Differences in ERP use and value across Iberian Manufacturing and Services SMEs

Enterprise Resource Planning (ERP) system literature reports very little research on post-adoption stages, that is, actual usage and value. Even fewer studies focus on the specificities of an industry analysis. Based on the Technology-Organizational-Environment (TOE) framework and the Resource-Based View (RBV) theory, we develop a research model to measure and examine determinants of ERP use and value and their impact in the Iberian region (Portugal and Spain) across Manufacturing and Services industries in Small and Medium Enterprises (SMEs). The empirical test was conducted through structural equation modelling, using data from 261 firms in the peninsula in the Manufacturing and Service industries. Results show that amongst ERP use determinants, Training is the most important determinant for Service firms and Compatibility for Manufacturing firms. Firm size, Analytics, and Collaboration contribute to ERP Value in both industries, with Analytics being more important for the Service industry. The paper provides insight into which determinants contribute to ERP use and ERP value in Iberian Manufacturing and Services SMEs, offering managerial and academic implications.

How to improve Sonae's processes of suppliers of services' management?

Sonae is one of the greatest retailers in Portugal. As the business got bigger, it centralized operations. Direc����o de Servi��os Administrativos processes all invoices sent by suppliers. However, there are many which deliver errors and are not processed automatically. As a result, there are lost invoices and suppliers who are not paid, while the company���s accountability becomes less transparent. Such is due to a lack of proactive attitude towards suppliers as well as to a lack of incentives for employees to perform well. Great savings may be achieved with little effort, if the right things are measured so that the right tools may be applied.

Posicionamento do Brasil face aos pa��ses mais avan��ados em cloud computing

This study discusses some fundamental issues so that the development and diffusion of services based in cloud computing happen positively in several countries. For exposure of this subject is discusses public initiatives by the most advanced countries in terms of cloud computing application and the brazilin position in this context. Based on presented evidences here it appears that the essential elements for the development and diffusion of cloud computing in Brazil made important steps and show evidence of maturity, as the cybercrime legislation. However, other elements still require analysis and specifically adaptations for the cloud computing case, such as the Intellectual Property Rights. Despite showing broadband services still lacking, one cannot disregard the government effort to facilitate access for all society. In contrast, the large volume of the Brazilian IT market is an interest factor for companies seeking to invest in the country.

Barriers preventing the successful integration of mental health services into Primary Health Care in Nigeria : a mixed methods approach

RESUMO: A Nig��ria tem uma popula����o estimada em cerca de 170 milh��es de pessoas. O n��mero de profissionais de sa��de mental �� muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um r��cio de psiquiatra: popula����o de mais de 1:1 milh��o de pessoas. O Plano Nacional de Sa��de Mental de 1991 reconheceu esta insufici��ncia e recomendou a integra����o dos servi��os de sa��de mental nos cuidados de sa��de prim��rios (CSP). Depois de mais de duas d��cadas, essa pol��tica n��o foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos servi��os de sa��de mental da Nig��ria, e explorar os desafios e barreiras que impedem a integra����o bem-sucedida dos servi��os de sa��de mental nos cuidados de sa��de prim��rios, isto segundo a perspectiva dos profissionais dos cuidados de sa��de prim��rios. Com este objetivo, desenvolveu-se um estudo explorat��rio sequencial e utilizou-se um modelo misto para a recolha de dados. A aplica����o em simult��neo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integra����o dos servi��os de sa��de mental nos CSP na Nig��ria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma vis��o global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integra����o bem-sucedida dos servi��os de sa��de mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em sa��de mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um question��rio para an��lise quantitativa das opini��es de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doen��a mental, a forma����o inadequada dos profissionais dos CPS sobre sa��de mental, a perce����o pela equipa dos CSP de baixa prioridade de a����o do Governo, o medo da agress��o e viol��ncia pela equipa dos CSP, bem como a falta de disponibilidade de f��rmacos. As recomenda����es para superar estes desafios incluem a melhoria sustentada dos esfor��os da advocacia �� sa��de mental que vise uma maior valoriza����o e apoio governamental, a forma����o e treino organizados dos profissionais dos cuidados prim��rios, a cria����o de redes de refer��ncia e de apoio com institui����es terci��rias adjacentes, e o engajamento da comunidade para melhorar o acesso aos servi��os e �� reabilita����o, pelas pessoas com doen��a mental. Estes resultados fornecem indica����es ��teis sobre a perce����o das barreiras para a integra����o bem sucedida dos servi��os de sa��de mental nos CSP, enquanto se recomenda uma abordagem hol��stica e abrangente. Esta informa����o pode orientar as futuras tentativas de implementa����o da integra����o dos servi��os de sa��de mental nos cuidados prim��rios na Nig��ria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

