Case management for frequent users of the emergency department: study protocol of a randomised controlled trial.

BACKGROUND: We devised a randomised controlled trial to evaluate the effectiveness and efficiency of an intervention based on case management care for frequent emergency department users. The aim of the intervention is to reduce such patients' emergency department use, to improve their quality of life, and to reduce costs consequent on frequent use. The intervention consists of a combination of comprehensive case management care and standard emergency care. It uses a clinical case management model that is patient-identified, patient-directed, and developed to provide high intensity services. It provides a continuum of hospital- and community-based patient services, which include clinical assessment, outreach referral, and coordination and communication with other service providers. METHODS/DESIGN: We aim to recruit, during the first year of the study, 250 patients who visit the emergency department of the University Hospital of Lausanne, Switzerland. Eligible patients will have visited the emergency department 5 or more times during the previous 12 months. Randomisation of the participants to the intervention or control groups will be computer generated and concealed. The statistician and each patient will be blinded to the patient's allocation. Participants in the intervention group (N = 125), additionally to standard emergency care, will receive case management from a team, 1 (ambulatory care) to 3 (hospitalization) times during their stay and after 1, 3, and 5 months, at their residence, in the hospital or in the ambulatory care setting. In between the consultations provided, the patients will have the opportunity to contact, at any moment, the case management team. Participants in the control group (N = 125) will receive standard emergency care only. Data will be collected at baseline and 2, 5.5, 9, and 12 months later, including: number of emergency department visits, quality of life (EuroQOL and WHOQOL), health services use, and relevant costs. Data on feelings of discrimination and patient's satisfaction will also be collected at the baseline and 12 months later. DISCUSSION: Our study will help to clarify knowledge gaps regarding the positive outcomes (emergency department visits, quality of life, efficiency, and cost-utility) of an intervention based on case management care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01934322.

Solution scanning as a key policy tool: identifying management interventions to help maintain and enhance regulating ecosystem services

The major task of policy makers and practitioners when confronted with a resource management problem is to decide on the potential solution(s) to adopt from a range of available options. However, this process is unlikely to be successful and cost effective without access to an independently verified and comprehensive available list of options. There is currently burgeoning interest in ecosystem services and quantitative assessments of their importance and value. Recognition of the value of ecosystem services to human well-being represents an increasingly important argument for protecting and restoring the natural environment, alongside the moral and ethical justifications for conservation. As well as understanding the benefits of ecosystem services, it is also important to synthesize the practical interventions that are capable of maintaining and/or enhancing these services. Apart from pest regulation, pollination, and global climate regulation, this type of exercise has attracted relatively little attention. Through a systematic consultation exercise, we identify a candidate list of 296 possible interventions across the main regulating services of air quality regulation, climate regulation, water flow regulation, erosion regulation, water purification and waste treatment, disease regulation, pest regulation, pollination and natural hazard regulation. The range of interventions differs greatly between habitats and services depending upon the ease of manipulation and the level of research intensity. Some interventions have the potential to deliver benefits across a range of regulating services, especially those that reduce soil loss and maintain forest cover. Synthesis and applications: Solution scanning is important for questioning existing knowledge and identifying the range of options available to researchers and practitioners, as well as serving as the necessary basis for assessing cost effectiveness and guiding implementation strategies. We recommend that it become a routine part of decision making in all environmental policy areas.

Key Account Management in Paper and Board Industry- Identification of Key Accounts for Stora Enso Graphical Boards

Tutkimuksen tarkoituksena oli tunnistaa nykyiset sekä potentiaaliset avainasiakkaat case yritykselle. Avainasiakkaat tunnistettiin Chevertonin tunnistamis- ja valintamatriisin avulla, jossa asiakkaan sijoittumista matriisiin arvioidaan asiakkaan houkuttelevuuden sekä toimittajan suhteellisten vahvuuksien avulla. Kriteereiksi avainasiakkaiden tunnistamiseen valittiin asiakkaan vuotuinen ostovolyymi, asiakkaan business-potentiaali sekä case-yrityksen toimittajaosuus. Asiakkaat luokiteltiin avainasiakkaisiin, kehitettäviin avainasiakkaisiin, ylläpidettäviin asiakkaisiin sekä satunnaisiin asiakkaisiin. Tutkimus tarjosi lähtökohdan case-yrityksen uusille avainasiakaspäälliköille sekä osoitti suunnan tulevaisuuden tutkimustarpeille. Aktiivisen tiedonvaihdannan kautta eri myyntikonttoreiden johtohenkilöstön sekä myös yrityksen eri funktionaalisten divisioonien välillä voidaan saavuttaa kilpailuetua kun lähestytään asiakasta toimintojaan järkiperäisesti koordinoineena toimittajana samalla kun asiakkaat keskittävät ostojaan. Jotta yrityksen tavoitteet, markkinamahdollisuudet sekä resurssit olisivat hyvin tasapainossa, tulisi myös asiakaskannattavuutta sekä asiakkaiden strategista merkittävyyttä arvioida ja mitata säännöllisesti tässä tutkimuksessa käytettyjen tunnistuskriteereiden lisäksi.

