Outsourcing and Subcontracting Strategy Creation in a Global Manufacturing Company

Työn tavoitteena oli tutkia lähestymistapoja ostaa-valmistaa - päätöksentekotilanteessa. Näillä päätöksillä voi olla lopputulemana joko oma valmistus tai ulkopuolisen toimittajan käyttäminen, jolloin puhutaanjoko ulkoistetusta tai alihankitusta valmistuksesta. Päätökseen vaikuttavista tekijöistä merkittävimmät on koottu viitekehykseen, joka opastaa huomioimaan eri tekijät, jotka toistuvat olosuhteista riippumatta. . Toimittajakentän mahdollisuuksilla on vaikutusta päätöksentekotilanteessa. Olennainen osa ulkoistamis- ja alihankintastrategiaa liittyy toimittajavalintaan, sekä valittavaan yhteistyömalliin.

Using the balanced scorecard as a tool for procurement strategy implementation

Tavoitteena diplomityössä oli tutkia, miten hankintastrategiaa saataisiin paremmin toteutettua jokapäiväisessä työssä. Strategian implementointiin käytettiin strategiakarttaa sekä balanced scorecard -mittareita. Tutkimus toteutettiin hankintaosastolla Vaasan & Vaasan Oy:ssä, joka toimii leipomotoimialalla viidessä maassa Itämeren alueella. Hankinnan strategiakartta ja balanced scorecard -mittarit laadittiin olemassa olevan hankintastrategian pohjalta. Perinteisiä balanced scorecard -näkökulmia muokattiin paremmin hankintatoimeen sopiviksi. Malliin lisättiin toimittajanäkökulma ja hankinnan rooli pääprosessien tukifunktiona otettiin huomioon muuttamalla balanced scorecardin asiakasnäkökulma sisäisen asiakkaan näkökulmaksi. Strategiakartta myös laadittiin niin, että hankinnan sisäisten asiakkaiden odotukset ovat kartassa tasavertaisina taloudellistentavoitteiden kanssa. Balanced scorecard -mittareiden määrä pidettiin pienenä, jotta niiden toimintaa ohjaava vaikutus olisi mahdollisimman suuri. Mittareita voidaan vaihtaa strategian muuttuessa. Työssä todettiin, että strategiakartta ja balanced scorecard ovat hyviä välineitä strategian muuttamiseen konkreettisiksi toimenpiteiksi myös tukifunktiossa, kun esimerkiksi mallin näkökulmia muokataan tapauskohtaisesti. Strategiakartat ja balanced scorecard tulisi kytkeä osaksi koko yrityksen strategista suunnittelua. Strategiakartan ja balanced scorecardin käytöstä on hankinnalle monia hyötyjä. Työntekijät hahmottavat paremmin oman panoksensa yrityksen tavoitteiden saavuttamisessa. Käytetyt työkalut voivat tukea myös konsernin yksiköiden hankintojen keskittämiskehitystä.

Team Effectiveness in Patient Health Management: An Overview of Reviews

Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in inter-professional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for perform- ance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effective- ness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease management are needed to more accurately assess its net program efficacy and population effectiveness.

Targeting the proteolytic processing of the viral glycoprotein precursor is a promising novel antiviral strategy against arenaviruses.

