877 resultados para Financial Management, Hospital
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The aim of this study was to contribute to the current knowledge-based theory by focusing on a research gap that exists in the empirically proven determination of the simultaneous but differentiable effects of intellectual capital (IC) assets and knowledge management (KM) practices on organisational performance (OP). The analysis was built on the past research and theoreticised interactions between the latent constructs specified using the survey-based items that were measured from a sample of Finnish companies for IC and KM and the dependent construct for OP determined using information available from financial databases. Two widely used and commonly recommended measures in the literature on management science, i.e. the return on total assets (ROA) and the return on equity (ROE), were calculated for OP. Thus the investigation of the relationship between IC and KM impacting OP in relation to the hypotheses founded was possible to conduct using objectively derived performance indicators. Using financial OP measures also strengthened the dynamic features of data needed in analysing simultaneous and causal dependences between the modelled constructs specified using structural path models. The estimates were obtained for the parameters of structural path models using a partial least squares-based regression estimator. Results showed that the path dependencies between IC and OP or KM and OP were always insignificant when analysed separate to any other interactions or indirect effects caused by simultaneous modelling and regardless of the OP measure used that was either ROA or ROE. The dependency between the constructs for KM and IC appeared to be very strong and was always significant when modelled simultaneously with other possible interactions between the constructs and using either ROA or ROE to define OP. This study, however, did not find statistically unambiguous evidence for proving the hypothesised causal mediation effects suggesting, for instance, that the effects of KM practices on OP are mediated by the IC assets. Due to the fact that some indication about the fluctuations of causal effects was assessed, it was concluded that further studies are needed for verifying the fundamental and likely hidden causal effects between the constructs of interest. Therefore, it was also recommended that complementary modelling and data processing measures be conducted for elucidating whether the mediation effects occur between IC, KM and OP, the verification of which requires further investigations of measured items and can be build on the findings of this study.
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This thesis reveals the topic of reputational risk management as a key element for business continuity and value maximization. The purpose of the work is to investigate reputational risk from the side of its definition, management (including legal requirements on this risk category) and measurement and to analyse reputational risks impact on business continuity and value maximization. To be able to do this, different respective articles, reports of financial institutions are gathered and constructive summaries and analysis are made. In order to deeply investigate the impact of reputational risk on business continuity and value maximization, it was chosen to study it from three aspects: 1) check the impact of stock valuation of 7 companies that experienced reputational catastrophe / risk, 2) analyse a case study on disagreements in management of reputational risk among case companies and impact on their respective performance, and 3) conduct a survey of financial sector companies in Liechtenstein to see how reputational risk management works in practice. The findings of the research showed a significant impact of reputation decadence on companys value and trading volume, and showed crucial importance of post-crisis management for the companys financial performance. The results of the qualitative research based on survey proved that companies consider reputational risk management as a one of the key elements for their business continuity and value maximization.
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The financial sector has been viewed traditionally as either providing the "oil" for the "wheels of commerce" or as a parasite on the real sector of the economy where real productivity gains provide for increasing real wages and per capita incomes. The present paper takes a different route and attempts to an analysis of financial institutions on a par with the production sector of the economy. It also develops a link which amalgamates "the knowledge-based" perspective on firms' operations with Schumpeterian financial leverage to exploit productivity enhancing innovations, and Minsky's tendency towards financial fragility. The analysis also leads to some policy recommendations concerning financial regulation, risk management and financial institution's building.
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The role of the hospital-employed nurse educator is evolving. Factors influencing this change include the introduction of standards for nurse educators by the College of Nurses of Ontario (CNO), a change in the way nurses are educated, the emergence of nursing as a profession, and hospital restructuring as a result of budgetary constraints. Two of these influencing factors: the introduction of the updated Standards of Practice for Registered Nurses and Registered Practical Nurses (1996) and hospital restructuring occurred over the last 7 years at several hospitals in southern Ontario. Current literature as well as the Standards of Practice (1996) were utilized to examine the current roles and responsibilities of nurse educators and subsequently develop a questionnaire to study the impact of these influencing factors on the role of the nurse educator. This questionnaire was piloted and revised before its distribution at 4 hospitals in southern Ontario. Twenty-five of the 41 surveys (61%) distributed were returned for analysis. The data reflected that the Standards of Practice had a positive influence on the role of the nurse educator, while hospital restructuring had a negative impact. In addition, many of the roles and responsibilities identified in the literature were indeed part of the current role of nurse educators, as well as several responsibilities not captured in the literature. The predictions for the future of this role in its current state were not positive given the financial status of the health care system as well as the lack of clarity for the role and the current level ofjob satisfaction among practicing nurse educators. However, a list of recommendations were generated which, if implemented, could add clarity to the role and improve job satisfaction. This could enhance the retention of current nurse educators and the possibility of recruiting competent nurse educators to the role in the future.
