Care delivery value chains for ophthalmic clinics in Switzerland

Perceived patient value is often not aligned with the emerging expenses for health care services. In other words, the costs are often supposed as rising faster than the actual value for the patients. This fact is causing major concerns to governments, health plans, and individuals. Attempts to solve the problem have habitually been on the operational effectiveness side: increasing patient volume, minimizing costs, rationing, or closing hospitals, usually resulting in a zero-sum game. Only few approaches come from the strategic positioning side and "competition" among hospitals is still perceived rather as a danger than as a chance to create a positive-sum game and stimulate patient value. In their 2006 book, "Redefining Health Care", the renowned Harvard strategy professor Michael E. Porter and hospital management expert Professor Elizabeth Olmsted Teisberg approach the challenge from the positive-sum perspective: they propose to form Integrated Practice Units (IPUs) and manage hospitals in a modern, patient value oriented way. They argue that creating value-based competition on results should have the same effect on the health care sector like transparency and competition turned other industries with out-dated management models (like recently the inert telecommunication industry) into highly competitive and customer value creating businesses. The objective of this paper is to elaborate Care Delivery Value Chains for Integrated Practice Units in ophthalmic clinics and gather a first feedback from Swiss hospital managers, ophthalmologists, and patients, if such an approach could be a realistic way to improve health care management. First, Porter's definition of competitiveness (distinction between operational effectiveness and strategic positioning) is explained. Then, the Care Delivery Value Chain is introduced as a key element for understanding value-based management, followed by three practice examples for ophthalmic clinics. Finally, recommendations are given how the Care Delivery Value Chain can be managed efficiently and how the obstacles of becoming a patient-oriented organization can be overcome. The conclusion is that increased transparency and value-based competition on results has the potential to change the mindset of hospital managers-which will align patient value with the emerging health care expenses. Early adapters of this management approach will gain a competitive advantage. [Author, p. 6]

Added value of SPECT/CT in addition to whole-body scintigraphy augmented with prone lateral views in patients with well-differentiated thyroid carcinoma

Purpose: We aimed to determine the impact of SPECT/CT performed in addition to whole-­‐body scintigraphy augmented with prone lateral views in patients with well-­‐differentiated thyroid carcinoma. Methods and Materials: This retrospective study included 141 patients (87 female, 54 male, mean age 47 years) with well-­‐differentiated thyroid carcinoma (105 papillary, 31 follicular, 1 Hürthle cell and 4 poorly differentiated) treated with radioiodine therapy (1000-7400 MBq). Patients were referred for either first postsurgical therapy (n=76) or further treatment (n=65). Two nuclear medicine physicians interpreted the scans in consensus (first whole-­‐body scintigraphy with prone lateral view, then SPECT/CT) reporting abnormal iodine uptake in the thyroid bed, lymph nodes and distant metastasis. The corresponding ATA risk score was calculated for each patient before and after SPECT/CT, as well as change in disease extension Results: The analysis showed a difference between scintigraphy and SPECT/CT in n=17 lesions in 14 patients (9.9%): 12 were described as suspicious on scintigraphy and could be considered as benign on SPECT/CT (3 corresponded to local iodine uptake, 6 to lymph nodes metastases and 3 to distant metastases). The others 5 corresponded to metastases (4 lymph nodes and 1 distant) that were not seen on whole-­‐body scintigraphy augmented with prone lateral views. In 10 of 141 (7.1%) patients, we observed a change in ATA risk stratification, with a risk increase in 4 of them (2.8%). Conclusion: SPECT/CT allowed detecting 5 focal lesions missed on planar scintigraphy, and to precise benignity of 12 suspicious lesions on planar scintigraphy. Moreover, SPECT/CT improved the risk stratification in 10 patients with a significant change in the patient management

Exploring the link between flexible working and organizational performance

The expansion of flexible work experienced since the 1980s in developed economies is consistent with a more generic trend towards organizational flexibility, which many authors see as essential in order to compete in the dynamic global environment (Volberda, 1998). From this point of view, the changing demands of the environment have forced organizations to seek the ability to adapt rapidly and effectively as a means to be successful or even to survive. In the quest for flexibility, every area of the organization has been scrutinized in order to render it as ¿agile¿ as possible. In the human resources arena, this analysis has led to the definition of diverse ¿flexible working practices¿ (FWP) that describe a wide range of employment practices, which differ from the traditional full-time job with a fixed salary and a permanent contract. These practices have been described using other terms, such as ¿alternative¿ (Polivka, 1996; Powell & Mainiero, 1999), ¿non-standard¿ (Kalleberg, 2000), or ¿atypical¿ (De Grip, Hoevenberg, &m Willems, 1997), which coincide in denoting their divergence from the most traditional forms of employment. This article will show that quite different practices have been embraced by the common term ¿flexible working practices.¿ Subsequently, the results of empirical research regarding the implications for organizational performance of a number of flexible practices will be commented on.

