The impact of nurse practitioner services on cost, quality of care, satisfaction and wait times in the emergency department: A systematic review

Aims To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. Background The delivery of quality care in the emergency department is one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. Data A comprehensive search of four electronic databases from 2006-­‐2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. Methods A three step approach was used. Following a comprehensive search, two reviewers assessed identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data extracted using standardised tools. Results Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-­‐analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding impact on costs. Conclusion Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reforming emergency department service provision. The findings suggest that further quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in delivering quality patient care.

Policy as a struggle for meaning: disentangling knowledge translation across international health contexts

Over the last decade, research in medical science has focused on knowledge translation and diffusion of best practices to enable improved health outcomes. However, there has been less attention given to the role of policy in influencing the translation of best practice across different national contexts. This paper argues that the underlying set of public discourses of healthcare policy significantly influences its development with implications for the dissemination of best practices. Our research uses Critical Discourse Analysis to examine the policy discourses surrounding the treatment of stroke across Canada and the U.K. It focuses in specific on how concepts of knowledge translation, user empowerment, and service innovation construct different accounts of the health service in the two countries. These findings provide an important yet overlooked starting point for understanding the role of policy development in knowledge transfer and the translation of science into health practice. © 2011 Operational Research Society. All rights reserved.

Third Sector Experiences of Work Programme Delivery.

This paper explores the organisational experiences of governmental policy change and implementation on the third sector. Using a four-year longitudinal study of 13 third sector organisations (TSOs) it provides evidence based on the experiences of, and effects on, third sector organisations involved in the UK’s Work Programme in Scotland. The paper explores third sector experiences of the Work Programme during the preparation and introductory phase, as well as the effects of subsequent Work Programme implementation. By gathering evidence contemporaneously and longitudinally a unique in-depth analysis is provided of the introduction and implementation of a major new policy. The resource cost and challenges to third sector ways of working for the organisations in the Work Programme supply chain, as well as those not in the supply chain, are considered. The paper considers some of the responses adopted by the third sector to manage the opportunities and challenges presented to them through the implementation of the Work Programme. The paper also reflects on the broader context of the employability services landscape and raises questions as to whether, as a result of the manner in which the Work Programme was contracted, there is evidence of a move towards service homogenisation, challenging perceived TSO characteristics of service innovation and personalisation.

Ideation at Canon business services

Digitalisation, globalisation, and evolving customer demands are only a few of the factors that are bound to transform the business process services industry for CBS. By investigating new ways to address these imminent challenges, this thesis explores the feasibility of implementing a formal approach to ideation to complement CBS’ service innovation practice. Two workshops were therefore conducted to put theory into action by generating new service ideas in a multifunctional team. Applying both divergent and convergent ideation techniques revealed that the latter improved an idea’s novelty and creativity as opposed to the expected increase in workability and relevance. Additionally, further analysis sheds light into the potential influence of individual characteristics and group dynamics on creativity. The thesis concludes with a discussion on the organisational implications of the findings and recommendations for future research.

Incremento de la salud financiera mediante la utilización de la relación estratégica comunitaria y marketing.

Debido a las crisis mundiales, la perdurabilidad empresarial se ha convertido en la primera preocupación de las organizaciones, puesto que los problemas económicos en otros países pueden generar un efecto negativo en las condiciones del mercado doméstico, que junto con el entorno empresarial complejo y dinámico en el que se deben desempeñar las empresas hoy en día gracias a la globalización, sumado al aumento en la competitividad nacional e internacional, la perdurabilidad de las empresas se está viendo seriamente comprometida. Lo anterior, ha llevado a las empresas a buscar nuevas formas de mejorar su salud financiera. Para medir la salud financiera empresarial, se pueden usar distintos indicadores como lo es el flujo de caja que está asociado con la rentabilidad, el patrimonio que está asociado a las dificultades financieras, entre otros, o a través de varios modelos de bancarrota, los cuales, por medio de un conjunto de ratios financieros, reflejan el estado actual de la organización y su probabilidad de fracaso en el futuro. Las estrategias comunitarias y el marketing permiten incrementar la salud financiera de las empresas a través de la orientación al cliente y el establecimiento de relaciones gana-gana a largo plazo con las diferentes comunidades con las que se relaciona la organización.

