Responding to Fluctuating Demand for Healthcare Services

The level of demand for healthcare services can fluctuate quite strongly. Indeed, some parts of the healthcare service are renowned for having peaks of demand which challenge capacity. Dealing with fluctuations in demand is a common problem in many service industries. This article examines some of the strategies available for influencing the level of demand, including the use of price, communications and demand analysis. The article also outlines a wide variety of ways in which patients can be encouraged to be more tolerant of waiting to receive service from healthcare professionals. In particular, eight principles of waiting are discussed and illustrated in the context of healthcare services.

Research in practice: Bringing behavioural change from lab to studio

Design influences behaviour, whether it's planned or not. Service Design has a great opportunity to lead the emerging field of design for behavioural change, helping guide and shape experiences to benefit users, service providers and wider society. In this article, presented as an evolving conversation between research and practice, Nick Marsh (EMC Consulting) and Dan Lockton (Brunel University) discuss and explore design patterns for influencing behaviour through Service Design, and how Service Designers and academics can work together for social benefit.

Study of Alternate Pavement Designs, 1968

This report is submitted pursuant to a contract dated August 30, 1967, between the Iowa State Highway Commission and Howard, Needles, Tammen & Bergendoff, Consulting Engineers, in connection with studies determining (11,A) alternate pavement designs, and (11,B) criteria for geometric design studies. Included herein is that portion of the report covering Paragraph 11,A, comprising preparation of alternate type pavement designs (Portland Cement and Asphaltic Concrete) for the Cedar Valley Freeway and proposed US-518 from 1-80 to US-30. These alternate pavement designs consider quality and availability of aggregates, soil conditions and traffic information, to determine details and dimensions of pavement design. Comparative cost studies were prepared from alternate design data and recommendations as to pavement type are presented for Commission review.

Developing and Using Consultancy Skills

In Chapter 4, ‘Developing and using consultancy skills’, Ruth Sacks and I discuss what it means to be a consultant and what is it that consultants do. This is presented in the order of stages in a project; starting, ‘doing’ and ending, with specific sections dedicated to examining each stage. Adopting a consulting approach helps L&D professionals to ‘demonstrate’ the value they bring, and may be undertaken through projects that have been articulated and justified through a business case.

Inserção de fornecedores locais como fonte de desempenhos em custos de transação e legitimidade: estudo de caso na cadeia produtiva do petróleo e gás do Rio Grande do Norte

The inclusion of local suppliers in production chains has considerable impact on its performance, but most notably in its main actors. The results of this process may be of different kinds and can be analyzed from economic or institutional approaches. This study aimed to verify the existence of different performances of Petrobras due to the inclusion of local suppliers in the oil and gas production chain in the state of Rio Grande do Norte, from the viewpoints of transaction costs and the Institutional Theory. In order to this, were made the characterization of the PROMINP, the description of its actions and results, the mapping of its institutional context of reference, and identification of results obtained by Petrobras in terms of transaction costs and legitimacy. The theoretical framework is based on authors dealing with industrial concentration, as like Marshall, Krugman, Porter and Schmitz, from the sociological perspective of neoinstitucional theory, as like DiMaggio and Powell and Scott and Meyer, and transaction costs, as like Williamson. This is a qualitative research, with data collection done by consulting secondary fonts and semi-structured interviews with nineteen actors of three groups, namely: actors involved in actions of the program, representatives of enterprises and representative of Petrobras. To analyze the content was used the Suchman s model (1995) for categories associated with strategies of legitimation and fourteen variables associated with the three variables assets specificity, bounded rationality and opportunism (Williamson, 1995, 1989) in the case of transaction costs. The results indicate that PROMINP has achieved its objectives by encouraging the increased participation of local companies in the oil and gas production chain, reflecting in the economic development of the state. The Redepetro/RN, fostered and built upon the interaction of the participants, is presented as a solution of continuity to the participation of enterprises in the chain, after the closure of the actions of the program. PROMINP demands responses to coercive, legislative and regulatory pressures of the organizational field, whose institutional context of reference is wide. From the point of view of legitimacy, through strategies to gain cognitive legitimacy and maintaining pragmatic legitimacy, Petrobras can manipulate the environment, ensuring the compliance of the constituents to their technical and institutional demands. Enterprises, in turn, respond to the demands through compliance with technical demands, mainly through the certification of processes, and cultural changes. There aren t clear gains related to the transaction costs, however, gains in legitimacy can be seen as a cumulative capital that can serve as a competitive differential that generates economic gains. In terms of theoretical findings, it was found that, due to its explanatory power for actions that are difficult to explain only in economic terms, Institutional Theory may be used as theoretical support concurrent with other theories. TCE model has limitations in explaining the program actions. In the case, it s emphasized that Petrobras doesn t seek only economic efficiency, but has in its mission the commitment to social development.

