Tuottavuuden mittaaminen ja johtaminen Etel��-Karjalan keskussairaalassa

Tutkimuksen tavoitteena oli arvioida, miten tuottavuustietoa voidaan hy��dynt���� johtamisen tukena ja kuinka tuottavuustietoa t��ll�� hetkell�� hy��dynnet����n Etel��-Karjalan keskussairaalassa (EKKS). Tuottavuuden mittaamisessa hy��dynnet����n Terveyden- ja hyvinvoinnin laitoksen (THL) vuosittain julkaisemassa Hoito-toiminnan tuottavuus -tilastossa k��ytett��v���� tuottavuuden mittaamismenetelm����, jossa panoksina ovat sairaalan tai erikoisalan hoitotoiminnasta aiheutuneet kustannukset ja tuotoksina NordDRG-ryhmittelij��n avulla painotetut hoitojaksot ja k��ynnit. Tutkimuksessa arvioitiin tuottavuuden mittaamiseen liittyvien mahdollisten virhetekij��iden vaikutusta sairaalan tuottavuuteen EKKS:n tapauksessa ja t��m��n perusteella tunnistettiin, miten THL:n julkaisemaa tuottavuustilastoa ja sis��ist�� tuottavuustietoa voidaan hy��dynt���� sairaalan johtamisen tukena. P����asiallisena aineistona ty��ss�� k��ytettiin EKKS:n henkil��st��n haastatteluja ja sairaalan taloudellisia raportteja sek�� THL:n julkista ja julkaisematonta aineistoa. THL:n kehitt��m��n hoitotoiminnan tuottavuuden mittaamismenetelm��n havaittiin soveltuvan yksitt��isen sairaalan k��ytt����n tietyin muutoksin. Vaadittavien muutosten lis��ksi tutkimuksessa tunnistettiin taustatekij��t, jotka THL:n tuottavuustilaston ja sis��isen tuottavuustiedon tulkitsijan tulee ottaa huomioon. EKKS:n tuottavuustietojen keruussa havaittiin kehitt��miskohteita, joita paran-tamalla tuottavuustiedon luotettavuutta ja hy��dynnett��vyytt�� voidaan edelleen kehitt����. Tuottavuustiedon hy��dynt��mist�� voidaan niin ik����n edelleen kehitt���� EKKS:ssa.

Working capital management in the value chain of automotive industry

The objective of this Master���s thesis is to examine working capital management in the automotive industry in years 2006-2008. The study is conducted by the analysis of financial statements. The sample consists of 65 companies that represent different stages in the value chain of automotive industry beginning from raw material suppliers and ending to car dealers. Working capital management is studied by the cash conversion cycle (CCC). The results show that the average CCC of the value chain is 67 days. Car manufacturers had the longest CCC, 106 days, whereas the CCC of oil companies was the shortest, 22 days. The findings suggest that the cycle time of working capital usually follows the cycle time of inventories, since the changes in cycle times of accounts receivable and payable compensate each other. Improvements in working capital management could be achieved by sharing more accurate information in the chain for example about inventory levels and order points of customer. It could also be discussed within the automotive industry, if the long credit periods, which tie up working capital, are really needed. New technologies enable faster payments, which would reduce the cash conversion cycles, improve the profitability of companies, and increase the competitiveness of the value chain. Working capital should not be reduced at the expense of value chain partners, because nowadays the competition is rather between the value chains than between the companies. Similar research design is applied earlier to study working capital management in the value chain of pulp and paper industry. Even if the industries and the structures of the chains differ from each other, results were surprisingly similar. In future research, working capital management in other industries��� value chains could still be studied and compared to previous studies. ICT industry, for example, could be an interesting object.