The Key Features of Knowledge and Knowledge Management in Product Development Process

Tutkimusongelmana oli kuinka tiedon johtamisella voidaan edesauttaa tuotekehitysprosessia. Mitkä ovat ne avaintekijät tietoympäristössä kuin myös itse tiedossa, joilla on merkitystä erityisesti tuotekehitysprosessin arvon muodostumiseen ja prosessien kehittämiseen? Tutkimus on laadullinen Case-tutkimus. Tutkimusongelmat on ensin selvitetty kirjallisuuden avulla, jonka jälkeen teoreettinen viitekehys on rakennettu tutkimaan rajattua ongelma-aluetta case-yrityksestä. Empiirisen tutkimuksen materiaali koostuu pääasiallisesti henkilökohtaisten teemahaastattelujen aineistosta. Tulokset merkittävimmistä tiedon hyväksikäytön haittatekijöistä, kuten myös parannusehdotukset on lajiteltu teoreettisessa viitekehyksessä esitettyjen oletustekijöiden mukaan. Haastatteluissa saadut vastaukset tukevat kirjallisuudesta ja alan ammattilaiselta saatua käsitystä tärkeimmistä vaikuttavista tekijöistä. Tärkeimmät toimenpiteet ja aloitteet joilla parannettaisiin tiedon muodostumista, koskivat ennnen kaikkea työnteon ulkoisia olosuhteita, eikä niinkään tiedon muodostumisen prosessia itseään. Merkittävimpiä haittatekijöitä olivat kultturiin, fyysiseen ja henkiseen tilaan ja henkilöstöresursseihin liittyvät ongelmat. Ratkaisuja ongelmiin odotettiin saatavan lähinnä tietotekniikan, henkilöstöresurssien ja itse tiedon muokkaamisen avulla. Tuotekehitysprosessin ydin tietovirtojen ja –pääomien luokittelu ja tulkitseminen tiedon muodostusta kuvaavan Learning Spiralin avulla antoi lähinnä teoreettisia viitteitä siitä millaisia keinoja on olemassa tiedon lisäämiseen ja jakamiseen eri tietotyypeittäin. Tulosten perusteella caseyrityksessä pitäisi kiinnittää erityistä huomiota tiedon dokumentointiin ja jakamiseen erityisesti sen tiedon osalta, joka on organisaatiossa vain harvalla ja/tai luonteeltaan hyvin tacitia.

Capability matrix – Identifying and evaluating the key capabilities of purchasing and supply management

Organizations gain resources, skills and technologies to find out the ultimate mix of capabilities to be a winner in the competitive market. These are all important factors that need to be taken into account in organizations operating in today's business environment. So far, there are no significant studies on the organizational capabilities in the field of PSM. The literature review shows that the PSM capabilities need to be studied more comprehensively. This study attempts to reveal and fill this gap by providing the PSM capability matrix that identifies the key PSM capabilities approached from two angles: there are three primary PSM capabilities and nine subcapabilities and, moreover, the individual and organizational PSM capabilities are identified and evaluated. The former refers to the PSM capability matrix of this study which is based on the strategic and operative PSM capabilities that complement the economic ones, while the latter relates to the evaluation of the PSM capabilities, such as the buyer profiles of individual PSM capabilities and the PSMcapability map of the organizational ones. This is a constructive case study. The aim is to define what the purchasing and supply management capabilities are and how they can be evaluated. This study presents a PSM capability matrix to identify and evaluate the capabilities to define capability gaps by comparing the ideal level of PSM capabilities to the realized ones. The research questions are investigated with two case organizations. This study argues that PSM capabilities can be classified into three primary categories with nine sub-categories and, thus, a PSM capability matrix with four evaluation categories can be formed. The buyer profiles are moreover identified to reveal the PSM capability gap. The resource-based view (RBV) and dynamic capabilities view (DCV) are used to define the individual and organizational capabilities. The PSM literature is also used to define the capabilities. The key findings of this study are i) the PSM capability matrix to identify the PSM capabilities, ii) the evaluation of the capabilities to define PSM capability gaps and iii) the presentation of the buyer profiles to identify the individual PSM capabilities and to define the organizational PSM capabilities. Dynamic capabilities are also related to the PSM capability gap. If a gap is identified, the organization can renew their PSM capabilities and, thus, create mutual learning and increase their organizational capabilities. And only then, there is potential for dynamic capabilities. Based on this, the purchasing strategy, purchasing policy and procedures should be identified and implemented dynamically.