Relação entre ciclo de vida do produto turístico e estratégias de cooperação na faixa litorânea urbana do município de Natal

Tourism in the Northeast of Brazil was introduced as an alternative economic development for the Region by federal promoting policies that focused primarily in structuring the local geographic area. With the completion of these structuring actions, mass tourism expanding the area, as well as spread actions based on cooperation and formalization of governance institutions. This study aimed to examine the relationship between the life cycle of the tourism product 'Coastal Cities of Natal and the cooperation strategies in a historical perspective. Thus was submitted to the life cycle of the tourism product 'Coastal Cities of Natal ; the major projects of tourism development were mapped, the existing cooperation strategies were characterized, and investigated the influence of the cooperation actions for the current stage of product. The specific theoretical support to tourism was built on the perspective of the Theory of Population Ecology, System of Tourism and Touristic Product Life Cycle. Regarding to cooperation the theoretical foundation addressed issues of strategy, New Forms and Collective Efficiency. The survey consisted of a causal descriptive study, using a case study. We used the qualitative and quantitative methodological approaches, and data collected by consulting of secondary data and semistructured interviews with twelve staff working in tourism in Natal. Results showed that the life cycle graph of product 'Coastal Cities of Natal is moving from one stage of growth to a stage of maturity, with a primary upward trend and with crises that are up over the graph. They have been mapped six of tourism development projects of relevance to the product: The Politics of Mega Projects, PRODETUR/NE, Municipalization National Program of Tourism, Regionalization Program, Urbanization Project Beach do Meio and Actions for the Promotion of Destiny. They have been identified sixty-four participating players in process of tourism development, which twenty were considered relevant to the respondents. The main strategies identified for cooperation were the consortium, collective strategy and clusters. Results indicated that co-operation strategies were adopted so that the benefits were obtained at the collective level, dedicated to the strengthening of Natal Destiny and its products. The main reasons were the need of cooperative marketing, international market entry and actions inducing the state. Finally, it was concluded that strategies for cooperation related to product life cycle 'Coastal Cities of Natal' as that work in the consolidation of projects for development of tourism, when the efficiency of collective action is achieved

Learning from one another: evaluating the impact of horizontal knowledge exchange for environmental management and governance

There is increasing advocacy for inclusive community-based approaches to environmental management, and growing evidence that involving communities improves the sustainability of social-ecological systems. Most community-based approaches rely on partnerships and knowledge exchange between communities, civil society organizations, and professionals such as practitioners and/or scientists. However, few models have actively integrated more horizontal knowledge exchange from community to community. We reflect on the transferability of community owned solutions between indigenous communities by exploring challenges and achievements of community peer-to-peer knowledge exchange as a way of empowering communities to face up to local environmental and social challenges. Using participatory visual methods, indigenous communities of the North Rupununi (Guyana) identified and documented their community owned solutions through films and photostories. Indigenous researchers from this community then shared their solutions with six other communities that faced similar challenges within Guyana, Suriname, Venezuela, Colombia, French Guiana, and Brazil. They were supported by in-country civil society organizations and academics. We analyzed the impact of the knowledge exchange through interviews, field reports, and observations. Our results show that indigenous community members were significantly more receptive to solutions emerging from, and communicated by, other indigenous peoples, and that this approach was a significant motivating force for galvanizing communities to make changes in their community. We identified a range of enabling factors, such as building capacity for a shared conceptual and technical understanding, that strengthens the exchange between communities and contributes to a lasting impact. With national and international policy-makers mobilizing significant financial resources for biodiversity conservation and climate change mitigation, we argue that the promotion of community owned solutions through community peer-to-peer exchange may deliver more long-lasting, socially and ecologically integrated, and investment-effective strategies compared to top-down, expert led, and/or foreign-led initiatives.

