di essa, e non appena ci si ferma per prendere fiato si viene seppelliti”. Si intuisce come il cambiamento tecnologico non solo sia di fondamentale evidenza nella vita di ognuno, ma come esso abbia cambiato e stia cambiando il modo di fare business. In questo umile lavoro si è voluto analizzare come certi tipi di innovazione abbiano il potere di cambiare tutto un sistema di riferimento sul quale prima l’impresa faceva affidamento. Sono le Disruptive Innovation – le innovazioni dirompenti – quelle innovazioni che ribaltano un modello di business, il modo di vedere un prodotto, la logica dietro a certe operations aziendali, che seppur sembrassero solide, si sgretolano scontrandosi con innovazioni così forti. Vi è poi una domanda critica a cui si è cercato di rispondere. Si può fare Disruptive Marketing? Alcuni esempi virtuosi ci mostrano come si possa attuare una strategia di questo genere, e come si possa “comprendere, creare, comunicare e distribuire valore” in modo innovativo.

Three-Dimensional Structure and Disposition of the Air Conducting and Gas Exchange Conduits of the Avian Lung: The Domestic Duck (Cairina moschata)

The anatomy of the domestic duck lung was studied macroscopically, by casting and by light, transmission, and scanning electron microscopy. The lung had four categories of secondary bronchi (SB), namely, the medioventral (MV, 4-5), laterodorsal (LD, 6-10), lateroventral (LV, 2-4), and posterior secondary bronchi (PO, 36-44). The neopulmonic parabronchi formed an intricate feltwork on the ventral third of the lung and inosculated those from the other SB. The lung parenchyma was organized into cylindrical parabronchi separated by thin septa containing blood vessels. Atria were shallow and well-fortified by epithelial ridges reinforced by smooth muscle bundles and gave rise to 2-6 elongate infundibulae. Air capillaries arose either directly from the atria or from infundibulae and were tubular or globular in shape with thin interconnecting branches. The newly described spatial disposition of the conducting air conduits closely resembles that of the chicken. This remarkable similarity between the categories, numbers, and 3D arrangement of the SB in the duck and chicken points to a convergence in function-oriented design. To illuminate airflow dynamics in the avian lung, precise directions of airflow in the various categories of SB and parabronchi need to be characterized.

A influência dos aplicativos móveis no negócio das empresas prestadoras de serviço de táxis em São Paulo: um estudo de caso

Este estudo pretende identificar as mudanças relevantes no mercado e qual o valor percebido pelos clientes e taxistas, considerando-se a inserção das empresas prestadoras de serviços de táxis da cidade de São Paulo no mundo virtual, através do uso de aplicativos. Para tanto, explanamos o conceito de cadeia de valor, incluindo cadeia de valor virtual e rede de valor, a fim de um melhor entendimento da estrutura em que se embasam as empresas desse novo ambiente, bem como explicamos os conceitos de modelo de negócio e Business Model Canvas. Com esse embasamento teórico propomos um framework com a finalidade de auxiliar o processo de extração e análise das informações que permitiram identificar as mudanças relevantes que ocorreram nesse mercado e o valor percebido pelos clientes e taxistas, fazendo uso de um estudo de caso. O tema é relevante, por se tratar de uma mudança significativa na forma como as empresas se relacionam com seus clientes e prestadores; e por permitir observar que valor agregado esse modelo tem propiciado, que fez com que cerca de 30 mil taxistas, dos 35 mil da cidade de São Paulo, optassem pelo uso de aplicativos, fazendo com que uma das empresas estudadas nessa dissertação atingisse mais de 2.5 milhões de downloads em todo o Brasil. Espera-se, com este estudo, identificar as mudanças relevantes que a inserção dos aplicativos trouxeram aos usuários e taxistas e apresentar um framework que pode ser utilizado como um facilitador na análise da cadeia de valor e cadeia de valor virtual do mercado de prestação de serviços de taxis, esclarecendo que esse modelo não é apenas um modismo ao qual se pode atribuir uma série de benefícios, mas, sim, uma tendência que está redefinindo o formato das empresas desse mercado.