Possibilities and challenges of longitudinal studies in operations management

Longitudinal studies are quite rare in the area of Operations Management. One reason might be the time needed to conduct such studies, and then the lack of experience and real-life examples and results. The aim of the thesis is to examine longitudinal studies in the area of OM and the possible advantages, challenges and pitfalls of such studies. A longitudinal benchmarking study, Made in Finland, was analyzed in terms of the study methodology and its outcomes. The timeline of this longitudinal study is interesting. The first study was made in 1993, the second in 2004 and the third in 2010. Between these studies some major changes occurred in the Finnish business environment. Between the first and second studies, Finland joined the ETA and the EU, and globalization started with the rise of the Internet era, while between the second and third studies financial turmoil started in 2007. The sample and cases used in this study were originally 23 manufacturing sites in Finland. These sites were interviewed in 1993, in 2004 and 2010. One important and interesting aspect is that all the original sites participated in 2004, and 19 sites were still able to participate in 2010. Four sites had been closed and/or moved abroad. All of this gave a good opportunity to study the changes that occurred in the Finnish manufacturing sites and their environment, and how they reacted to these changes, and the effects on their performance. It is very seldom, if ever, that the same manufacturing sites have been studied in a longitudinal setting by using three data points. The results of this study are thus unique, and the experience gained is valuable for practitioners.

Financial losses in pork supply chain: a study of the pre-slaughter handling impacts

Brazil is amongst the world’s largest swine producers. However, its competitiveness has been vulnerable due to a lack of cooperation between the supply chain players. This condition makes the financial losses to be evaluated taking into account only an individual node, and most of the time, these damages are imputed by swine breeders. Living weight losses occur between the farm to slaughterhouses, and the main cause of these losses is the pre-slaughter handling, especially during animal transportation. In this research, we analyzed the pre-slaughter handling in a swine farm in Brasilândia, MS, Brazil. Analyzed data were provided by five slaughterhouses (farm clients) from the studied region, in which it was considered living weight losses, carcass bruising, animal injury, and death rate. The results indicated that total financial losses represent 160 thousand dollars per year, when taking into account the supply chain management.

Corporate Social Responsibility in the Oil and Gas Industry: Environmental Management Systems as a Source of Sustainable Development

The environmental aspect of corporate social responsibility (CSR) expressed through the process of the EMS implementation in the oil and gas companies is identified as the main subject of this research. In the theoretical part, the basic attention is paid to justification of a link between CSR and environmental management. The achievement of sustainable competitive advantage as a result of environmental capital growth and inclusion of the socially responsible activities in the corporate strategy is another issue that is of special significance here. Besides, two basic forms of environmental management systems (environmental decision support systems and environmental information management systems) are explored and their role in effective stakeholder interaction is tackled. The most crucial benefits of EMS are also analyzed to underline its importance as a source of sustainable development. Further research is based on the survey of 51 sampled oil and gas companies (both publicly owned and state owned ones) originated from different countries all over the world and providing reports on sustainability issues in the open access. To analyze their approach to sustainable development, a specifically designed evaluation matrix with 37 indicators developed in accordance with the General Reporting Initiative (GRI) guidelines for non-financial reporting was prepared. Additionally, the quality of environmental information disclosure was measured on the basis of a quality ��� quantity matrix. According to results of research, oil and gas companies prefer implementing reactive measures to the costly and knowledge-intensive proactive techniques for elimination of the negative environmental impacts. Besides, it was identified that the environmental performance disclosure is mostly rather limited, so that the quality of non-financial reporting can be judged as quite insufficient. In spite of the fact that most of the oil and gas companies in the sample claim the EMS to be embedded currently in their structure, they often do not provide any details for the process of their implementation. As a potential for the further development of EMS, author mentions possible integration of their different forms in a single entity, extension of existing structure on the basis of consolidation of the structural and strategic precautions as well as development of a unified certification standard instead of several ones that exist today in order to enhance control on the EMS implementation.

CSR standards and financial performance in forest industry - Empirical analysis

The definition of corporate social responsibility (CSR) has been developed since 1950s but even today there is no consensus what CSR includes. The main purpose of this thesis was to find out whether financial performance is better among first adopters of CSR standards in forest industry. To support the main purpose it was critical also investigate what kind of companies adopt CSR standards. The empirical part of the thesis based on a survey which was done in 2010 to forest industry companies and financial data that was gathered from different databases from years 2003-2010. According to the research results it seems the early CSR standards adopters benefits the position of the first adopter many times. Especially cash position and solvency of early adopter companies were better than later adopters or those who did not adopt CSR standards at all. Profitability seemed to be better among CSR standards adopters but early adopters did not have significantly better position compared to later adopters. CSR standards adopters were companies that considered themselves as environmental performance pioneers and had employee oriented management.