Customer knowledge processing in key account management

The ability of the supplier firm to generate and utilise customer-specific knowledge has attracted increasing attention in the academic literature during the last decade. It has been argued the customer knowledge should treated as a strategic asset the same as any other intangible assets. Yet, at the same time it has been shown that the management of customer-specific knowledge is challenging in practice, and that many firms are better at acquiring customer knowledge than at making use of it. This study examines customer knowledge processing in the context of key account management in large industrial firms. This focus was chosen because key accounts are demanding and complex. It is not unusual for a single key account relationship to constitute a complex web of relationships between the supplier and the key account – thus easily leading to the dispersion of customer-specific knowledge in the supplier firm. Although the importance of customer-specific knowledge generation has been widely acknowledged in the literature, surprisingly little attention has been paid to the processes through which firms generate, disseminate and use such knowledge internally for enhancing the relationships with their major, strategically important key account customers. This thesis consists of two parts. The first part comprises a theoretical overview and draws together the main findings of the study, whereas the second part consists of five complementary empirical research papers based on survey data gathered from large industrial firms in Finland. The findings suggest that the management of customer knowledge generated about and form key accounts is a three-dimensional process consisting of acquisition, dissemination and utilization. It could be concluded from the results that customer-specific knowledge is a strategic asset because the supplier’s customer knowledge processing activities have a positive effect on supplier’s key account performance. Moreover, in examining the determinants of each phase separately the study identifies a number of intra-organisational factors that facilitate the process in supplier firms. The main contribution of the thesis lies in linking the concept of customer knowledge processing to the previous literature on key account management. Moreover, given than this literature is mainly conceptual or case-based, a further contribution is to examine its consequences and determinants based on quantitative empirical data.

Key success factors and process for IT project portfolio management

The importance of Information Technology (IT) in the business environment is continuously growing. This stimulates the increase of size, complexity and number of IT projects and raises the need for IT Project Portfolio Management (IT PPM). While being actively discussed for the last few decades, IT PPM has a short history of practical implementation. This creates inconsistency in the views of different authors and provides an opportunity for additional research. As a first step, this research explores the existing studies and brings together the views of different authors on IT PPM. As a result, a high-level IT PPM Process Cycle and a set of Key Success Factors for IT PPM are proposed. IT PPM Process Cycle gives an overview of the main elements of IT PPM process, while the set of Key Success Factors provides a number of factors that should be considered during the implementation. As a second step, both theoretical deliverables are empirically tested by a case study and a survey conducted in a big multinational company. The case study is used to analyze process framework of the studied company towards the developed IT PPM Process Cycle. Subsequently, a survey was conducted among subject matter experts of the same company to evaluate the importance and relevance of the proposed Key Success Factors. Finally, this thesis concludes with findings made during the case study and provides an empirically tested selection of factors to be taken into account. These two deliverables can be used by both academics and practitioners to close the gaps in existing literature and assist in IT PPM implementation.

The key practices of customer portfolio management (CPM) process in the medical and healthcare B2B industry

The goal of this study is to deepen the understanding of the customer portfolio management process. There are many models for the process, and they are not necessarily exclusive of each other. Consequently, the inclusion of many models might even prove out to be beneficial. Other theoretical framework include the current economical situation and its propose on customer portfolio management. With an understanding of the theoretical models as a background, the empirical part of this study compares Finnish multinational medical and healthcare technology companies’ customer portfolio management practices. The empirical research was carried out with theme interviews held with 11 sales and marketing managers or directors from four different companies. The goal was to discover the most essential practices of the process steps in the companies. The result of this study is that there is a lack of systematic customer portfolio management, but most companies are aiming to improve this in the near future. The most essential practices are analysis of sales, communication level, learning, and commitment to strategy of the focal company. Special characteristics of this industry include large business networks that include customers, professional end-users, institutions, universities, researchers, and key opinion leaders. The management and analysis of this comprehensive network has been seen to be extremely important for this industry.

Reputational Risk Management as a key element for business continuity and value maximization

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 risk’s 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 company’s value and trading volume, and showed crucial importance of post-crisis management for the company’s 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.