Prácticas socio comunitarias en el trayecto formativo del profesional de Educación Especial

El artículo presenta la incorporación de prácticas socio-comunitaria durante el trayecto de formación de grado de Profesores y Licenciados en Educación Especial en la Universidad Nacional de Río Cuarto. Desde un marco institucional, las prácticas socio-comunitarias se entienden como experiencias de aprendizaje de contenidos académicos orientadas por los docentes, realizadas con sectores de la comunidad excluidos de la vida económica, política, social y cultural, dirigida a contribuir a la comprensión, abordaje o resolución de problemáticas sociales críticas. Se trata que los estudiantes aprendan contenidos de sus respectivos campos profesionales participando en experiencias socio-comunitarias. Se hace referencia a una experiencia en la asignatura “Planeamiento Institucional" , cuyo propósito es aportar a la formación de los alumnos del Profesorado de Educación Especial mediante la construcción de competencias profesionales establecidas en el perfil del egresado tales como: “Planificar, ejecutar y evaluar proyectos de educación especial en diferentes contextos institucionales y grupales".La práctica socio-comunitaria consistió en la ejecución de un relevamiento socio-educativo en diversos barrios de la ciudad como parte del Programa Alfabetizando que coordina la Sub-Secretaría de Educación de la Municipalidad de Río Cuarto.

Propuesta de un modelo de sistema de información interorganizacional: aplicación en el sector de la domótica para la gestión de servicios del hogar digital