Identifying pedagogical, technological and organizational barriers in virtual learning environments

Virtual learning environments are online spaces where learners interact with other learners, teachers, resources and the environment in itself. Although technology is meant to enhance the learning process, there are important issues regarding pedagogical and organizational aspects that must be addressed. In this paper we review the barriers detected in a virtual university which exclusively uses Internet as the main channel of communication, with no face-to-face requirements exceptthose related to final evaluation.

Tietointensiivisten yrityspalveluiden tuotteistaminen Case: Lappeenrannan teknillisen yliopiston Tietohallinto

Työ käsittelee tietohallintoa tietointensiivisenä yrityspalveluna Lappeenrannan teknillisessä yliopistossa. Yliopiston tulee keskittyä omaan ydinosaamiseensa sekä erottaa sisäiset yrityspalvelut omiksi kokonaisuuksikseen. Tähän on käytetty tietohallinnon osalta tilaaja tuottajamallia. Mallin puitteissa tietohallintoyksikkö on kattavasti tunnistanut ja määritellyt oman toimintansa sekä asiakkaidensa perustarpeet. Tietohallinnon palvelut ovat tietointensiivisiä yrityspalveluita, joiden tarkoituksena on täydentää asiakkaiden osaamista ja kykyä tuottaa innovaatioita sekä välittää muualla tuotettua tietoa ja teknisiä ratkaisuja tähän tarpeeseen. Tietointensiivisen palveluntuottajan asiantuntijuus on kokemusperäistä ja hiljaista tietoa, jota on lähtökohtaisesti vaikea muuttaa organisatoriseksi tiedoksi eli lisäarvoksi organisaation toiminnalle. Tuotteistamista on hyödynnetty tietohallinnon prosessien muuttamiseksi eksplisiittisiksi. Tuotteistamalla standardoidaan prosesseihin liittyvät parhaat käytänteet, joka tarkoittaa kokemusperäisesti hyväksi havaittujen toimintatapojen rutinoimista. Tuotetut palvelut on tuotteistettu palvelupaketeiksi, joista on laadittu yksityiskohtainen palvelukuvaus sekä laskettu tuotekohtainen hinta. Palvelumallin soveltaminen takaa yksikkökustannusten, skaalaetujen, riskin jakaantumisen ja teknologisen kehityksen optimoinnin yliopistossa.

Market orientation and performance in entrepreneurial SMEs

Market orientation is the organizational culture that creates the necessary behaviors for continuous additional value for customers and thus continuous superior performance for the business. The field of market orientation has been studied repeatedly during the past two decades. Yet research has concentrated on large firms in large domestic markets creating a need for diversifying research. The master’s thesis at hand examined the general incidence of market orientation among SMEs from five different industries as well as its consequences on SME performance. The empirical part of the thesis was conducted with a web-based survey that resulted in 255 responses. The data of the survey was analyzed by statistical analysis. The incidence of market orientation varied among dimensions and market orientation did not show any direct effect on firm performance. Customer orientation was the only dimension that showed a direct (positive) effect. On the contrary, moderating effects were found which indicate that the effect of market orientation in SMEs is influenced by other factors that should receive further attention. Also industry specific differences were discovered and should be further examined.

Estimating extreme value cumulative distribution functions using bias-corrected kernel approaches

We propose a new kernel estimation of the cumulative distribution function based on transformation and on bias reducing techniques. We derive the optimal bandwidth that minimises the asymptotic integrated mean squared error. The simulation results show that our proposed kernel estimation improves alternative approaches when the variable has an extreme value distribution with heavy tail and the sample size is small.

Liderazgo y dirección de empresas en el s. XXI

Peer-reviewed

Developing the environmental marketing of an industrial company

The objective of this study was to examine how the customers of Larox Flowsys value environmental issues and how environmental issues affect their purchasing behaviour. A comparison between Larox peristaltic pumps and competing pump brands and types was also made in order to find out whether LPP pumps possess some more environmentally beneficial features that other pumps do not have. Finally, if the answers to the first two research questions show that a need for a new marketing message does exist, then the final stage is to select the most appropriate environmental arguments for Larox Flowsys. The empirical data in the study was collected from several different sources, but the main sources were the customer interviews and the outsourced market research. The data was analysed mainly by using content analysis, but theme formation and quantification were also utilized. The results showed that the customers do not consider environmental issues as a main purchasing criterion, but they may well be the criterion that differentiates the product from competing ones. The comparison proved that LPP pumps do possess some significant environmental benefits over competing pumps and therefore, the prerequisite for the use of environmental arguments exists. The final stage in the study was to select the proper environmental arguments for Larox Flowsys.