Management of commercial property derived risks in the market context of the Russian Federation

The objective of the thesis is to examine the current state of risk management and to determine an appropriate risk management policy for commercial property derived risks in the Russian branch of a Finnish retail trade company. The employed research methodologies are comparative in-depth interviews and empirical value at risk analysis, including portfolio risk decomposition to determine the inter-currency characteristics. For a multinational retail trade company, the commercial property derived risks open up as a diverse combination of financial and non-financial risks with four distinctive interest groups. The research results indicate that geographical diversification across currency regimes provides diversification benefits. The Russian ruble is the most significant single risk component when considering the net investments outside the euro-zone. Decreasing the Russian ruble and Swedish krona exposures are the most effective methods to reduce translation derived risk. Exchange rate volatility varies over time according to idiosyncratic currency regime characteristics, and cost-effective risk management requires comprehensive analysis of the business environment. Profound and proactive risk management methods are found to be pivotal for companies with cross-border operations in order to succeed among international competitors.

Public-private partnership in marine litter waste management

Marine litter is an international environmental problem that causes considerable costs to coastal communities and the fishing industry. Several international and national treaties and regulations have provisions to marine litter and forbid disposal of waste into the sea. However, none of these regulations state a responsibility for public authorities to recover marine litter from the sea, like they do for marine litter that washes up on public beaches. In a financial evaluation of a value chain for marine litter incineration it was found out that the total costs of waste incineration are approximately 100 ��� 200 % higher than waste fees offered by waste contractors of ports. The high costs of incineration are derived from the high calorific value of marine litter and therefore a high incineration cost for the waste, and long distances between ports that are taking part in a project for marine litter recovery from the sea and an Energy-from-Waste (EfW) facility. This study provides a possible solution to diverting marine litter from landfills to more environmentally sustainable EfW use by using a public-private partnership (PPP) framework. PPP would seem to fit as a suitable cooperative approach for answering problems of current marine litter disposal in theory. In the end it is up to the potential partners of this proposed PPP to decide whether the benefits of cooperation justify the required efforts.

MASTER DATA MANAGEMENT MATURITY AND TECHNOLOGY ASSESSMENT - From theory to practice, case Ineo Oy

After decades of mergers and acquisitions and successive technology trends such as CRM, ERP and DW, the data in enterprise systems is scattered and inconsistent. Global organizations face the challenge of addressing local uses of shared business entities, such as customer and material, and at the same time have a consistent, unique, and consolidate view of financial indicators. In addition, current enterprise systems do not accommodate the pace of organizational changes and immense efforts are required to maintain data. When it comes to systems integration, ERPs are considered ���closed��� and expensive. Data structures are complex and the ���out-of-the-box��� integration options offered are not based on industry standards. Therefore expensive and time-consuming projects are undertaken in order to have required data flowing according to business processes needs. Master Data Management (MDM) emerges as one discipline focused on ensuring long-term data consistency. Presented as a technology-enabled business discipline, it emphasizes business process and governance to model and maintain the data related to key business entities. There are immense technical and organizational challenges to accomplish the ���single version of the truth��� MDM mantra. Adding one central repository of master data might prove unfeasible in a few scenarios, thus an incremental approach is recommended, starting from areas most critically affected by data issues. This research aims at understanding the current literature on MDM and contrasting it with views from professionals. The data collected from interviews revealed details on the complexities of data structures and data management practices in global organizations, reinforcing the call for more in-depth research on organizational aspects of MDM. The most difficult piece of master data to manage is the ���local��� part, the attributes related to the sourcing and storing of materials in one particular warehouse in The Netherlands or a complex set of pricing rules for a subsidiary of a customer in Brazil. From a practical perspective, this research evaluates one MDM solution under development at a Finnish IT solution-provider. By means of applying an existing assessment method, the research attempts at providing the company with one possible tool to evaluate its product from a vendor-agnostics perspective.

