Performance management in health centres: evidence from a field study

There has been a growing interest in research on performance measurement and management practices, which seems to reflect researchers’ response to calls for the need to increase the relevance of management accounting research. However, despite the development of the new public management literature, studies involving public sector organizations are relatively small compared to those involving business organizations and extremely limited when it comes to public primary health care organizations. Yet, the economic significance of public health care organizations in the economy of developed countries and the criticisms these organizations regularly face from the public suggests there is a need for research. This is particularly true in the case of research that may lead to improvement in performance measurement and management practices and ultimately to improvements in the way health care organizations use their limited resources in the provision of services to the communities. This study reports on a field study involving three public primary health care organisations. The evidence obtained from interviews and archival data suggests a performance management practices in these institutions lacked consistency and coherence, potentially leading to decreased performance. Hierarchical controls seemed to be very weak and accountability limited, leading to a lack of direction, low motivation and, in some circumstances to insufficient managerial abilities and skills. Also, the performance management systems revealed a number of weaknesses, which suggests that there are various opportunities for improvement in performance in the studied organisations.

Children visual screening protocol: validation by a focus group panel of experts

Screening programs, particularly the inclusion of specific orthoptic tests to detect visual abnormalities, varies among countries. This study aims to: 1) describes expert perception of issues related with children visual screening; 2) identify specific orthoptic tests to detect visual abnormalities in children visual screening.

Visual Screening Competencies Questionnaire (VSCQ) and orthoptic practice

The identification of core competencies which are important for undertaking accurate visual screening by orthoptists is considered in this study. The aim was to construct and validate a questionnaire for orthoptists to assess visual screening competency. This study comprised three steps. The first step involved a 69-item self-assessment questionnaire constructed to assess orthoptists' perception of their competencies in visual screening programs for children. This questionnaire was constructed with statements from the Orthoptic Benchmark Statement for Health Care Programmes (Quality Assurance Agency for Higher Education, UK) and included three competency dimensions: interpersonal (IP), instrumental (IT) and systemic (ST). The second step involved questionnaire translation.

Perceção visual na avaliação diagnóstica em mamografia: uma revisão sistemática

Introdução – Na avaliação diagnóstica em mamografia, o desempenho do radiologista pode estar sujeito a erros de diagnóstico. Objetivo – Descrever a importância da perceção visual na análise da mamografia, identificando os principais fatores que contribuem para a perceção visual do radiologista e que condicionam a acuidade diagnóstica. Metodologia – Estudo descritivo baseado numa revisão sistemática de literatura através da PubMed e da Science Direct. Foram incluídos 42 artigos que respeitavam, pelo menos, um dos critérios de inclusão no estudo. Para a seleção das referências foi utilizada a metodologia PRISMA, constituída por 4 fases: identificação, seleção preliminar, elegibilidade e estudos incluídos. Resultados – Na avaliação diagnóstica em mamografia, a perceção visual está intimamente relacionada com: 1) diferentes parâmetros visuais e da motilidade ocular (acuidade visual, sensibilidade ao contraste e à luminância e movimentos oculares); 2) com condições de visualização de uma imagem (iluminância da sala e luminância do monitor); e 3) fadiga ocular provocada pela observação diária consecutiva de imagens. Conclusões – A perceção visual pode ser influenciada por 3 categorias de erros observados: erros de pesquisa (lesões não são fixadas pela fóvea), erros de reconhecimento (lesões fixadas, mas não durante o tempo suficiente) e erros de decisão (lesões fixadas, mas não identificadas como suspeitas). Os estudos analisados sobre perceção visual, atenção visual e estratégia visual, bem como os estudos sobre condições de visualização não caracterizam a função visual dos observadores. Para uma avaliação correta da perceção visual em mamografia deverão ser efetuados estudos que correlacionem a função visual com a qualidade diagnóstica. ABSTRACT - Introduction – Diagnostic evaluation in mammography could be influenced by the radiologist performance that could be under diagnostic errors. Aims – To describe the importance of radiologist visual perception in mammographic diagnostic evaluation and to identify the main factors that contribute to diagnostic accuracy. Methods – In this systematic review 42 references were included based on inclusion criteria (PubMed and Science Direct). PRISMA method was used to select the references following 4 steps: identification, screening, eligibility and included references. Results – Visual perception in mammography diagnostic evaluation is related with: 1) visual parameters and ocular motility (visual acuity, contrast sensitivity and luminance and ocular movements); 2) image visualization environment (room iluminance and monitor luminance); and 3) eyestrain caused by image daily consecutive observation. Conclusions – Visual perception can be influenced by three errors categories: search errors (lesions are never looked at with high-resolution foveal vision), recognition errors (lesions are looked at, but not long enough to detect or recognize) and decision errors (lesions are looked at for long periods of time but are still missed). The reviewed studies concerning visual perception, visual attention, visual strategies and image visualization environment do not describe observer’s visual function. An accurate evaluation of visual perception in mammography must include visual function analysis.