Two new tools for assessing patients' knowledge and beliefs about obstructive sleep apnea and continuous positive airway pressure therapy

Background and purpose: Patients' knowledge and beliefs about their illnesses are known to influence a range of health related variables, including treatment compliance. It may, therefore, be important to quantify these variables to assess their impact on compliance, particularly in chronic illnesses such as Obstructive Sleep Apnea (OSA) that rely on self-administered treatments. The aim of this study was to develop two new tools, the Apnea Knowledge Test (AKT) and the Apnea Beliefs Scale (ABS), to assess illness knowledge and beliefs in OSA patients. Patients and methods: The systematic test construction process followed to develop the AKT and the ABS included consultation with sleep experts and OSA patients. The psychometric properties of the AKT and ABS were then investigated in a clinical sample of 81 OSA patients and 33 healthy, non-sleep disordered adults. Results: Results suggest both measures are easily understood by OSA patients, have adequate internal consistency, and are readily accepted by patients. A preliminary investigation of the validity of these tools, conducted by comparing patient data to that of the 33 healthy adults, revealed that apnea patients knew more about OSA, had more positive attitudes towards continuous positive airway pressure (CPAP) treatment, and attributed more importance to treating sleep disturbances than non-clinical groups. Conclusions: Overall, the results of psychometric analyses of these tests suggest these measures will be useful clinical tools with numerous beneficial applications, particularly in CPAP compliance studies and apnea education program evaluations. (C) 2004 Elsevier B.V. All rights reserved.

Validation of the Action Research Arm Test using item response theory in patients after stroke

Objective: To validate the unidimensionality of the Action Research Arm Test (ARAT) using Mokken analysis and to examine whether scores of the ARAT can be transformed into interval scores using Rasch analysis. Subjects and methods: A total of 351 patients with stroke were recruited from 5 rehabilitation departments located in 4 regions of Taiwan. The 19-item ARAT was administered to all the subjects by a physical therapist. The data were analysed using item response theory by non-parametric Mokken analysis followed by Rasch analysis. Results: The results supported a unidimensional scale of the 19-item ARAT by Mokken analysis, with the scalability coefficient H = 0.95. Except for the item pinch ball bearing 3rd finger and thumb'', the remaining 18 items have a consistently hierarchical order along the upper extremity function's continuum. In contrast, the Rasch analysis, with a stepwise deletion of misfit items, showed that only 4 items (grasp ball'', grasp block 5 cm(3)'', grasp block 2.5 cm(3)'', and grip tube 1 cm(3)'') fit the Rasch rating scale model's expectations. Conclusion: Our findings indicated that the 19-item ARAT constituted a unidimensional construct measuring upper extremity function in stroke patients. However, the results did not support the premise that the raw sum scores of the ARAT can be transformed into interval Rasch scores. Thus, the raw sum scores of the ARAT can provide information only about order of patients on their upper extremity functional abilities, but not represent each patient's exact functioning.

Sviluppo e Applicazione di Metodologie per l'Ottimizzazione di Sistemi Energetici