A crucial step in the arenavirus life cycle is the biosynthesis of the viral envelope glycoprotein (GP) responsible for virus attachment and entry. Processing of the GP precursor (GPC) by the cellular proprotein convertase site 1 protease (S1P), also known as subtilisin-kexin-isozyme 1 (SKI-1), is crucial for cell-to-cell propagation of infection and production of infectious virus. Here, we sought to evaluate arenavirus GPC processing by S1P as a target for antiviral therapy using a recently developed peptide-based S1P inhibitor, decanoyl (dec)-RRLL-chloromethylketone (CMK), and the prototypic arenavirus lymphocytic choriomeningitis virus (LCMV). To control for off-target effects of dec-RRLL-CMK, we employed arenavirus reverse genetics to introduce a furin recognition site into the GPC of LCMV. The rescued mutant virus grew to normal titers, and the processing of its GPC critically depended on cellular furin, but not S1P. Treatment with the S1P inhibitor dec-RRLL-CMK resulted in specific blocking of viral spread and virus production of LCMV. Combination of the protease inhibitor with ribavirin, currently used clinically for treatment of human arenavirus infections, resulted in additive drug effects. In cells deficient in S1P, the furin-dependent LCMV variant established persistent infection, whereas wild-type LCMV underwent extinction without the emergence of S1P-independent escape variants. Together, the potent antiviral activity of an inhibitor of S1P-dependent GPC cleavage, the additive antiviral effect with ribavirin, and the low probability of emergence of S1P-independent viral escape variants make S1P-mediated GPC processing by peptide-derived inhibitors a promising strategy for the development of novel antiarenaviral drugs.

Customization, transparency and proximity: a user- centered content strategy applied to the design of a virtual library website

We present a case study of the redesign of the organizational presentation and content of the Virtual Library website at the Universitat Oberta de Catalunya (Open University of Catalonia, UOC), based on a user-centered design strategy. The aim of the redesign was to provide users with more intuitive, usable and understandable content (textual content, resources and services) by implementing criteria of customization, transparency and proximity. The study also presents a selection of best practices for applying these criteria to the design of other library websites.

The Role of an Enterprise Portal in Knowledge Management Strategy, Case: Private Equity Investor

Työ tutkii yritysportaalin roolia organisaation tietojohtamisessa. Tutkimusongelman ratkaisemiseksi luodaan viitekehys, jossa yritysportaalin ja tietojohtamisen teoriat linkittyvät. Työn empiirisessä osassa viitekehys on pohjana case-yritykselle rakennettavalle yritysportaalille. Laadullinen tutkimus käsittää teoriaosuuden sekä osallistuvaan case-tutkimukseen perustuvan empiriaosuuden. Työn runko muodostuu kahden vastakkaisen tietojohtamisajattelun vuoropuhelusta, jotka ovat informaatioteknologiaan- ja strategiseen johtamiseen perustuvat näkökulmat. Toimivan tietojohtamismallin täytyy sisältää molemmat aspektit. Jokainen organisaatio tarvitsee informaation hallintaan liittyviä toiminnallisuuksia ja täten eksplisiittisen tiedon hallinta tietojärjestelmien avulla on onnistuneen tietojohtamisen kulmakiviä. Tätä perusinfrastruktuuria on mahdollista laajentaa hiljaisen tiedon hallintaan perustuvilla tietojohtamismenetelmillä. Työn ratkaisu näiden kahden näkemyksen, 'kovan' informaatioteknogiaan painottuvan sekä 'pehmeän' ihmisnäkökulman integrointiin, on yritysportaali. Työssä käytettävä yritysportaalin viitekehys rakentuu kolmeen päätoiminnallisuuteen; sisällönhallintaan, yhteistyöominaisuuksiin ja liiketoimintatiedon hallintaan. Työ todistaa yhteyden viitekehyksen sekä tietojohtamisen perusmallien, kuten tietojohtamisen prosessimallin sekä tietoympäristöjen välillä. Yritysportaali voi täten toimia, ei ainoastaan yksittäisten tietojohtamistyökalujen implementoinnissa, vaan tietojohtamisstrategian luomisen apuna tarjoten alustan tai 'katalyytin' kokonaisvaltaiselle tietojohtamiselle.

Primary fluid bolus therapy for infection-associated hypotension in the emergency department.