A Ouvidoria Pública como instrumento de controle das ações da Secretaria de Saúde do Pará

The State and Public Administration have gone through several reforms in search of a quick operation and the provision of services with quality. With the democratization of the country and the issue of the Constitution in 1988, further reform of the State and Public Administration, joined the government agenda in 1995 and included among its objectives, the principles of participation and social control. In view of this, it raises the Public Ombudsman in order to be a channel for the participation of users in the management of public affairs, social control, transparency of administrative actions, improving the quality of service and meeting the needs of the community. The aim of this study is to assess whether the Ombudsman of the State Department of Public Health to contribute to the period 2006-2008, for the improvement of specialized consulting services. The research is characterized as descriptive, qualitative approach. The collection technique used was the interview, conducted with 37 service users and two servants of the Ombudsman. The analysis was developed based on the perception of users and servers in the opinion of the Ombudsman. The most relevant results of the research showed that 41% of users search the Ombudsman because they believed that solve the problem presented. However, even with this level of public acceptance, the Ombudsman reached average index of resolvability of 53% in the period. In his role has not developed mechanisms for quality control of services, which is mentioned by 67% of users. It turned out the same fact in relation to popular participation, which is confirmed by 84% of users. For 24% of users, the problems raised were resolved, and of these, 56% believe that the Ombudsman has contributed to the positive outcome. As a result of the search results, it appears that the Ombudsman's SESPA / PA, is not fulfilling its role to ensuring the democratization of articipation in management, social control and has limited contribution to solving the problems of users and to improve the quality of services

Using social network analysis to identify key stakeholders in agricultural biodiversity governance and related land-use decisions at regional and local level

In 2013 the European Commission launched its new green infrastructure strategy to make another attempt to stop and possibly reverse the loss of biodiversity until 2020, by connecting habitats in the wider landscape. This means that conservation would go beyond current practices to include landscapes that are dominated by conventional agriculture, where biodiversity conservation plays a minor role at best. The green infrastructure strategy aims at bottom-up rather than top-down implementation, and suggests including local and regional stakeholders. Therefore, it is important to know which stakeholders influence land-use decisions concerning green infrastructure at the local and regional level. The research presented in this paper served to select stakeholders in preparation for a participatory scenario development process to analyze consequences of different implementation options of the European green infrastructure strategy. We used a mix of qualitative and quantitative social network analysis (SNA) methods to combine actors’ attributes, especially concerning their perceived influence, with structural and relational measures. Further, our analysis provides information on institutional backgrounds and governance settings for green infrastructure and agricultural policy. The investigation started with key informant interviews at the regional level in administrative units responsible for relevant policies and procedures such as regional planners, representatives of federal ministries, and continued at the local level with farmers and other members of the community. The analysis revealed the importance of information flows and regulations but also of social pressure, considerably influencing biodiversity governance with respect to green infrastructure and biodiversity.

Capacity Management in Healthcare Services

The level of demand for healthcare services can fluctuate widely and this can place pressure on the capacity of service providers. This article examines some of the approaches used to influence the level of available capacity in the healthcare services sector. A number of strategies designed to flex capacity are discussed, including the development of flexible approaches to human resources; rapid responses to changes in demand; the use of self-service technology and self-care; and the use of temporary additional facilities.

Une approche algorithmique des difficultés de raisonnement clinique : étude d’utilité, d’acceptabilité et de faisabilité