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The study was undertaken to investigate organizational readiness for change to a total quality management (TQM) paradigm as the corporate-wide strategy within a long-term care facility. The focus of the study was on leadership values and organizational cultural characteristics that could either accelerate or impede the change process at The Public Hospital. structurally, the ~tudy included 'three distinct components. The first component examined the management philosophy outlined by Deming (1986) and his contemporary Juran (1989) in order to determine what leadership values best support the new Total Quality Management paradigm. Secondly, this information was compared to present leadership values at The Public Hospital with the purpose of identifying opportunities for improvement within the organization's current culture as the hospital moves toward the desired TQM culture. The final component, a roadmap, was developed to reflect the most appropriate direction for organizational change at The Public Hospital.
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Corporate law integrates a stakeholder conception through the comprehensive meaning of the best interests of the corporation. In this paper, I address criticisms about classical definition of the firms purpose. Even if American law is more discreet and uncertain, it is possible to defend a broad conception of the best interests of the corporation. The interests of Canadian and French firms include their partners. While the notion of intrt social is debatable in France, Canada has recently modified its point of view regarding the purpose of the firm. Indeed, the decision of the Supreme Court of Canada Magasins rayons Peoples Inc. (Syndic de) v. Wise in 2004 changed the concept of corporate law. With respect to fiduciary duties, the Supreme Court set aside the traditional interpretation of the best interests of the corporation which gave primacy to shareholders interests. The Court held that the expression best interests of the corporation refers to the maximization of the corporations value. This innovative vision of the best interest of the corporation introduces stakeholder theory and corporate social responsibility (CSR) into corporate law and provides a new field for the firms management to frame their responsibilities. This paper concludes with an extended discussion of the implications of stakeholder and CSR influence for the future of corporate law, economy and financial researches.
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[Support Institutions:] Department of Administration of Health, University of Montreal, Canada Public Health School of Fudan University, Shanghai, China
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Cette thse envisage un ensemble de mthodes permettant aux algorithmes d'apprentissage statistique de mieux traiter la nature squentielle des problmes de gestion de portefeuilles financiers. Nous dbutons par une considration du problme gnral de la composition d'algorithmes d'apprentissage devant grer des tches squentielles, en particulier celui de la mise--jour efficace des ensembles d'apprentissage dans un cadre de validation squentielle. Nous numrons les desiderata que des primitives de composition doivent satisfaire, et faisons ressortir la difficult de les atteindre de faon rigoureuse et efficace. Nous poursuivons en prsentant un ensemble d'algorithmes qui atteignent ces objectifs et prsentons une tude de cas d'un systme complexe de prise de dcision financire utilisant ces techniques. Nous dcrivons ensuite une mthode gnrale permettant de transformer un problme de dcision squentielle non-Markovien en un problme d'apprentissage supervis en employant un algorithme de recherche bas sur les K meilleurs chemins. Nous traitons d'une application en gestion de portefeuille o nous entranons un algorithme d'apprentissage optimiser directement un ratio de Sharpe (ou autre critre non-additif incorporant une aversion au risque). Nous illustrons l'approche par une tude exprimentale approfondie, proposant une architecture de rseaux de neurones spcialise la gestion de portefeuille et la comparant plusieurs alternatives. Finalement, nous introduisons une reprsentation fonctionnelle de sries chronologiques permettant des prvisions d'tre effectues sur un horizon variable, tout en utilisant un ensemble informationnel rvl de manire progressive. L'approche est base sur l'utilisation des processus Gaussiens, lesquels fournissent une matrice de covariance complte entre tous les points pour lesquels une prvision est demande. Cette information est utilise bon escient par un algorithme qui transige activement des carts de cours (price spreads) entre des contrats terme sur commodits. L'approche propose produit, hors chantillon, un rendement ajust pour le risque significatif, aprs frais de transactions, sur un portefeuille de 30 actifs.