Programas de self-management em pacientes com DPOC: uma revisão sistemática

Introdução: Programas de self-management têm como objectivo habilitar os pacientes com estratégias necessárias para levar a cabo procedimentos específicos para a patologia. A última revisão sistemática sobre selfmanagament em DPOC foi realizada em 2007, concluindo-se que ainda não era possível fornecer dados claros e suficientes acerca de recomendações sobre a estrutura e conteúdo de programas de self-managament na DPOC. A presente revisão tem o intuito de complementar a análise da revisão anterior, numa tentativa de inferir a influência do ensino do self-management na DPOC. Objectivos: verificar a influência dos programas de self-management na DPOC, em diversos indicadores relacionados com o estado de saúde do paciente e na sua utilização dos serviços de saúde. Estratégia de busca: pesquisa efectuada nas bases de dados PubMed e Cochrane Collaboration (01/01/2007 – 31/08/2010). Palavras-chave: selfmanagement education, self-management program, COPD e pulmonary rehabilitation. Critérios de Selecção: estudos randomizados sobre programas de selfmanagement na DPOC. Extracção e Análise dos Dados: 2 investigadores realizaram, independentemente, a avaliação e extracção de dados de cada artigo. Resultados: foram considerados 4 estudos randomizados em selfmanagement na DPOC nos quais se verificaram benefícios destes programas em diversas variáveis: qualidade de vida a curto e médio prazo, utilização dos diferentes recursos de saúde, adesões a medicação de rotina, controle das exacerbações e diminuição da sintomatologia. Parece não ocorrer alteração na função pulmonar e no uso de medicação de emergência, sendo inconclusivo o seu efeito na capacidade de realização de exercício. Conclusões: programas de self-management aparentam ter impacto positivo na qualidade de vida, recurso a serviços de saúde, adesão à medicação, planos de acção e níveis de conhecimento da DPOC. Discrepâncias nos critérios de selecção das amostras utilizadas, períodos de seguimento desiguais, consistência das variáveis mensuradas, condicionam a informação disponibilizada sobre este assunto.

Participação ocupacional do idoso com deficiência visual: sua percepção

O estudo apresentado visava responder às necessidades emergentes de justificação da intervenção da Terapia Ocupacional na população idosa com deficiência visual. Teve como objectivo explorar as perspectivas dos idosos com deficiência visual na experiência que têm da sua participação ocupacional. Paralelamente a este objectivo procurou-se, também, conhecer as atitudes e comportamentos em relação ao apoio da Terapia Ocupacional. Para estudar estas questões utilizou-se uma metodologia qualitativa, a fenomenologia, que permitiu descrever fielmente a experiência que se pretendia conhecer. A recolha de dados foi feita através de duas sessões de focus groups distintas, onde num dos grupos participaram idosos com deficiência visual que tiveram apoio de Terapia Ocupacional e no outro idosos com deficiência visual que não usufruíram deste apoio. Após a análise do conteúdo resultante dos focus groups emergiram os seguintes temas: impacto da deficiência visual, onde foram englobadas as categorias de implicações psicossociais da deficiência visual e restrições nas actividades e ocupações do idoso com deficiência visual; o segundo tema onde se incluíram as categorias de apoio e atitudes sociais, instituições e recursos acessíveis e estratégias utilizadas; por fim o tema dos benefícios percebidos, do qual fazem parte as categorias, benefícios psicológicos e participação. Estes temas permitiram perceber as perspectivas de participação ocupacional do idoso, após o aparecimento da deficiência visual, bem como conhecer as melhorias ao nível dessa participação após intervenção especializada, destacando-se a relevância da intervenção do terapeuta ocupacional na população idosa com deficiência visual.

Organization knowledge management change from a complex adaptive systems perpective with ability for ambidexeterity

We are working on the confluence of knowledge management, organizational memory and emergent knowledge with the lens of complex adaptive systems. In order to be fundamentally sustainable organizations search for an adaptive need for managing ambidexterity of day-to-day work and innovation. An organization is an entity of a systemic nature, composed of groups of people who interact to achieve common objectives, making it necessary to capture, store and share interactions knowledge with the organization, this knowledge can be generated in intra-organizational or inter-organizational level. The organizations have organizational memory of knowledge of supported on the Information technology and systems. Each organization, especially in times of uncertainty and radical changes, to meet the demands of the environment, needs timely and sized knowledge on the basis of tacit and explicit. This sizing is a learning process resulting from the interaction that emerges from the relationship between the tacit and explicit knowledge and which we are framing within an approach of Complex Adaptive Systems. The use of complex adaptive systems for building the emerging interdependent relationship, will produce emergent knowledge that will improve the organization unique developing.