Estimating the value of the metal-ligand bond dissociation enthalpy<D> (M-L) for adducts using empirical equations supported by TG data

In this work is presented and tested (for 106 adducts, mainly of the zinc group halides) two empirical equations supported in TG data to estimate the value of the metal-ligand bond dissociation enthalpy for adducts: <D> (M-O) = t i / g if t i < 420 K and <D> (M-O) = (t i / g ) - 7,75 . 10-2 . t i if t i > 420 K. In this empirical equations, t i is the thermodynamic temperature of the beginning of the thermal decomposition of the adduct, as determined by thermogravimetry, andg is a constant factor that is function of the metal halide considered and of the number of ligands, but is not dependant of the ligand itself. To half of the tested adducts the difference between experimental and calculated values was less than 5%. To about 80% of the tested adducts, the difference between the experimental (calorimetric) and the calculated (using the proposed equations) values are less than 15%.

Verkkolaskuinvestoinnin kriittiset menestystekijät - empiirinen tutkielma

Kvalitatiivisen tutkielman tavoitteena oli selvittää verkkolaskuinvestoinnin kriittiset menestystekijät: investointiprojektin eri vaiheiden onnistumisen edellytykset sekä investoinnin nykyarvoon ratkaisevimmin vaikuttavat tekijät. Case-kohteen, Etelä-Karjalan sairaanhoitopiirin, osalta tavoitteena oli analysoida verkkolaskujen vastaanoton menestyksellisen käyttöönoton edellytykset julkisen sektorin erityispiirteet huomioiden. Verkkolaskuinvestointiprojektin vaiheista tärkeimmäksi osoittautui suunnitteluvaihe, jossa ennakoidaan tämänhetkisen tilanteen lisäksi myös tulevaisuuden tarpeet. Hankkeen nykyarvon kannalta kriittisimmiksi tekijöiksi kulminoituivat puolestaan arvio ajan käytön tehostumisesta paperilaskun ja verkkolaskun käsittelyketjua verrattaessa sekä verkkolaskujen osuus yrityksen kaikista laskuista. Case-kohteella on hyvät edellytykset onnistuneeseen verkkolaskuinvestointiin. Verkkolaskuinvestoinnin hyötyjen optimointi edellyttää kuitenkin jonkinlaista toimintakulttuurin muutosta prosessien tehokkuuden varmistamiseksi.

Trust in inter-organizational relationships

Trust in inter-organizational collaborative relationships has attracted substantial research interest among academics and practitioners. Previous studies have concentrated on the benefits of trust to business outcomes and economic performance, as it is considered to be a source of competitive advantage. Despite this increased level of interest, there is no consensus, much less overall agreement, about how it should be conceptualized or about the number of dimensions it incorporates. On the inter-organizational level there is an obvious challenge in defining both the trusting party and the objects of trust. Thus, the notion of trust as an under-theorized and poorly understood phenomenon still holds. Hence, the motivation of this study was fuelled by the need to increase our knowledge and understanding of the role and nature of trust in inter-organizational collaborative relationships. It is posited that there is a call for more understanding about its antecedents and consequences, as well as about the very concept in inter-organizational collaborative relationships. The study is divided into two parts. The first part gives a general overview, and the second part comprises four research publications. Both qualitative and quantitative research methodology is utilized. A multi-method research design was used because it provides different levels of data and different perspectives on the phenomenon. The results of this study reveal that trust incorporates three dimensions on both the individual and the organizational level: capability, goodwill, and self-reference. Trust develops from the reputation and behavior of the trusted party. It appears from this study that trust is clearly directed towards both individual boundary spanners and the counterpart company itself – i.e. not only to one or the other. The trusting party, on the other hand, is always an individual, and not the organization per se. Trust increases collaboration benefits and lowers collaboration drawbacks, thus having a positive effect on relationship performance. The major contribution of this study lies in uncovering the critical points and drawbacks in prior research and thereby in responding to the highlighted challenges. The way in which these challenges were addressed offers contributions to three major issues in the emerging theory of trust in the inter-organizational context: firstly, this study clarifies the trustor-trustee discussion; secondly, it conceptualizes trust as existing on both individual and organizational levels; and thirdly, it provides more information about the antecedents of trust and the ways in which it affects relationship performance.