La riduzione dei consumi di combustibili fossili e lo sviluppo di tecnologie per il risparmio energetico sono una questione di centrale importanza sia per l’industria che per la ricerca, a causa dei drastici effetti che le emissioni di inquinanti antropogenici stanno avendo sull’ambiente. Mentre un crescente numero di normative e regolamenti vengono emessi per far fronte a questi problemi, la necessità di sviluppare tecnologie a basse emissioni sta guidando la ricerca in numerosi settori industriali. Nonostante la realizzazione di fonti energetiche rinnovabili sia vista come la soluzione più promettente nel lungo periodo, un’efficace e completa integrazione di tali tecnologie risulta ad oggi impraticabile, a causa sia di vincoli tecnici che della vastità della quota di energia prodotta, attualmente soddisfatta da fonti fossili, che le tecnologie alternative dovrebbero andare a coprire. L’ottimizzazione della produzione e della gestione energetica d’altra parte, associata allo sviluppo di tecnologie per la riduzione dei consumi energetici, rappresenta una soluzione adeguata al problema, che può al contempo essere integrata all’interno di orizzonti temporali più brevi. L’obiettivo della presente tesi è quello di investigare, sviluppare ed applicare un insieme di strumenti numerici per ottimizzare la progettazione e la gestione di processi energetici che possa essere usato per ottenere una riduzione dei consumi di combustibile ed un’ottimizzazione dell’efficienza energetica. La metodologia sviluppata si appoggia su un approccio basato sulla modellazione numerica dei sistemi, che sfrutta le capacità predittive, derivanti da una rappresentazione matematica dei processi, per sviluppare delle strategie di ottimizzazione degli stessi, a fronte di condizioni di impiego realistiche. Nello sviluppo di queste procedure, particolare enfasi viene data alla necessità di derivare delle corrette strategie di gestione, che tengano conto delle dinamiche degli impianti analizzati, per poter ottenere le migliori prestazioni durante l’effettiva fase operativa. Durante lo sviluppo della tesi il problema dell’ottimizzazione energetica è stato affrontato in riferimento a tre diverse applicazioni tecnologiche. Nella prima di queste è stato considerato un impianto multi-fonte per la soddisfazione della domanda energetica di un edificio ad uso commerciale. Poiché tale sistema utilizza una serie di molteplici tecnologie per la produzione dell’energia termica ed elettrica richiesta dalle utenze, è necessario identificare la corretta strategia di ripartizione dei carichi, in grado di garantire la massima efficienza energetica dell’impianto. Basandosi su un modello semplificato dell’impianto, il problema è stato risolto applicando un algoritmo di Programmazione Dinamica deterministico, e i risultati ottenuti sono stati comparati con quelli derivanti dall’adozione di una più semplice strategia a regole, provando in tal modo i vantaggi connessi all’adozione di una strategia di controllo ottimale. Nella seconda applicazione è stata investigata la progettazione di una soluzione ibrida per il recupero energetico da uno scavatore idraulico. Poiché diversi layout tecnologici per implementare questa soluzione possono essere concepiti e l’introduzione di componenti aggiuntivi necessita di un corretto dimensionamento, è necessario lo sviluppo di una metodologia che permetta di valutare le massime prestazioni ottenibili da ognuna di tali soluzioni alternative. Il confronto fra i diversi layout è stato perciò condotto sulla base delle prestazioni energetiche del macchinario durante un ciclo di scavo standardizzato, stimate grazie all’ausilio di un dettagliato modello dell’impianto. Poiché l’aggiunta di dispositivi per il recupero energetico introduce gradi di libertà addizionali nel sistema, è stato inoltre necessario determinare la strategia di controllo ottimale dei medesimi, al fine di poter valutare le massime prestazioni ottenibili da ciascun layout. Tale problema è stato di nuovo risolto grazie all’ausilio di un algoritmo di Programmazione Dinamica, che sfrutta un modello semplificato del sistema, ideato per lo scopo. Una volta che le prestazioni ottimali per ogni soluzione progettuale sono state determinate, è stato possibile effettuare un equo confronto fra le diverse alternative. Nella terza ed ultima applicazione è stato analizzato un impianto a ciclo Rankine organico (ORC) per il recupero di cascami termici dai gas di scarico di autovetture. Nonostante gli impianti ORC siano potenzialmente in grado di produrre rilevanti incrementi nel risparmio di combustibile di un veicolo, è necessario per il loro corretto funzionamento lo sviluppo di complesse strategie di controllo, che siano in grado di far fronte alla variabilità della fonte di calore per il processo; inoltre, contemporaneamente alla massimizzazione dei risparmi di combustibile, il sistema deve essere mantenuto in condizioni di funzionamento sicure. Per far fronte al problema, un robusto ed efficace modello dell’impianto è stato realizzato, basandosi sulla Moving Boundary Methodology, per la simulazione delle dinamiche di cambio di fase del fluido organico e la stima delle prestazioni dell’impianto. Tale modello è stato in seguito utilizzato per progettare un controllore predittivo (MPC) in grado di stimare i parametri di controllo ottimali per la gestione del sistema durante il funzionamento transitorio. Per la soluzione del corrispondente problema di ottimizzazione dinamica non lineare, un algoritmo basato sulla Particle Swarm Optimization è stato sviluppato. I risultati ottenuti con l’adozione di tale controllore sono stati confrontati con quelli ottenibili da un classico controllore proporzionale integrale (PI), mostrando nuovamente i vantaggi, da un punto di vista energetico, derivanti dall’adozione di una strategia di controllo ottima.