Implementation of a perioperative management protocol for patients undergoing orthopedic surgery

OBJECTIVE: To evaluate the initial results after the implementation of perioperative protocol in patients over 60 years of age undergoing surgical treatment for femur fractures.METHODS: We conducted a prospective study of patients older than 60 years who were hospitalized with femur fracture. They were operated under spinal anesthesia and analgesia by lumbar plexus blockade. Data evaluation was performed before arrival in the operating room during surgery, in the post-anesthesia recovery room and in the ward the next morning of the operation.RESULTS: 105 patients underwent various types of surgical corrections of the femur. The hospital stay ranged from three to 86 days. Fasting ranged from 9h15min to 19h30mn. Hypotension occurred in 5.7%. The duration of motor blockade ranged from 1h45min to 5h30imn. Maltodextrin feeding ranged from 50min to 3h45min and the time spent in the post-anesthetic care unit ranged from 50 minutes to 4 hours. Onset of oral intake in the ward ranged from 4hto 8h15min. The duration of anesthesia ranged from 14 to 33 hours. No patient required a urinary catheter, nor was transferred to the ICU. All patients were able to be discharged on the first postoperative day.CONCLUSION: The use of a protocol to accelerate the postoperative period may reduce the fasting time, length of hospital stay and provide faster i discharge n elderly patients with femur fractures.

Open abdomen management: single institution experience

OBJECTIVE: to evaluate the outcome of abdominal wall integrity of both techniques. METHODS: a retrospective study was carried out at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, identifying the patients undergoing temporary abdominal closure (TAC) from January 2005 to December 2011. Data were collected through the review of clinical charts. Inclusion criteria were indication of TAC and survival to definitive abdominal closure. In the post-operative period only a group of three surgeons followed all patients and performed the reoperations. RESULTS: Twenty eightpatients were included. The difference in primary closure rates and mean time for fascial closure did not reach statistical significance (p=0.98 and p=0.23, respectively). CONCLUSION: VAC and Bogota Bag do not differ significantly regarding the outcome of abdominal wall integrity, due to the monitoring of a specific team and the adoption of progressive closure

Innovation Project Portfolio Management

Companies today are forced to innovate in order to remain within business. Such innovation projects undertaken by the companies are defined in this study as creative ideas which have been managed through ���Stage-Gate��� innovation process. This process is used to manage innovation projects as they proceed from being newly created to ready for launching/implementing. This has ensured that the companies manage the innovation project right. However, with so many new creative ideas the companies can come up within limited resources, the companies must rely on Innovation Project Portfolio Management (IPPM) to ensure that they are managing only the right innovation projects. Although, there are many tools and techniques available for use within Project Portfolio Management, there is still no consensus on which are the most effective and no standard framework has been established especially for IPPM. Thus, this study proposes a practical framework for which individual innovative organization can follow as a guideline to manage its innovation project portfolio. The study theoretically first addresses the key differences between project portfolio management of innovation projects and other traditional projects - one of which is the stage nature of innovation projects due to their unclear objectives from the beginning compare to clearly established objectives of traditional projects. Secondly, different tools and techniques which can be used are examined based on the three goals of IPPM: (1) Maximizing the Value of Innovation Project Portfolio: Financial Methods, Decision Trees, Scoring Models and Checklists; (2) Balancing Innovation Project Portfolio: Visual Representations; and (3) Aligning Innovation Project Portfolio with Strategy: Bottom-Up (Scoring Models with Strategic Criteria) and Top-Down (Strategic Buckets). Finally, the two approaches in which IPPM can be integrated with Stage-Gate innovation process are discussed: (1) Gates- Dominated; and (2) Portfolio Reviews-Dominated. Practically, this study investigates IPPM of a case organization, and through analysis of the case study results proposes a practical framework for case organization to improve its current management of innovation project portfolio. This framework is then generalized to propose a final practical framework or guideline for which an innovative organization can follow to manage its innovation project portfolio.

The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy

ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.

Isolated liver gunshot injuries: nonoperative management is feasible?

ABSTRACTObjective:to evaluate the safety and effectiveness of non-operative management (NOM) of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6%) had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2%) were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%). Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.

Implementation of the trauma registry as a tool for quality improvement in trauma care in a brazilian hospital: the first 12 months

ABSTRACTObjective:to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS), and its ability to identify points for improvement in the quality of care provided.Methods:the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1) or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT) software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process.Results:data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI.Conclusion: the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.