Social tariffs for water and waste services in mainland Portugal: An impact analysis

This paper proposes to quantify the effect of social tariffs (ST) in the Portuguese water and waste sector (WWS). It calculates the amount of subsidy implicit in ST schemes, characterising the existing tariffs in 2011 and producing a synthetic tariff scene where the regulator���s recommendation is respected. This is the first time such an exercise is undertaken and it is very relevant in a context of deep economic crisis. Results suggest that there are fewer beneficiaries than what income eligibility criteria would imply and that putting the regulator���s recommendation in practice would considerably raise subsidy amounts, potentially leading to a severe increase in non-subsidised user tariffs to allow for break-even.

Estimating demand for primary health care services

Primary health services exist with the purpose of providing basic health care to every person at a cost they can afford. But is it fully available to everyone? The objective of this work project is to estimate the demand for primary health care services having into account that in some regions the citizens are not using as much health care as they would like due to supply side constraints. Using the number of consultations as proxy for demand, and applying an econometric tool called switching regression, the demand for primary health care services will be estimated.

Evaluation of outpatient child-adolescent mental health services (CAMHS) in Attica-Greece

ABSTRACT: Background: Childhood is a critical time for social and emotional development, educational progress and mental health prevention. Mental health for children and adolescents is defined by the achievement of expected developmental, cognitive, social and emotional skills. The development of child-adolescent mental health services (CAMHS) is a necessity for each country, not only as a prevention measure for the wellbeing of people, but also as an investment to the future of countries. Qualitative evaluation of services is the only way to ensure whether services function under quality standards and increase the possibility of better outcomes for their patients. This study examines the greek outpatient CAMHS against the British Standards of National Institute of Excellence for community CAMHS. The Standards assessed refer to the areas of Assessment, Care and Intervention. Objectives: The main objectives of the study are 1) to evaluate Greek outpatient CAMHS in the Attica region 2) to promote the evaluation process for mental health services in Greece. Methods: Due to the fact that Greek services are based on the British model, the tool used was the British self-review questionnaire of Quality Network for Community CAMHS(QNCC).The tool was translated, adapted and posted to services. Twelve out of twenty outpatient CAMHS of Attica (including Athens) responded. Data was collected and performed by the Statistical Package for Social Sciences SPSS. Results: The study resulted that the CAMHS examined, meet moderately the British Standards of 1) Referral and Access, 2) Assessment & Care planning, 3) Care & Intervention. Two out of twelve services examined, meet the standards of "Assessment and Care" in a higher percentage between 75% and 100%. Conclusions: The paper describes a satisfactory function of CAMHS in Attica prefecture taking into consideration the extremely difficult political situation of Greece at the time of the research. Strong and weak domains are identified. Also the translation and adaptation of British tools promote the evaluation process and quality assurance of Greek CAMHS.

Implementation progress of mental health services in Rwanda: Bugesera district case