Improving management skills through business simulation

A survey was conducted among students of the Accounting and Administration undergraduate degree at ISCAP – IPP (School of Accounting and Administration of Polytechnic Institute of Porto) in order to understand their perception value of their course Business Simulation (BS). This course is provided in a business environment where students can learn by doing through the management of a company as they were in the real life, but risk-free. The learning tasks are provided in an action-oriented format to maximize the learning process. Students learn by doing a set of tasks every session and have also to produce reports and presentations during the course. BS is part of the undergraduate degree of Accounting and Administration at ISCAP – IPP since the beginning of 2003. The questionnaire we used captured the students’ perception about general and specific skills and competencies considered important for managers and accountants in the real life, about the methodology used in the course, which is totally different from the traditional form, and also about the adequacy of the course included as part of the undergraduate degree. The results showed that students’ perception is highly positive and almost all of them think they improve the skills needed for a job during the course. These results are consistent with [1] Adler and Milne’s research in which the authors found that students agree with the use of action-oriented learning tasks in order to provide them the needed attitudes, skills, and knowledge. The improvement of group skills is the most important issue for students, which can be understandable as BS is the only course from the degree in Accounting and Administration they really have to work in groups.

A congestion management and transmission price simulator for competitive electricity markets

In a liberalized electricity market, the Transmission System Operator (TSO) plays a crucial role in power system operation. Among many other tasks, TSO detects congestion situations and allocates the payments of electricity transmission. This paper presents a software tool for congestion management and transmission price determination in electricity markets. The congestion management is based on a reformulated Optimal Power Flow (OPF), whose main goal is to obtain a feasible solution for the re-dispatch minimizing the changes in the dispatch proposed by the market operator. The transmission price computation considers the physical impact caused by the market agents in the transmission network. The final tariff includes existing system costs and also costs due to the initial congestion situation and losses costs. The paper includes a case study for the IEEE 30 bus power system.

Long-term price range forecast applied to risk management using regression models

Long-term contractual decisions are the basis of an efficient risk management. However those types of decisions have to be supported with a robust price forecast methodology. This paper reports a different approach for long-term price forecast which tries to give answers to that need. Making use of regression models, the proposed methodology has as main objective to find the maximum and a minimum Market Clearing Price (MCP) for a specific programming period, and with a desired confidence level α. Due to the problem complexity, the meta-heuristic Particle Swarm Optimization (PSO) was used to find the best regression parameters and the results compared with the obtained by using a Genetic Algorithm (GA). To validate these models, results from realistic data are presented and discussed in detail.

Virtual power players demand response programs management based on locational marginal prices

Power systems have been suffering huge changes mainly due to the substantial increase of distributed generation and to the operation in competitive environments. Virtual power players can aggregate a diversity of players, namely generators and consumers, and a diversity of energy resources, including electricity generation based on several technologies, storage and demand response. Resource management gains an increasing relevance in this competitive context, while demand side active role provides managers with increased demand elasticity. This makes demand response use more interesting and flexible, giving rise to a wide range of new opportunities.This paper proposes a methodology for managing demand response programs in the scope of virtual power players. The proposed method is based on the calculation of locational marginal prices (LMP). The evaluation of the impact of using demand response specific programs on the LMP value supports the manager decision concerning demand response use. The proposed method has been computationally implemented and its application is illustrated in this paper using a 32 bus network with intensive use of distributed generation.

Hydro energy systems management in Portugal: Profit-based evaluation of a mixed-integer nonlinear approach

In this paper, a novel mixed-integer nonlinear approach is proposed to solve the short-term hydro scheduling problem in the day-ahead electricity market, considering not only head-dependency, but also start/stop of units, discontinuous operating regions and discharge ramping constraints. Results from a case study based on one of the main Portuguese cascaded hydro energy systems are presented, showing that the proposedmixed-integer nonlinear approach is proficient. Conclusions are duly drawn. (C) 2010 Elsevier Ltd. All rights reserved.

Energy resource scheduling considering reactive power management

The reactive power management is an important task in future power systems. The control of reactive power allows the increase of distributed energy resources penetration as well as the optimal operation of distribution networks. Currently, the control of reactive power is only controlled in large power units and in high and very high voltage substations. In this paper a reactive power control in smart grids paradigm is proposed, considering the management of distributed energy resources and of the distribution network by an aggregator namely Virtual Power Player (VPP).

Short-term scheduling considering five-minute and hour-ahead energy resource management

The introduction of new distributed energy resources, based on natural intermittent power sources, in power systems imposes the development of new adequate operation management and control methods. This paper proposes a short-term Energy Resource Management (ERM) methodology performed in two phases. The first one addresses the hour-ahead ERM scheduling and the second one deals with the five-minute ahead ERM scheduling. Both phases consider the day-ahead resource scheduling solution. The ERM scheduling is formulated as an optimization problem that aims to minimize the operation costs from the point of view of a virtual power player that manages the network and the existing resources. The optimization problem is solved by a deterministic mixed-integer non-linear programming approach and by a heuristic approach based on genetic algorithms. A case study considering a distribution network with 33 bus, 66 distributed generation, 32 loads with demand response contracts and 7 storage units has been implemented in a PSCADbased simulator developed in the field of the presented work, in order to validate the proposed short-term ERM methodology considering the dynamic power system behavior.