El sector de la edificación es uno de los principales sectores económicos en España y, además, es un componente básico de la actividad económica y social, debido a su importante papel como generador de empleo, proveedor de bienes e incentivador del crecimiento. Curiosamente, es uno de los sectores con menos regulación y organización y que, además, está formado mayoritariamente por empresas de pequeña y mediana dimensión (pymes) que, por su menor capacidad, a menudo, se quedan detrás de las grandes empresas en términos de adopción de soluciones innovadoras. La complejidad en la gestión de toda la información relacionada con un proyecto de edificación ha puesto de manifiesto claras ineficiencias que se traducen en un gasto innecesario bastante representativo. La información y los conocimientos aprendidos rara vez son transmitidos de una fase a otra dentro del proyecto de edificación y, mucho menos, reutilizados en otros proyectos similares. De este modo, no sólo se produce un gasto innecesario, sino que incluso podemos encontrar información contradictoria y obsoleta y, por tanto, inútil para la toma de decisiones. A lo largo de los años, esta situación ha sido motivada por la propia configuración del sector, poniendo de manifiesto la necesidad de una solución que pudiera solventar este reto de gestión interorganizacional. Así, la cooperación interorganizacional se ha convertido en un factor clave para mejorar la competitividad de las organizaciones, típicamente pymes, que componen el sector de la edificación. La información es la piedra angular de cualquier proceso de negocio. Durante la última década, una amplia gama de industrias han experimentado importantes mejoras de productividad con la aplicación eficiente de las TIC, asociadas, principalmente, a incrementos en la velocidad de proceso de información y una mayor coherencia en la generación de datos, accesibilidad e intercambio de información. La aplicación eficaz de las TIC en el sector de la edificación requiere una combinación de aspectos estratégicos y tácticos, puesto que no sólo se trata de utilizar soluciones puntuales importadas de otros sectores para su aplicación en diferentes áreas, sino que se buscaría que la información multi-agente estuviera integrada y sea coherente para los proyectos de edificación. El sector de la construcción ha experimentado un descenso significativo en los últimos años en España y en Europa como resultado de la crisis financiera que comenzó en 2007. Esta disminución está acompañada de una baja penetración de las TIC en la interorganizacionales orientadas a los procesos de negocio. El descenso del mercado ha provocado una desaceleración en el sector de la construcción, donde sólo las pymes flexibles han sido capaces de mantener el ritmo a pesar de la especialización y la innovación en los servicios adaptados a las nuevas demandas del mercado. La industria de la edificación está muy fragmentada en comparación con otras industrias manufactureras. El alto grado de esta fragmentación está íntimamente relacionado con un impacto significativo en la productividad y el rendimiento. Muchos estudios de investigación han desarrollado y propuesto una serie de modelos de procesos integrados. Por desgracia, en la actualidad todavía no se está en condiciones para la formalización de cómo debe ser la comunicación y el intercambio de información durante el proceso de construcción. El paso del proceso secuencial tradicional a los procesos de interdependencia recíproca sin lugar a duda son una gran demanda asociada a la comunicación y el flujo de información en un proyecto de edificación. Recientemente se está poniendo mucho énfasis en los servicios para el hogar como un primer paso hacia esta mejora en innovación ya que la industria de los servicios digitales interactivos tiene un alto potencial para generar innovación y la ventaja estratégica para las empresas existentes. La multiplicidad de servicios para el hogar digital (HD) y los proveedores de servicios demandan, cada vez más, la aparición de una plataforma capaz de coordinar a todos los agentes del sector con el usuario final. En consecuencia, las estructuras organizacionales tienden a descentralizarse en busca de esa coordinación y, como respuesta a esta demanda, se plantea, también en este ámbito, el concepto de cooperación interorganizacional. Por lo tanto, ambos procesos de negocio -el asociado a la construcción y el asociado a la provisión de servicios del hogar digital, también considerado como la propia gestión de ese hogar digital o edificio, inteligente o no- deben de ser vistos en su conjunto mediante una plataforma tecnológica que les dé soporte y que pueda garantizar la agregación e integración de los diversos procesos, relacionados con la construcción y gestión, que se suceden durante el ciclo de vida de un edificio. Sobre esta idea y atendiendo a la evolución permanente de los sistemas de información en un entorno de interrelación y cooperación daría lugar a una aplicación del concepto de sistema de información interorganizacional (SIIO). El SIIO proporciona a las organizaciones la capacidad para mejorar los vínculos entre los socios comerciales a lo largo de la cadena de suministro, por lo que su importancia ha sido reconocida por organizaciones de diversos sectores. Sin embargo, la adopción de un SIIO en diferentes ámbitos ha demostrado ser complicada y con una alta dependencia de las características particulares de cada sector, siendo, en este momento, una línea de investigación abierta. Para contribuir a esta línea de investigación, este trabajo pretende recoger, partiendo de una revisión de la literatura relacionada, un enfoque en un modelo de adopción de un SIIO para el objeto concreto de esta investigación. El diseño de un SIIO está basado principalmente, en la identificación de las necesidades de información de cada uno de sus agentes participantes, de ahí la importancia en concretar un modelo de SIIO en el ámbito de este trabajo. Esta tesis doctoral presenta el modelo de plataforma virtual de la asociación entre diferentes agentes del sector de la edificación, el marco de las relaciones, los flujos de información correspondientes a diferentes procesos y la metodología que subyace tras el propio modelo, todo ello, con el objeto de contribuir a un modelo unificado que dé soporte tanto a los procesos relacionados con la construcción como con la gestión de servicios en el hogar digital y permitiendo cubrir los requisitos importantes que caracterizan este tipo de proyectos: flexibilidad, escalabilidad y robustez. El SIIO se ha convertido en una fuente de innovación y una herramienta estratégica que permite a las pymes obtener ventajas competitivas. Debido a la complejidad inherente de la adopción de un SIIO, esta investigación extiende el modelo teórico de adopción de un SIIO de Kurnia y Johnston (2000) con un modelo empírico para la caracterización de un SIIO. El modelo resultante tiene como objetivo fomentar la innovación de servicios en el sector mediante la identificación de los factores que influyen en la adopción de un SIIO por las pymes en el sector de la edificación como fuente de ventaja competitiva y de colaboración. Por tanto, esta tesis doctoral, proyectada sobre una investigación empírica, proporciona un enfoque para caracterizar un modelo de SIIO que permita dar soporte a la gestión integrada de los procesos de construcción y gestión de servicios para el hogar digital. La validez del modelo de SIIO propuesto, como fuente y soporte de ventajas competitivas, está íntimamente relacionada con la necesidad de intercambio de información rápido y fiable que demandan los agentes del sector para mejorar la gestión de su interrelación y cooperación con el fin de abordar proyectos más complejos en el sector de la edificación, relacionados con la implantación del hogar digital, y contribuyendo, así a favorecer el desarrollo de la sociedad de la información en el segmento residencial. ABSTRACT The building industry is the largest industry in the world. Land purchase, building design, construction, furnishing, building equipment, operations maintenance and the disposition of real estate have an unquestionable prominence not only at economic but also at social level. In Spain, the building sector is one of the main drivers of economy and also a basic component of economic activity and its role in generating employment, supply of goods or incentive for growth is crucial in the evolution of the economy. Surprisingly, it is one of the sectors with less regulation and organization. Another consistent problem is that, in this sector, the majority of companies are small and medium (SMEs), and often behind large firms in terms of their adoption of innovative solutions. The complexity of managing all information related to this industry has lead to a waste of money and time. The information and knowledge gathered is frequently stored in multiple locations, involving the work of thousands of people, and is rarely transferred on to the next phase. This approach is inconsistent and makes that incorrect information is used for decisions. This situation needs a viable solution for interorganizational information management. So, interorganizational co-operation has become a key factor for organization competitiveness within the building sector. Information is the cornerstone of any business process. Therefore, information and communication technologies (ICT) offer a means to change the way business is conducted. During the last decade, significant productivity improvements were experienced by a wide range of industries with ICT implementation. ICT has provided great advantages in speed of operation, consistency of data generation, accessibility and exchange of information. The wasted money resulting from reentering information, errors and omissions caused through poor decisions and actions, and the delays caused while waiting for information, represent a significant percentage of the global benefits. The effective application of ICT in building construction sector requires a combination of strategic and tactical developments. The building sector has experienced a significant decline in recent years in Spain and in Europe as a result of the financial crisis that began in 2007. This drop goes hand in hand with a low penetration of ICT in inter-organizational-oriented business processes. The market decrease has caused a slowdown in the building sector, where only flexible SMEs have been able to keep the pace though specialization and innovation in services adapted to new market demands. The building industry is highly fragmented compared with other manufacturing industries. This fragmentation has a significant negative impact on productivity and performance. Many research studies have developed and proposed a number of integrated process models. Unfortunately, these studies do not suggest how communication and information exchange within the construction process can be achieved, without duplication or lost in quality. A change from the traditional sequential process to reciprocal interdependency processes would increase the demand on communication and information flow over the edification project. Focusing on home services, the digital interactive service industry has the potential to generate innovation and strategic advantage for existing business. Multiplicity of broadband home services (BHS) and suppliers suggest the need for a figure able to coordinate all the agents in sector with the final user. Consequently, organizational structures tend to be decentralized. Responding to this fact, the concept of interorganizational co-operation also is raising in the residential market. Therefore, both of these business processes, building and home service supply, must be complemented with a technological platform that supports these processes and guarantees the aggregation and integration of the several services over building lifecycle. In this context of a technological platform and the permanent evolution of information systems is where the relevance of the concept of inter-organizational information system (IOIS) emerges. IOIS improves linkages between trading partners along the supply chain. However, IOIS adoption has proved to be difficult and not fully accomplished yet. This research reviews the literature in order to focus a model of IOIS adoption. This PhD Thesis presents a model of virtual association, a framework of the relationships, an identification of the information requirements and the corresponding information flows, using the multi-agent system approach. IOIS has become a source of innovation and a strategic tool for SMEs to obtain competitive advantage. Because of the inherent complexity of IOIS adoption, this research extends Kurnia and Johnston’s (2000) theoretical model of IOIS adoption with an empirical model of IOIS characterization. The resultant model aims to foster further service innovation in the sector by identifying the factors influencing IOIS adoption by the SMEs in the building sector as a source of competitive and collaborative advantage. Therefore, this PhD Thesis characterizes an IOIS model to support integrated management of building processes and home services. IOIS validity, as source and holder of competitive advantages, is related to the need for reliable information interchanges to improve interrelationship management. The final goal is to favor tracking of more complex projects in building sector and to contribute to consolidation of the information society through the provision of broadband home services and home automation.