RESUMO: O Minist��rio da Sa��de do Governo do Ruanda identifica a sa��de mental como uma ��rea de prioridade estrat��gica para a interven����o em resposta �� alta carga dos transtornos mentais no Ruanda. Ao longo dos ��ltimos 20 anos ap��s o genoc��dio, o sector p��blico reconstruiu sua Resposta Nacional de Sa��de Mental com base no acesso equitativo aos cuidados, atrav��s do desenvolvimento de uma Pol��tica Nacional de Sa��de Mental e novas estruturas de sa��de mental. A pol��tica de Sa��de Mental do Ruanda, revista em 2010, prima pela descentraliza����o e integra����o dos servi��os de sa��de mental em todas as estruturas nacionais do sistema de sa��de e ao n��vel da comunidade. O presente estudo de caso tem como objetivo avaliar a situa����o do sistema de sa��de mental de um distrito t��pico de uma ��rea rural no Ruanda, e sugerir melhorias, incluindo algumas estrat��gias para monitoras as mudan��as. Os resultados do estudo permitir��o ao Ruanda refor��ar a sua capacidade para implementar o Plano Nacional de Sa��de Mental ao n��vel dos distritos. O relat��rio tamb��m ser�� ��til para monitorar o progresso da implementa����o de servi��os de sa��de mental nos distritos, incluindo a presta����o de servi��os de base comunit��ria e a participa����o dos usu��rios, suas fam��lias e outros interessados na promo����o, preven����o, assist��ncia e reabilita����o em sa��de mental. Este estudo tamb��m procurou avaliar o progresso da implementa����o dos cuidados de sa��de mental a n��vel descentralizado, com vista a compreender as implica����es em termos de recursos desses processos. Foi realizada uma an��lise situacional num local do distrito, baseado em entrevistas com as principais partes interessadas respons��veis, usando o Instrumento de Avalia����o de Sistemas de Sa��de Mental da Organiza����o Mundial da Sa��de (WHO-AIMS). Os resultados sugerem que os recursos humanos para a sa��de mental e servi��os de base comunit��ria de sa��de mental no distrito continuam a ser extremamente limitados. Os profissionais de sa��de mental s��o adicionalmente limitados na sua capacidade para oferecer interven����es de emerg��ncia a pacientes psiqui��tricos e garantir a continuidade do tratamento farmacol��gico a pacientes com condi����es cr��nicas. Para planejar efetivamente, de acordo com as necessidades da comunidade, sugerimos que o sistema de sa��de mental deve envolver tamb��m os representantes das fam��lias e dos usu��rios no processo de planifica����o de modo a melhorar a sua contribui����o no processo de implementa����o das atividades de sa��de mental. Este estudo de caso do Distrito de Bugesera oferece a primeira an��lise de n��vel distrital dos servi��os de sa��de mental no Ruanda, e pode servir como uma mais-valia para a melhoria do sistema de sa��de mental, incluindo a advocacia para a melhoria da qualidade dos cuidados de sa��de mental a este n��vel, aumentando o financiamento para a implementa����o de servi��os cl��nicos de sa��de mental e os recursos humanos dispon��veis para a presta����o de cuidados de sa��de mental, principalmente a n��vel dos cuidados prim��rios.--------------------- ABSTRACT: To deal with the high burden of mental health disorders resulting from consequences of the 1994 genocide against Tutsis, the Rwanda Ministry of Health (MoH) considers mental health as a priority intervention. For the last 20 years, Ministry of Health focused on rebuilding a national and equity-oriented mental health program responding to the population needs in mental health. Mental health services are now decentralized and integrated in the national health system, from the community level up to the referral level. This study assessed the situation of mental health services in one rural district in Rwanda. It was aimed at assessing the progress of implementation of mental health care at the decentralized level, focusing on resource implications and processes. This study is based on interviews conducted with key stakeholders, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Findings show that human resources for mental health care and community-based mental health services of the assessed district remain extremely limited. Mental health professionals face limitation regarding the ability to provide emergency management of psychiatric patients and to ensure continuity of psychopharmacological treatment of patients with chronic conditions. To improve the implementation process of mental health interventions and activities, a planning process based on community needs and the involvement of representatives of families and users in planning process should be considered. The Bugesera case study on the situation of mental health services can serve as a baseline for improvement of the mental health program in Rwanda, in terms of quality care services, infrastructure and equipment, human and financial resources.

Product extension services deployment platform

Due to the progresses made in the branch of embedded technologies, manufacturers are becoming able to pack their shop floor level manufacturing resources with even more complex functionalities. This technological progression is radically changing the way production systems are designed and deployed, as well as, monitored and controlled. The dissemination of smart devices inside production processes confers new visibility on the production system while enabling for a more efficient and effective management of the operations. By turning the current manufacturing resources functionalities into services based on a Service Oriented Architecture (SOA), in order to expose them as a service to the user, the binomial manufacturing resource/service will push the entire manufacturing enterprise visibility to another level while enabling the global optimization of the operations and processes of a production system while, at the same time, supporting its accommodation to the operational spike easily and with reduced impact on production. The present work implements a Cloud Manufacturing infrastructure for achieving the resource/service value-added i.e. to facilitate the creation of services that are the composition of currently available atomic services. In this context, manufacturing resource virtualization (i.e. formalization of resources capabilities into services accessible inside and outside the enterprise) and semantic representation/description are the pillars for achieving resource service composition. In conclusion, the present work aims to act on the manufacturing resource layer where physical resources and shop floor capabilities are going to be provided to the user as a SaaS (Software as a Service) and/or IaaS (Infrastructure as a Service).