A TV digital e o setor industrial tecnológico brasileiro

O presente estudo disserta sobre o papel da indústria, com foco nos fabricantes de televisores e sua participação na implantação e desenvolvimento da TV Digital no Brasil, como os primeiros atores desse cenário a apontar o norte para a viabilização de um modelo de negócio para a Televisão Digital (TVD) e Televisão Digital Interativa (TVDI): a TV Conectada e a TV Inteligente. Faz um levantamento histórico do tema desde o Governo FHC, passando pelo Governo Lula até o atual Governo Dilma. O texto apresenta os desafios técnico, político e econômico dessa implementação. Pretende identificar os acertos e enganos dos atores envolvidos nesse cenário, montado para a implementação do sistema digital da TV brasileira. Ressalta os interesses, nem sempre harmônicos, de todos os envolvidos: do capital, com foco no lucro; do governo, com seus acordos políticos, muitas vezes contrapondo ao cumprimento de seu papel de representante dos interesses da maioria da população brasileira; e da dinâmica científico tecnológico-industrial, que necessita de campo fértil, propício e contínuo para se desenvolver.(AU)

TV Digital aberta no Brasil

O presente trabalho analisa os importantes desafios que as novas tecnologias e as transformações na sociedade pós-industrial estão impondo à TV digital brasileira e ao seu modelo de negócios. Tem como principal objetivo realizar uma reflexão sobre a viabilidade financeira das emissoras abertas com a chegada da TV digital. Para tanto, analisa o modelo de negócios anterior, da TV analógica, baseado nos comerciais de trinta segundos e como esta forma poderá ser afetada inviabilizando a estrutura de produção e distribuição de conteúdo pelas emissoras abertas digitais. Ainda, busca evidenciar demais fatores que contribuem para a migração da audiência para outras plataformas de distribuição de conteúdo, refutando o senso comum de que o acesso à internet banda larga é a principal causa da queda dos índices de audiência. Este estudo se utiliza de uma ampla bibliografia que extrapola o campo específico da Comunicação e amplia o olhar sobre a indústria televisiva aberta no Brasil, enumerando fragilidades do setor e apontando possíveis estratégias para que a televisão brasileira possa se adaptar à nova estrutura da comunicação que está se formando em nosso país.

A study of the impact of lean on UK manufacturing organisations that view it as a philosophy

There were three principal research aims: primarily, Lean is and always should be regarded as a business model as depicted by Toyota who is dedicated towards finding better ways of producing cars; consequently an investigation of whether organisations embracing Lean as a philosophy were indeed more triumphant. An adapted balanced scorecard was used which embraced strategic, operation and indices focused towards the future prospects of an organisation. Secondly, it was obligatory to explicitly and precisely determine whether an organisation espoused Lean as a philosophy as opposed to another process or strategy. Thirdly, since Lean has to be envisaged as a never-ending journey; it was important to map out the Lean journey and to be able to categorize the juncture an organisation occupies at any particular phase of its overall implementation. This affords an opportunity to advise an organisation of specific requirements it needs to satisfy should it wish to embrace Lean as a philosophy. The methodological approach focused on the effective deployment of survey questionnaires in sixty-eight organisations and seven extensive case studies in manufacturing organisations of varying sizes. The CIMA organisational classification, the Puttick grid and the Product-Process matrix were used to analyse the range of organisations used in this investigation. Whilst there was a requirement to investigate whether Lean indeed equates to success, pertinent performance measurement was considered decisive; the DMP Model (Maltz et al., 2003) was modified to perform this role. An unremitting theme both in literature concerning the implementation of Lean and in the research evolves around the notion of corporate cultures. Its relevance is explored further within the analysis. In accepting the premise that Lean incorporates a journey, it was fundamental to identify the voyage. Prevalent frameworks are deficient in identifying the sustainability and ideological facets of Lean. Consequently, an extensive Lean audit was developed and piloted in twenty disparate organisations.