Enhancing competitive advantage with radio-frequency identification (RFID) enabled returnable transport equipment (RTE)

Fierce competition within the third party logistics (3PL) market has developed as providers compete to win customers and enhance their competitive advantage through cost reduction plans and creating service differentiation. 3PL providers are expected to develop advanced technological and logistical service applications that can support cost reduction while increasing service innovation. To enhance competitiveness, this paper proposes the implementation of radio-frequency identification (RFID) enabled returnable transport equipment (RTE) in combination with the consolidation of network assets and cross-docking. RFID enabled RTE can significantly improve network visibility of all assets with continuous real-time data updates. A four-level cyclic model aiding 3PL providers to achieve competitive advantage has been developed. The focus is to reduce assets, increase asset utilisation, reduce RTE cycle time and introduce real-time data in the 3PL network. Furthermore, this paper highlights the need for further research from the 3PL perspective. Copyright © 2013 Inderscience Enterprises Ltd.

Distinctive Features of Mobile Messages Processing

World’s mobile market pushes past 2 billion lines in 2005. Success in these competitive markets requires operational excellence with product and service innovation to improve the mobile performance. Mobile users very often prefer to send a mobile instant message or text messages rather than talking on a mobile. Well developed “written speech analysis” does not work not only with “verbal speech” but also with “mobile text messages”. The main purpose of our paper is, firstly, to highlight the problems of mobile text messages processing and, secondly, to show the possible ways of solving these problems.