Drivers and Barriers of Collaboration in the Value Chain of Paperboard-Packed Consumer Goods

Value chain collaboration has been a prevailing topic for research, and there is a constantly growing interest in developing collaborative models for improved efficiency in logistics. One area of collaboration is demand information management, which enables improved visibility and decrease of inventories in the value chain. Outsourcing of non-core competencies has changed the nature of collaboration from intra-enterprise to cross-enterprise activity, and this together with increasing competition in the globalizing markets have created a need for methods and tools for collaborative work. The retailer part in the value chain of consumer packaged goods (CPG) has been studied relatively widely, proven models have been defined, and there exist several best practice collaboration cases. The information and communications technology has developed rapidly, offering efficient solutions and applications to exchange information between value chain partners. However, the majority of CPG industry still works with traditional business models and practices. This concerns especially companies operating in the upstream of the CPG value chain. Demand information for consumer packaged goods originates at retailers' counters, based on consumers' buying decisions. As this information does not get transferred along the value chain towards the upstream parties, each player needs to optimize their part, causing safety margins for inventories and speculation in purchasing decisions. The safety margins increase with each player, resulting in a phenomenon known as the bullwhip effect. The further the company is from the original demand information source, the more distorted the information is. This thesis concentrates on the upstream parts of the value chain of consumer packaged goods, and more precisely the packaging value chain. Packaging is becoming a part of the product with informative and interactive features, and therefore is not just a cost item needed to protect the product. The upstream part of the CPG value chain is distinctive, as the product changes after each involved party, and therefore the original demand information from the retailers cannot be utilized as such – even if it were transferred seamlessly. The objective of this thesis is to examine the main drivers for collaboration, and barriers causing the moderate adaptation level of collaborative models. Another objective is to define a collaborative demand information management model and test it in a pilot business situation in order to see if the barriers can be eliminated. The empirical part of this thesis contains three parts, all related to the research objective, but involving different target groups, viewpoints and research approaches. The study shows evidence that the main barriers for collaboration are very similar to the barriers in the lower part of the same value chain; lack of trust, lack of business case and lack of senior management commitment. Eliminating one of them – the lack of business case – is not enough to eliminate the two other barriers, as the operational model in this thesis shows. The uncertainty of the future, fear of losing an independent position in purchasing decision making and lack of commitment remain strong enough barriers to prevent the implementation of the proposed collaborative business model. The study proposes a new way of defining the value chain processes: it divides the contracting and planning process into two processes, one managing the commercial parts and the other managing the quantity and specification related issues. This model can reduce the resistance to collaboration, as the commercial part of the contracting process would remain the same as in the traditional model. The quantity/specification-related issues would be managed by the parties with the best capabilities and resources, as well as access to the original demand information. The parties in between would be involved in the planning process as well, as their impact for the next party upstream is significant. The study also highlights the future challenges for companies operating in the CPG value chain. The markets are becoming global, with toughening competition. Also, the technology development will most likely continue with a speed exceeding the adaptation capabilities of the industry. Value chains are also becoming increasingly dynamic, which means shorter and more agile business relationships, and at the same time the predictability of consumer demand is getting more difficult due to shorter product life cycles and trends. These changes will certainly have an effect on companies' operational models, but it is very difficult to estimate when and how the proven methods will gain wide enough adaptation to become standards.

Fair value versus historic cost-valuation for biological assets: Implications for the quality of financial information

[spa] Este trabajo realiza un estudio empírico sobre los efectos, que se señalan en las discusiones teóricas, de la utilización del valor razonable (VR) frente al coste histórico (CH), utilizando dos muestras de explotaciones agrícolas, una de las cuales valora sus activos biológicos a CH y la otra a VR. No se encontraron diferencias significativas en los beneficios e ingresos entre ambas muestras, ni siquiera en sus volatilidades. Tampoco se encontraron diferencias significativas en rentabilidad, manipulación contable, ni en el poder de ambos criterios de valoración para predecir los flujos de tesorería. Por el contrario, la mayor parte de los tests realizados revelan un mayor poder de los beneficios calculados bajo el VR para la predicción de los beneficios futuros, respecto de cuando son calculados bajo el CH. El estudio proporciona también evidencia empírica de prácticas contables defectuosas de CH en el sector agrícola, concluyendo que el VR puede representar un criterio de valoración interesante para un sector, como el agrícola, caracterizado por el predominio de pequeñas explotaciones familiares.