Résumé: INTRODUCTION Si les cliniciens enseignants détectent aisément les difficultés des apprenants, ils sont souvent peu outillés pour les étapes subséquentes, du diagnostic à la remédiation. Quoique des outils aient été développés pour les guider face aux difficultés de raisonnement clinique de leurs apprenants, ces outils peuvent être moins familiers des cliniciens et moins adaptés à des contextes de supervision ponctuelle et de soins aigus comme l’urgence. Nous avons donc développé une application algorithmique, à partir de la taxonomie d’Audétat et al. (2010), pour guider les cliniciens enseignants juste-à-temps face aux difficultés de raisonnement clinique. MÉTHODOLOGIE Une étude descriptive interprétative a été réalisée afin d’évaluer l’utilité, l’acceptabilité et la faisabilité d’utiliser cette application à l’urgence. Des entrevues semi-dirigées ont été menées auprès d’un échantillon de convenance de douze urgentistes, avant et après une période d’essai de l’outil de trois mois. RÉSULTATS L’application a été perçue comme particulièrement utile pour préciser les difficultés de raisonnement clinique des apprenants. Utiliser l’outil a été considérée acceptable et faisable en contexte d’urgence, en particulier grâce au format mobile. DISCUSSION Ces résultats suggèrent que l’outil peut être considéré utile pour faciliter l’identification des difficultés des apprenants, mais aussi pour offrir un soutien professoral accessible. Le format mobile et algorithmique semble avoir été un facteur facilitant, ce format étant déjà utilisé par les cliniciens pour consulter ponctuellement de l’information lors de la résolution de problèmes cliniques. CONCLUSION L’étude a démontré globalement une bonne utilité, acceptabilité et faisabilité de l’outil dans un contexte de supervision ponctuelle en soins aigus, ce qui soutient son utilisation par les cliniciens enseignants dans ce contexte. L’étude corrobore également l’intérêt d’un format mobile et algorithmique pour favoriser le transfert de connaissances en pédagogie médicale.

O Contributo dos Sistemas de Informação para a Eficácia da Liderança e para a Mudança do Comportamento Organizacional

O presente trabalho debruça-se sobre os constructos da liderança e do comportamento de auto-eficácia da liderança nas organizações. Reflecte-se sobre a importância dos sistemas de informação no clima organizacional, com efeitos sobre a eficácia na liderança. Trata-se de uma perspetiva pertinente na conjuntura organizacional atual, dado que incide sobre valores patrimoniais intangíveis que, quando dinamizados, dão suporte à performance organizacional. A nossa preocupação central é a auto-eficácia. Através dela pretende-se melhorar a eficiência organizacional, porque minimiza prejuízos e desperdícios. Também se relaciona a eficácia com o desempenho da liderança organizacional e com o capital ‘confiança’. Dessa forma, os novos caminhos passam por auscultar a percepção dos colaboradores sobre a importância da cultura organizacional face ao desempenho e à eficácia de longo prazo na organização. Com a presente reflexão, evidencia-se que a espiritualidade no local de trabalho é um factor de apoio ao desenvolvimento holístico dos colaboradores. Fica sublinhado que é fundamental que os líderes tenham noção e consciência de “si” e dos seus papéis, e como estes se reflectem no seu comportamento quotidiano na organização. O estudo assenta num trabalho de campo, elaborado numa organização intensiva em informação e que presta serviços de consultoria e informática. Os resultados apurados tentam dizer que, globalmente, no estudo longitudinal das hetero-percepções dos gestores directos e indirectos, o gap cultural diminuiu em todas as dimensões relativas às competências dos papéis, sendo vital destacar o quadrante designado por Apoio. As hetero-percepções dos gestores directos demonstram que o menor gap cultural mantem-se no quadrante de Objectivos Racionais e Competir no modelo de CVF, caracterizado por uma cultura de mercado, e relacionado com a fase da Combinação no modelo de SECI (processos que fomentam os relacionamentos e intercâmbios informais – conversão do conhecimento explícito para o explícito). Enquanto que o maior gap cultural reside no quadrante Apoio e Colaborar no modelo CVF, relacionado com a fase da Socialização no modelo de SECI (processos que fomentam os relacionamentos e intercâmbios informais – conhecimento tácito para tácito). Como o gap cultural diminuiu em todas as dimensões, pode realçar uma melhoria das percepções do desempenho organizacional. Contudo, um resultado inesperado está associado ao quadrante Apoio com a cultura de clã, uma vez que são os gestores indirectos na empresa em estudo que fomentam esta cultura, e não os gestores directos, conforme seria desejável. Um resultado favorável para o estudo da auto-eficácia da liderança demonstra que as médias são mais elevadas para atributos de Gestão e Resolução de Problemas. Os resultados que não corresponderam às expectativas iniciais estão associados às médias baixas relativamente aos atributos Sociais/de Comunicação, o que pode ser uma debilidade porque seria desejável que a equipa de gestão tivesse maior sensibilidade perante os capitais sociais, emocionais e espirituais, os quais estão relacionados com estes atributos.