Capabilities for advanced services:a multi-actor perspective

Servitization involves manufacturers developing service offerings to grow revenue and profit. Advanced services, in particular, can facilitate a more service-focused organization and impact customers' business processes significantly. However, approaches to servitization are often discussed solely from the manufacturer's perspective; overlooking the role of other network actors. Adopting a multi-actor perspective, this study investigates manufacturer, intermediary and customer perspectives to identify complementary and competing capabilities within a manufacturer's downstream network, required for advanced services. Interviews were conducted with 24 senior executives in 19 UK-based manufacturers, intermediaries and customers across multiple sectors. The study identified six key business activities, within which advanced services capabilities were grouped. The unique and critical capabilities for advanced services for each actor were identified as follows: manufacturers; the need to balance product and service innovation, developing customer-focused through-life service methodologies and having distinct, yet synergistic product and service cultures; intermediaries, the coordination and integration of third party products/services; customers, co-creating innovation and having processes supporting service outsourcing. The study is unique in highlighting the distinct roles of different actors in the provision of advanced services and shows that they can only be developed and delivered by the combination of complex interconnected capabilities found within a network.

The antecedents of post-initial adoption behavior in a S-D logic context

Repercussions of innovation adoption and diffusion studies have long been imperative to the success of novel introductions. However, perceptions and deductions of current innovation understandings have been changing over time. The paradigm shift from the goods-dominant (G-D) logic to the service-dominant (S-D) logic potentially makes the distinction between product (goods) innovation and service innovation redundant as the S-D logic lens views all innovations as service innovations (Vargo and Lusch, 2004; 2008; Lusch and Nambisan, 2015). From this perspective, product innovations are in essence service innovations, as goods serve as mere distribution mechanisms to deliver service. Nonetheless, the transition to such a broadened and transcending view of service innovation necessitates concurrently a change in the underlying models used to investigate innovation and its subsequent adoption. The present research addresses this gap by engendering a novel model for the most crucial period of service diffusion within the S-D logic context – the post-initial adoption phase, which demarcates an individual’s behavior after the initial adoption decision of a service. As a wellfounded understanding of service diffusion and the complementary innovation adoption still lingers in its infancy, the current study develops a model based on interdisciplinary domains mapping. Here fore, knowledge of the relatively established viral source domain is mapped to the comparatively undetermined target domain of service innovation adoption. To assess the model and test the importance of the explanatory variables, survey data from 750 respondents of a bank in Northern Germany is scrutinized by means of Structural Equation Modeling (SEM). The findings reveal that the continuance intention of a customer, actual usage of the service and the customer influencer value all constitute important postinitial adoption behavior that have meaningful implications for a successful service adoption. Second, the four constructs customer influencer value, organizational commitment, perceived usefulness and service customization are evidenced to have a differential impact on a iv customer’s post-initial adoption behavior. Third, this study indicates that post-initial adoption behavior further underlies the influence of a user’s age and besides that is also provoked by the internal and external environments of service adoption. Finally, this research amalgamates the broad view of service innovation by Nambisan and Lusch (2015) with the findings ensuing this enquiry’s model to arrive at a framework that it both, generalizable and practically applicable. Implications for academia and practitioners are captured along with avenues for future research.

Defining reference service life : an open innovation approach

The endeavour to obtain estimates of durability of components for use in lifecycle assessment or costing and infrastructure and maintenance planning systems is large. The factor method and the reference service life concept provide a very valuable structure, but do not resolve the central dilemma of the need to derive an extensive database of service life. Traditional methods of estimating service life, such as dose functions or degradation models, can play a role in developing this database, however the scale of the problem clearly indicates that individual dose functions cannot be derived for each component in each different local and geographic setting. Thus, a wider range of techniques is required in order to devise reference service life. This paper outlines the approaches being taken in the Cooperative Research Centre for Construction Innovation project to predict reference service life. Approaches include the development of fundamental degradation and microclimate models, the development of a situation-based reasoning ‘engine’ to vary the ‘estimator’ of service life, and the development of a database on expert performance (Delphi study). These methods should be viewed as complementary rather than as discrete alternatives. As discussed in the paper, the situation-based reasoning approach in fact has the possibility of encompassing all other methods.