Consumer satisfaction with water, wastewater and waste services in Portugal

While the concept of consumer satisfaction is a central topic in modern marketing theory and practice, citizens' satisfaction with public services, and especially water and waste services, is a eld that still remains empirically rather unexplored. The following study aims to contribute to this area by analysing the determinants of user satisfaction in the water, wastewater and waste sector in Portugal, using a unique survey of 1070 consumers undertaken by the Portuguese Water and Waste Regulator ERSAR. I perform an analysis of the relation between overall service satisfaction and attributespeci c service satisfaction with an ordered logit model. I then explore if subjective consumer satisfaction can be re ected by ERSAR's technical performance indicators. The results suggest that overall consumer satisfaction is driven by consumer's satisfaction with speci c service aspects but unrelated to socioeconomic and demographic characteristics. Furthermore, I show that there is no monotonic association between ERSAR's technical performance indicators and consumers' levels of satisfaction.

What do broadband consumers want? Design and execution of a questionnaire on demand for bundled services on the Portuguese telecomunications market

The report addresses the question of what are the preferences of broadband consumers on the Portuguese telecommunication market. A triple play bundle is being investigated. The discrete choice analysis, adopted in the study, base on 110 responses, mainly from NOVA students. The data for the analysis was collected via manually designed on-line survey. The results show that the price attribute is relatively the most important one while the television attribute is being overlooked in the decision making process. Main effects examined in the research are robust. In addition, "extras" components are being tested in terms of users' preferences.

Contribution of Mental Health Service User Groups to Mental Health Services and Policy in Ghana : The Case of Mental Health Society of Ghana

RESUMO: Este estudo procurou documentar a perspectiva (s) dos utentes de sa��de mental e das associa����es de prestadores de cuidados sobre a presta����o, o papel e a contribui����o de servi��os de sa��de mental da comunidade tal como foram percebidos por um n��mero de informadores-chave, incluindo os utentes do servi��o mentais e os pr��prios prestadores de cuidados. O caso espec��fico da Sociedade Sa��de Mental do Gana (MEHSOG) foi o foco deste estudo. O modelo foi o de um estudo de caso, utilizando discuss��es de grupo e entrevistas com informadores-chave como instrumentos de recolha de dados. Estas ferramentas de colheita de dados foram complementadas por observa����es dos participantes e pela revis��o de documentos da MEHSOG e dos v��rios grupos de apoio da comunidade de auto-ajuda que comp��em a associa����o nacional. O estudo revelou que os utentes dos servi��os de sa��de mental e seus prestadores de cuidados constituem um importante grupo de partes interessadas na presta����o de servi��os de sa��de mental da comunidade e no desenvolvimento de pol��ticas que tenham em conta as necessidades e os direitos das pessoas com doen��a mental ou epilepsia. O envolvimento da MEHSOG promove a mobiliza����o de membros e fam��lias relacionadas com a doen��a mental de beneficiar de servi��os de tratamento bem organizados com um impacto significativo na melhoria da sa��de e da participa����o dos utentes dos servi��os e seus prestadores de cuidados prim��rios em processos de tomada de decis��o da fam��lia e na comunidade processos de desenvolvimento. Os utentes dos servi��os por beneficiarem de tratamento, e os prestadores de cuidados prim��rios, por se tornarem mais livres e menos sobrecarregados com a responsabilidade de cuidar, podem passar a envolver-se mais em atividades que melhoramo seu estado, o de suas fam��lias e das comunidades. A advocacia dos membros da MEHSOG para conseguir que a ���Mental Health Bill��� se transforme numa Lei foi tamb��m um desenvolvimento significativo resultante da participa����o ativa dos utentes do servi��o em chamar a aten����o para uma nova e inclusiva legisla����o de sa��de mental para o Gana. Entre os fatores e oportunidades que permitiram aos utentes dos servi��os de sa��de mental e aos prestadores de cuidados prim��rios de pessoas com doen��a mental apoiar activamente a presta����o de servi��os de sa��de mental comunit��ria e o desenvolvimento de pol��ticas conta-se a contribui����o da sociedade civil do Gana, particularmente o movimento da defici��ncia, e os esfor��os anteriores de ONGs em sa��de mental e dos profissionais de sa��de mental para ter uma nova lei em sa��de mental. Observ��mos um certo n��mero de desafios e barreiras que actuam de forma a limitar a influ��ncia dos utentes dos servi��os de sa��de mental na provis��o da sa��de mental comunit��ria e no desenvolvimento de pol��ticas. Entre elas o estigma social contra a doen��a mental e pessoas com doen��a mental ou epilepsia e seus cuidadores primaries �� um factor chave. O estigma tem alterado a percep����o e as an��lises do p��blico em geral, especialmente dos profissionais de sa��de e das autoridades pol��ticas afetando a prioriza����o dos problemas de sa��de mental nas pol��ticas e programas. Outro desafio foi a deficiente infra-estrutura dispon��vel para apoiar servi��os de sa��de mentais que assegurem aos utentes permanecerem em bom estado de sa��de e bem-estar para serem advogados de si pr��prios. A recomenda����o do presente estudo �� que os movimentos de utentes dos servi��os de sa��de mental s��o importantes e que eles precisam de ser apoiados e encorajados a desempenhar o seu papel como pessoas com experi��ncia vivida para contribuir para a organiza����o e presta����o de servi��os de sa��de mental, bem como para a implementa����o, monitoriza����o e avalia����o de pol��ticas e programas. ------------------------------------ ABSTRACT: This study sought to document the perspective(s) of mental health users and care-givers associations in community mental health service provision and their role and contribution as it was perceived by a number of key informants including the mental service users and care-givers themselves. The specific case of the Mental Health Society of Ghana (MEHSOG) was the focus of this study. A case study approach was used to with Focus Group Discussions and Key Informants Interviews being the data collection tools that were used. These data collection tools were complemented by participant observations and review of documents of the MEHSOG and the various community self-help peer support groups that make up the national association. The study revealed that mental health service users and their care-givers constitute an important stakeholder group in community mental health service provision and development of policies that factor in the needs and rights of persons with mental illness or epilepsy. MEHSOG���s involvement in mobilising members and education families to come forward with the relations with mental illness to benefit from treatment services were well made a significant impact in improving the health and participation of service users and their primary carers in family decision-making processes and in community development processes. Service users, on benefiting from treatment, and primary care-givers, on becoming freer and less burdened with the responsibility of care, move on to engage in secure livelihoods activities, which enhanced their status in their families and communities. The advocacy MEHSOG members undertook in getting the mental health Bill become Law was also noted as significant development that was realised as a result of active involvement of service users in calling for a new and inclusive mental health legislation for Ghana. Enabling factors and opportunities that enabled mental health service users and primary care-givers of people with mental illness to actively support community mental health service provision and policy development is with the vibrant civil society presence in Ghana, particularly the disability movement, and earlier efforts by NGOs in mental health in Ghana long-side mental health professionals to have a new law in mental health. A number of challenges were also noted which were found to limit the extent to which mental health service users can be influential in community mental health service provision and policy development. Key among them was the social stigma against mental illness and people with mental illness or epilepsy and their primary carers. Stigma has affected perceptions, analyses of the general public, especially health practitioners and policy authorities that it has affected their prioritisation of mental health issues in policies and programmes. Another challenge was the poor infrastructure available to support enhanced mental health care services that ensure mental health service users remain in a good state of health and wellbeing to advocate for themselves. The recommendation from the study is that mental health service user movements are important and need to be supported and encouraged to play their role as persons with lived experience to inform organisation and provision of mental health services as well as design and implementation, monitoring and evaluation of policies and programes.

Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementa����o de modelos de Interven����o Precoce em Psicose. No entanto, esta organiza����o do servi��o n��o mudou nos ��ltimos 19 anos. Segundo os dados obtidos da utiliza����o do servi��o, no per��odo de 1996 -2012 foram atendidos 997 doentes, que tinham um n��mero m��dio de 89 contactos (IQR: 36-184), com uma dura����o m��dia de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um n��mero m��dio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) n��o necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asi��ticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relat��rio inclui 15 recomenda����es para orientar as reformas para o servi��o e, nomeadamente, delinear a import��ncia de uma vis��o organizacional e dos seus componentes-chave. As recomenda����es incluem o refor��o da gest��o e da lideran��a numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencializa����o da comunidade, a educa����o e dete����o precoce, bem como a capacidade de receber referencia����es diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa et��ria alvo atual. A dura����o do servi��o deve ser aumentada para um m��nimo de tr��s anos, com a op����o de aument��-la para cinco anos. A propor����o de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio n��o-cl��nico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um servi��o local de presta����o de cuidados deve ser desenvolvido com, nomeadamente, interven����es culturais para responder ��s necessidades da popula����o multicultural de Auckland. A capacidade de investiga����o deve ser incorporada no Servi��o de Interven����o Precoce em Psicoses. Qualquer altera����o dever�� envolver contacto com todas as partes interessadas, e a Administra����o Regional de Sa��de deve comprometer-se em tempo, recursos humanos e pol��ticos para apoiar e facilitar a mudan��a do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.