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Pour rpondre aux exigences du gouvernement fdral quant aux temps dattente pour les chirurgies de remplacement du genou et de la hanche, les tablissements canadiens ont adopt des stratgies de gestion des listes dattentes avec des niveaux de succs variables. Notre question de recherche visait comprendre Quels facteurs ont permis de maintenir dans le temps un temps dattente rpondant aux exigences du gouvernement fdral pendant au moins 6-12 mois? Nous avons dvelopp un modle possdant quatre facteurs, inspir du modle de Parsons (1977), afin danalyser les facteurs comprenant la gouvernance, la culture, les ressources, et les outils. Trois tudes de cas ont t menes. En somme, le 1er cas a t capable dobtenir les exigences pendant six mois mais incapable de les maintenir, le 2e cas a t capable de maintenir les exigences > 18 mois et le 3e cas a t incapable datteindre les objectifs. Des documents furent recueillis et des entrevues furent ralises auprs des personnes impliques dans la stratgie. Les rsultats indiquent que lhpital qui a t en mesure de maintenir le temps dattente possde certaines caractristiques: ralisation exclusive de chirurgie de remplacement de la hanche et du genou, prsence dun personnel motiv, non distrait par dautres proccupations et un esprit dquipe fort. Les deux autres cas ont eu faire face une culture mdicale moins homogne et moins axs sur latteinte des cibles; des ressources disperses et une politique intra-tablissement imprcise. Le modle dhpital factory est intressant dans le cadre dune chirurgie surspcialise. Toutefois, les patients sont slectionns pour des chirurgies simples et dont le risque de complication est faible. Il ne peut donc pas tre retenu comme le modle durable par excellence.
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Cette thse est principalement constitue de trois articles traitant des processus markoviens additifs, des processus de Lvy et d'applications en finance et en assurance. Le premier chapitre est une introduction aux processus markoviens additifs (PMA), et une prsentation du problme de ruine et de notions fondamentales des mathmatiques financires. Le deuxime chapitre est essentiellement l'article "Lvy Systems and the Time Value of Ruin for Markov Additive Processes" crit en collaboration avec Manuel Morales et publi dans la revue European Actuarial Journal. Cet article tudie le problme de ruine pour un processus de risque markovien additif. Une identification de systmes de Lvy est obtenue et utilise pour donner une expression de l'esprance de la fonction de pnalit actualise lorsque le PMA est un processus de Lvy avec changement de rgimes. Celle-ci est une gnralisation des rsultats existant dans la littrature pour les processus de risque de Lvy et les processus de risque markoviens additifs avec sauts "phase-type". Le troisime chapitre contient l'article "On a Generalization of the Expected Discounted Penalty Function to Include Deficits at and Beyond Ruin" qui est soumis pour publication. Cet article prsente une extension de l'esprance de la fonction de pnalit actualise pour un processus subordinateur de risque perturb par un mouvement brownien. Cette extension contient une srie de fonctions escompte spre des minima successives dus aux sauts du processus de risque aprs la ruine. Celle-ci a des applications importantes en gestion de risque et est utilise pour dterminer la valeur espre du capital d'injection actualis. Finallement, le quatrime chapitre contient l'article "The Minimal entropy martingale measure (MEMM) for a Markov-modulated exponential Lvy model" crit en collaboration avec Romuald Herv Momeya et publi dans la revue Asia-Pacific Financial Market. Cet article prsente de nouveaux rsultats en lien avec le problme de l'incompltude dans un march financier o le processus de prix de l'actif risqu est dcrit par un modle exponentiel markovien additif. Ces rsultats consistent charactriser la mesure martingale satisfaisant le critre de l'entropie. Cette mesure est utilise pour calculer le prix d'une option, ainsi que des portefeuilles de couverture dans un modle exponentiel de Lvy avec changement de rgimes.
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Article
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Contexte Locclusion dune artre du cur cause un syndrome coronarien aigu (SCA) soit avec une lvation du segment ST (IAMEST) ou sans lvation du segment ST (1). Le traitement des patients avec un IAMEST requiert soit une intervention coronarienne durgence (ICP primaire) ou une thrapie fibrinolytique (FL). La thrapie FL peut tre administre soit dans un contexte pr-hospitalier (PHL) ou lhpital. Une prise en charge prcoce des patients avec SCA peut tre amliore par un simple indice de risque. Objectifs Les objectifs de cette thse taient de : 1) comparer lICP primaire et la thrapie FL (2); dcrire plusieurs systmes internationaux de PHL; (3) dvelopper et valider un indice de risque simplifi pour une stratification prcoce des patients avec SCA. Mthodes Nous compltons des mta-analyses, de type hirarchique Baysiennes portant sur leffet de la randomisation, dtudes randomises et observationnelles; compltons galement un sondage sur des systmes internationaux de PHL; dveloppons et validons un nouvel indice de risque pour ACS (le C-ACS). Rsultats Dans les tudes observationnelles, lICP primaire, compare la thrapie FL, est associe une plus grande rduction de la mortalit court-terme; mais ce sans bnfices concluants long terme. La FL pr-hospitalire peut tre administre par des professionnels de la sant possdant diverses expertises. Le C-ACS a des bonnes proprits discriminatoires et pourrait tre utilis dans la stratification des patients avec SCA. Conclusion Nous avons combl plusieurs lacunes importantes au niveau de la connaissance actuelle. Cette thse de doctorat contribuera amliorer laccs des soins de qualit leve pour les patients ayant un SCA.
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Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The surveys response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.