OBJECTIVES: The physiological changes associated with fluid bolus therapy (FBT) for patients with infection-associated hypotension in the emergency department (ED) are poorly understood. We describe the physiological outcomes of FBT in the first 6 hours (primary FBT) for patients presenting to the ED with infection-associated hypotension. METHODS: We studied 101 consecutive ED patients with infection and a systolic blood pressure (SBP)<100 mmHg who underwent FBT in the first 6 hours. RESULTS: We screened 1123 patients with infection and identified 101 eligible patients. The median primary FBT volume given was 1570 mL (interquartile range, 1000- 2490 mL). The average mean arterial pressure (MAP) did not change from admission to 6 hours in the whole cohort, or in patients who were hypotensive on arrival at the ED. However, the average MAP increased from its lowest value during the first 6 hours (66 mmHg [SD, 10 mmHg]) to its value at 6 hours (73 mmHg [SD, 12 mmHg]; P<0.001). The mean heart rate, body temperature, respiratory rate and plasma creatinine level decreased (P<0.05). In patients who were severely hypotensive (SBP<90 mmHg) on arrival at the ED, the MAP increased from 54 mmHg (SD, 8 mmHg) to 70 mmHg (SD, 14 mmHg) (P<0.001). At 6 hours, however, SBP was still <100 mmHg in 44 patients and <90 mmHg in 17 patients. When noradrenaline was used, in 10 patients, hypotension was corrected in all 10 and the MAP increased from 58 mmHg (SD, 9 mmHg) to 75 mmHg (SD, 13 mmHg). CONCLUSION: Among ED patients admitted to an Australian teaching hospital with infection, hypotension was uncommon. FBT for hypotension was limited in volumes given and failed to achieve a sustained SBP of >100 mmHg in 40% of cases. In contrast, noradrenaline therapy corrected hypotension in all patients who received it.

Customization, transparency and proximity: a user- centered content strategy applied to the design of a virtual library website

We present a case study of the redesign of the organizational presentation and content of the Virtual Library website at the Universitat Oberta de Catalunya (Open University of Catalonia, UOC), based on a user-centered design strategy. The aim of the redesign was to provide users with more intuitive, usable and understandable content (textual content, resources and services) by implementing criteria of customization, transparency and proximity. The study also presents a selection of best practices for applying these criteria to the design of other library websites.

How to operate a university institute as a radiological emergency service?

The Institute of Radiation Physics (IRA) is attached to the Department of Medical Radiology at the Vaud University Hospital Center (CHUV) in Lausanne. The Institute's main tasks are strongly linked to the medical activities of the Department: radiotherapy, radiodiagnostics, interventional radiology and nuclear medicine. The Institute also works in the fields of operational radiation protection, radiation metrology and radioecology. In the case of an accident involving radioactive materials, the emergency services are able to call on the assistance of radiation protection specialists. In order to avoid having to create and maintain a specific structure, both burdensome and rarely needed, Switzerland decided to unite all existing emergency services for such events. Thus, the IRA was invited to participate in this network. The challenge is therefore to integrate a university structure, used to academic collaborations and the scientific approach, to an interventional organization accustomed to strict policies, a military-style command structure and "drilled" procedures. The IRA's solution entails mobilizing existing resources and the expertise developed through professional experience. The main asset of this solution is that it involves the participation of committed collaborators who remain in a familiar environment, and are able to use proven materials and mastered procedures, even if the atmosphere of an accident situation differs greatly from regular laboratory routines. However, this solution requires both a commitment to education and training in emergency situations, and a commitment in terms of discipline by each collaborator in order to be integrated into a response plan supervised by an operational command center.

Acute ischemic cerebrovascular events on antiplatelet therapy: what is the optimal prevention strategy?

Even though patients who develop ischemic stroke despite taking antiplatelet drugs represent a considerable proportion of stroke hospital admissions, there is a paucity of data from investigational studies regarding the most suitable therapeutic intervention. There have been no clinical trials to test whether increasing the dose or switching antiplatelet agents reduces the risk for subsequent events. Certain issues have to be considered in patients managed for a first or recurrent stroke while receiving antiplatelet agents. Therapeutic failure may be due to either poor adherence to treatment, associated co-morbid conditions and diminished antiplatelet effects (resistance to treatment). A diagnostic work up is warranted to identify the etiology and underlying mechanism of stroke, thereby guiding further management. Risk factors (including hypertension, dyslipidemia and diabetes) should be treated according to current guidelines. Aspirin or aspirin plus clopidogrel may be used in the acute and early phase of ischemic stroke, whereas in the long-term, antiplatelet treatment should be continued with aspirin, aspirin/extended release dipyridamole or clopidogrel monotherapy taking into account tolerance, safety, adherence and cost issues. Secondary measures to educate patients about stroke, the importance of adherence to medication, behavioral modification relating to tobacco use, physical activity, alcohol consumption and diet to control excess weight should also be implemented.