Stand-alone groundwater desalination system using reverse osmosis combined with a cooled greenhouse for use in arid and semi-arid zones of India

In many areas of northern India, salinity renders groundwater unsuitable for drinking and even for irrigation. Though membrane treatment can be used to remove the salt, there are some drawbacks to this approach e.g. (1) depletion of the groundwater due to over-abstraction, (2) saline contamination of surface water and soil caused by concentrate disposal and (3) high electricity usage. To address these issues, a system is proposed in which a photovoltaic-powered reverse osmosis (RO) system is used to irrigate a greenhouse (GH) in a stand-alone arrangement. The concentrate from the RO is supplied to an evaporative cooling system, thus reducing the volume of the concentrate so that finally it can be evaporated in a pond to solid for safe disposal. Based on typical meteorological data for Delhi, calculations based on mass and energy balance are presented to assess the sizing and cost of the system. It is shown that solar radiation, freshwater output and evapotranspiration demand are readily matched due to the approximately linear relation among these variables. The demand for concentrate varies independently, however, thus favouring the use of a variable recovery arrangement. Though enough water may be harvested from the GH roof to provide year-round irrigation, this would require considerable storage. Some practical options for storage tanks are discussed. An alternative use of rainwater is in misting to reduce peak temperatures in the summer. An example optimised design provides internal temperatures below 30EC (monthly average daily maxima) for 8 months of the year and costs about €36,000 for the whole system with GH floor area of 1000 m2 . Further work is needed to assess technical risks relating to scale-deposition in the membrane and evaporative pads, and to develop a business model that will allow such a project to succeed in the Indian rural context.

Evaluating productive efficiency:comparative study of commercial banks in Gulf countries

Financial institutes are an integral part of any modern economy. In the 1970s and 1980s, Gulf Cooperation Council (GCC) countries made significant progress in financial deepening and in building a modern financial infrastructure. This study aims to evaluate the performance (efficiency) of financial institutes (banking sector) in GCC countries. Since, the selected variables include negative data for some banks and positive for others, and the available evaluation methods are not helpful in this case, so we developed a Semi Oriented Radial Model to perform this evaluation. Furthermore, since the SORM evaluation result provides a limited information for any decision maker (bankers, investors, etc...), we proposed a second stage analysis using classification and regression (C&R) method to get further results combining SORM results with other environmental data (Financial, economical and political) to set rules for the efficient banks, hence, the results will be useful for bankers in order to improve their bank performance and to the investors, maximize their returns. Mainly there are two approaches to evaluate the performance of Decision Making Units (DMUs), under each of them there are different methods with different assumptions. Parametric approach is based on the econometric regression theory and nonparametric approach is based on a mathematical linear programming theory. Under the nonparametric approaches, there are two methods: Data Envelopment Analysis (DEA) and Free Disposal Hull (FDH). While there are three methods under the parametric approach: Stochastic Frontier Analysis (SFA); Thick Frontier Analysis (TFA) and Distribution-Free Analysis (DFA). The result shows that DEA and SFA are the most applicable methods in banking sector, but DEA is seem to be most popular between researchers. However DEA as SFA still facing many challenges, one of these challenges is how to deal with negative data, since it requires the assumption that all the input and output values are non-negative, while in many applications negative outputs could appear e.g. losses in contrast with profit. Although there are few developed Models under DEA to deal with negative data but we believe that each of them has it is own limitations, therefore we developed a Semi-Oriented-Radial-Model (SORM) that could handle the negativity issue in DEA. The application result using SORM shows that the overall performance of GCC banking is relatively high (85.6%). Although, the efficiency score is fluctuated over the study period (1998-2007) due to the second Gulf War and to the international financial crisis, but still higher than the efficiency score of their counterpart in other countries. Banks operating in Saudi Arabia seem to be the highest efficient banks followed by UAE, Omani and Bahraini banks, while banks operating in Qatar and Kuwait seem to be the lowest efficient banks; this is because these two countries are the most affected country in the second Gulf War. Also, the result shows that there is no statistical relationship between the operating style (Islamic or Conventional) and bank efficiency. Even though there is no statistical differences due to the operational style, but Islamic bank seem to be more efficient than the Conventional bank, since on average their efficiency score is 86.33% compare to 85.38% for Conventional banks. Furthermore, the Islamic banks seem to be more affected by the political crisis (second Gulf War), whereas Conventional banks seem to be more affected by the financial crisis.