Energy efficient measures to reduce electrical energy use in commercial buildings in New York City

GEA Consulting Engineers, acting as the design engineers, was hired by the owner, East Village 207 Residential LLC2 for energy modeling for compliance with LEED NC V3 -- This report details the results of the energy simulation done with the 100% construction documents -- This report only refers to entities within the LEED3 project boundary -- The project consists of a new eight-story high-end residential condominium building with 81 units, as shown in illustration 1, and approximately 117,905 GSF, equivalent to 10,953.73 m2, is located at 211 E 13th Street in New York, NY -- The residential portion of the building will function 24-7 -- The design goal is to utilize energy efficient measures to reduce electrical energy use and aims to achieve LEED certification -- LEED EA Credit 14 requires a building to demonstrate a percentage improvement in the proposed building performance compared with the baseline building -- The Credit rewards 1 point for achieving 12% reduction in energy costs -- Additionally, the Credit rewards another point for each subsequent reduction of 2% in the building’s energy cost

Health-related quality of life in portuguese SLE patients: an outcome measure independent of disease activity and cumulative damage

PURPOSE: To evaluate quality of life in Portuguese patients with Systemic Lupus Erithematosus (SLE) and its correlation with disease activity and cumulative damage. METHODS: We included consecutive SLE patients, fulfilling the 1997 ACR Classification Criteria for SLE and followed at the Rheumatology Department of the University Hospital of Coimbra, Portugal at time of visit to the outpatient clinic. Quality of life was evaluated using the patient self-assessment questionnaire Medical Outcomes Survey Short Form-36 (SF-36) (validated Portuguese version). The consulting rheumatologist fulfilled the SLE associated indexes for cumulative damage (Systemic Lupus International Collaborating Clinics- Damage Index: SLICC/ACR-DI) and disease activity (Systemic Lupus Erythematosus Disease Activity Index: SLEDAI 2000). Correlation between SLEDAI and SLICC and SF-36 was tested with the Spearman Coefficient. Significant level considered was 0.05. RESULTS: The study included 133 SLE patients (90.2% female, mean age - 40.7 years, mean disease duration - 8.7 years). Most patients presented low disease activity (mean SLEDAI = 4.23) and limited cumulative damage (mean SLICC = 0.76). Despite that, SF-36 mean scores were below 70% in all eight domains of the index. Physical function domains showed lower scores than mental function domains. The QoL in this group of patients is significantly impaired when compared with the reference Portuguese population (p<0.05 in all domains). There was no correlation between clinical activity or cumulative damage and quality of life. CONCLUSION: QoL is significantly compromised in this group of SLE patients, but not related with disease activity or damage. These findings suggest that disease activity, cumulative damage and QoL are independent outcome measures and should all be used to assess the full impact of disease in SLE patients.

Caso de estudio. International Soap, INC.

Internacional Soap, Inc. es una compañía norteamericana con su Casa Matriz en Nueva York, que cotiza en la Bolsa de Valores de esa ciudad y hace parte de las 50 compañías más grandes del mundo, según el listado publicado por la Revista Fortune. Como resultado de la globalización de la economía, la crisis financiera asiática y la inestabilidad de las economías emergentes, los ingresos y utilidades de la Corporación se han visto afectadas en los últimos dos años, principalmente por la fortaleza del dólar. De ahí que el Comité Ejecutivo facultara al Presidente para reducir los costos de producción en el mundo y de esta forma mejorar la rentabilidad de los accionistas. Después de un prolongado estudio que llevó más de dos años y en el que se involucraron consultores externos como McKinsey y Co y Andersen Consulting, la decisión estaba tomada: se requiere cerrar 30 de las 60 plantas que existen en el mundo para ser competitivos en el mercado actual; es necesario evitar la duplicidad de inversión de activos en las diferentes regiones y, además, es indispensable tomar ventaja del nuevo orden mundial en cuanto a comercio internacional se refiere. Los bloques económicos (Unión Europea, Mercosur, Nafta, etc.) están facilitando el intercambio entre países, por lo que ya no es necesario tener plantas de producción en cada uno de los países en los que se quiere mercadear el producto. Para Suramérica se definió que deberían quedar solamente dos plantas, una en la parte sur para atender Mercosur y otra en la parte norte, para atender los mercados del Pacto Andino, Centroamérica y el Caribe (actualmente existen plantas de producción en Colombia, Perú y Venezuela). El señor Carlos Casanova, Vicepresidente Operativo para América Latina es el encargado de ejecutar esta pesada y difícil decisión.