Strategy Implementation Bottlenecks: Identification, Analysis and Removal

This thesis investigates the strategy implementation process of enterprices; a process whichhas lacked the academic attentioon compared with a rich strategy formation research trdition. Strategy implementation is viewed as a process ensuring tha the strtegies of an organisation are realised fully and quickly, yet with constant consideration of changing circumstances. The aim of this sudy is to provide a framework for identifying, analysing and removing the strategy implementation bottleneck af an organization and thus for intesifying its strategy process.The study is opened by specifying the concept, tasks and key actors of strategy implementation process; especially arguments for the critical implementation role of the top management are provided. In order to facilitate the analysis nad synthetisation of the core findings of scattered doctrine, six characteristic approaches to strategy implementation phenomenon are identified and compared. The Bottleneck Framework is introduced as an instrument for arranging potential strategy realisation problems, prioritising an organisation's implementation obstacles and focusing the improvement measures accordingly. The SUCCESS Framework is introduced as a mnemonic of the seven critical factors to be taken into account when promoting sttrategy implementation. Both frameworks are empirically tested by applying them to real strategy implementation intesification process in an international, industrial, group-structured case enterprise.

Emergency hospital services utilization in Lleida (Spain): a cross-sectional study of immigrant and Spanish-born populations

Background: The use of emergency hospital services (EHS) has increased steadily in Spain in the last decade while the number of immigrants has increased dramatically. Studies show that immigrants use EHS differently than native-born individuals, and this work investigates demographics, diagnoses and utilization rates of EHS in Lleida (Spain). Methods: Cross-sectional study of all the 96,916 EHS visits by patients 15 to 64 years old, attended during the years 2004 and 2005 in a public teaching hospital. Demographic data, diagnoses of the EHS visits, frequency of hospital admissions, mortality and diagnoses at hospital discharge were obtained. Utilization rates were estimated by group of origin. Poisson regression was used to estimate the rate ratios of being visited in the EHS with respect to the Spanish-born population. Results: Immigrants from low-income countries use EHS services more than the Spanish-born population. Differences in utilization patterns are particularly marked for Maghrebi men and women and sub-Saharan women. Immigrant males are at lower risk of being admitted to the hospital, as compared with Spanish-born males. On the other hand, immigrant women are at higher risk of being admitted. After excluding the visits with gynecologic and obstetric diagnoses, women from sub-Saharan Africa and the Maghreb are still at a higher risk of being admitted than their Spanish-born counterparts. Conclusion: In Lleida (Spain), immigrants use more EHS than the Spanish born population. Future research should indicate whether the same pattern is found in other areas of Spain and whether EHS use is attributable to health needs, barriers to access to the primary care services or similarities in the way immigrants access health care in their countries of origin.

Once and for all - How people change strategy to ignore irrelevant information in visual tasks

Ignoring irrelevant visual information aids efficient interaction with task environments. We studied how people, after practice, start to ignore the irrelevant aspects of stimuli. For this we focused on how information reduction transfers to rarely practised and novel stimuli. In Experiment 1, we compared competing mathematical models on how people cease to fixate on irrelevant parts of stimuli. Information reduction occurred at the same rate for frequent, infrequent, and novel stimuli. Once acquired with some stimuli, it was applied to all. In Experiment 2, simplification of task processing also occurred in a once-for-all manner when spatial regularities were ruled out so that people could not rely on learning which screen position is irrelevant. Apparently, changes in eye movements were an effect of a once-for-all strategy change rather than a cause of it. Overall, the results suggest that participants incidentally acquired knowledge about regularities in the task material and then decided to voluntarily apply it for efficient task processing. Such decisions should be incorporated into accounts of information reduction and other theories of strategy change in skill acquisition.