PSS as a service based strategy for western manufacturers

A product-service system (PSS) is a subtle blend of products and services that are offered as an integrated solution to customers. Much existing work on PSS has originated from Scandinavia and has been motivated by a sustainability agenda. Although valuable, this form has limited appeal to western manufacturers. However, by expanding the concepts of PSS to also embrace leading thinking on large scale complex service systems and informated products and services, it is possible to put forward the basis of a service business model that offers the means to differentiate from competitors who simply offer lower priced products. This paper aims to build this case. It reports the state-of-the-art of PSS, defines the concept, reports on its origin and features, discusses examples of applications, and finally proposes a research strategy for future work on this topic.

The right time and place:strategic positioning for competitive manufacture

Increasingly in the UK, companies that have traditionally considered themselves as manufacturers are being advised to now see themselves as service providers and to reconsider whether to have any production capability. A key challenge is to translate this strategy into a selection of product and service-centred activities within the company's supply chain networks. Strategic positioning is concerned with the choice of business activities a company carries out itself, compared to those provided by suppliers, partners, distributors and even customers. In practice, strategic positioning is directly impacted by such decisions as outsourcing, off-shoring, partnering, technology innovation, acquisition and exploitation. If companies can better understand their strategic positioning, they can make more informed decisions about the adoption of alternative manufacturing and supply chain activities. Similarly, they are more likely to reject those that, like off-shoring, are currently en vogue but are highly likely to erode competitive edge and business success. Our research has developed a new concept we call 'competitive space' as a means of appreciating the strategic positioning of companies, along with a structured decision process for managing competitive space. Our ideas about competitive space, along with the decision process itself, have been developed and tested on a range of manufacturers. As more and more manufacturers are encouraged to move towards system integration and a serviceable business model, the challenge is to identify the appropriate strategic position for their organisations, or in other words, to identify their optimum competitive space for manufacture.

Delivering optometric care in the UK

Optometrists play an important part in delivering eye care in the United Kingdom; however opportunities for practitioners to extend their role through co-management of patients with ophthalmologists vary across the country. Devolution in Scotland and Wales has led to greater emphasis on community based care in these regions. This thesis reviews the current situation and, by examining ophthalmic outpatient clinic data, discusses further opportunities to reduce demands on secondary care and the cost savings that can be made. To assess whether the profession is currently in a position to adopt an extended clinical role, changes in the availability of optometric instrumentation are assessed over a two year period. An increased prevalence of fundus cameras and contact tonometers places optometrists in a good position to take on further responsibilities in glaucoma management, however future investment could be impacted by the current economic climate as value for money became increasingly important to practitioners looking to purchase equipment. Methods of training optometrists in the necessary skills to utilise new technology to extend their role are evaluated in terms of both learning and cost effectiveness. Interactive distance learning is proposed as a convenient and effective method to deliver continuing professional development. Any changes to optometric practice must take account of the need for a sustainable business and the importance of attracting and retaining patients. The views of patients are assessed through a validated service quality questionnaire, SERVQUAL. The questionnaire is found to be valid for use in an optometry setting. Patients have a generally positive view of the service quality they receive from their optical practice and consider the intangible aspects, in particular responsiveness and empathy, most important. Optometrists are well placed to increase their role in patient management; however a viable business model must exist to enable investment in instrumentation and training.