Channel Adaptive MAC Protocol with Traffic-Aware Distributed Power Management in Wireless Sensor Networks-Some Performance Issues

In Wireless Sensor Networks (WSN), neglecting the effects of varying channel quality can lead to an unnecessary wastage of precious battery resources and in turn can result in the rapid depletion of sensor energy and the partitioning of the network. Fairness is a critical issue when accessing a shared wireless channel and fair scheduling must be employed to provide the proper flow of information in a WSN. In this paper, we develop a channel adaptive MAC protocol with a traffic-aware dynamic power management algorithm for efficient packet scheduling and queuing in a sensor network, with time varying characteristics of the wireless channel also taken into consideration. The proposed protocol calculates a combined weight value based on the channel state and link quality. Then transmission is allowed only for those nodes with weights greater than a minimum quality threshold and nodes attempting to access the wireless medium with a low weight will be allowed to transmit only when their weight becomes high. This results in many poor quality nodes being deprived of transmission for a considerable amount of time. To avoid the buffer overflow and to achieve fairness for the poor quality nodes, we design a Load prediction algorithm. We also design a traffic aware dynamic power management scheme to minimize the energy consumption by continuously turning off the radio interface of all the unnecessary nodes that are not included in the routing path. By Simulation results, we show that our proposed protocol achieves a higher throughput and fairness besides reducing the delay

Autonomes Performance-Management in dienstorientierten Architekturen

Die Bedeutung des Dienstgüte-Managements (SLM) im Bereich von Unternehmensanwendungen steigt mit der zunehmenden Kritikalität von IT-gestützten Prozessen für den Erfolg einzelner Unternehmen. Traditionell werden zur Implementierung eines wirksamen SLMs Monitoringprozesse in hierarchischen Managementumgebungen etabliert, die einen Administrator bei der notwendigen Rekonfiguration von Systemen unterstützen. Auf aktuelle, hochdynamische Softwarearchitekturen sind diese hierarchischen Ansätze jedoch nur sehr eingeschränkt anwendbar. Ein Beispiel dafür sind dienstorientierte Architekturen (SOA), bei denen die Geschäftsfunktionalität durch das Zusammenspiel einzelner, voneinander unabhängiger Dienste auf Basis deskriptiver Workflow-Beschreibungen modelliert wird. Dadurch ergibt sich eine hohe Laufzeitdynamik der gesamten Architektur. Für das SLM ist insbesondere die dezentrale Struktur einer SOA mit unterschiedlichen administrativen Zuständigkeiten für einzelne Teilsysteme problematisch, da regelnde Eingriffe zum einen durch die Kapselung der Implementierung einzelner Dienste und zum anderen durch das Fehlen einer zentralen Kontrollinstanz nur sehr eingeschränkt möglich sind. Die vorliegende Arbeit definiert die Architektur eines SLM-Systems für SOA-Umgebungen, in dem autonome Management-Komponenten kooperieren, um übergeordnete Dienstgüteziele zu erfüllen: Mithilfe von Selbst-Management-Technologien wird zunächst eine Automatisierung des Dienstgüte-Managements auf Ebene einzelner Dienste erreicht. Die autonomen Management-Komponenten dieser Dienste können dann mithilfe von Selbstorganisationsmechanismen übergreifende Ziele zur Optimierung von Dienstgüteverhalten und Ressourcennutzung verfolgen. Für das SLM auf Ebene von SOA Workflows müssen temporär dienstübergreifende Kooperationen zur Erfüllung von Dienstgüteanforderungen etabliert werden, die sich damit auch über mehrere administrative Domänen erstrecken können. Eine solche zeitlich begrenzte Kooperation autonomer Teilsysteme kann sinnvoll nur dezentral erfolgen, da die jeweiligen Kooperationspartner im Vorfeld nicht bekannt sind und – je nach Lebensdauer einzelner Workflows – zur Laufzeit beteiligte Komponenten ausgetauscht werden können. In der Arbeit wird ein Verfahren zur Koordination autonomer Management-Komponenten mit dem Ziel der Optimierung von Antwortzeiten auf Workflow-Ebene entwickelt: Management-Komponenten können durch Übertragung von Antwortzeitanteilen untereinander ihre individuellen Ziele straffen oder lockern, ohne dass das Gesamtantwortzeitziel dadurch verändert wird. Die Übertragung von Antwortzeitanteilen wird mithilfe eines Auktionsverfahrens realisiert. Technische Grundlage der Kooperation bildet ein Gruppenkommunikationsmechanismus. Weiterhin werden in Bezug auf die Nutzung geteilter, virtualisierter Ressourcen konkurrierende Dienste entsprechend geschäftlicher Ziele priorisiert. Im Rahmen der praktischen Umsetzung wird die Realisierung zentraler Architekturelemente und der entwickelten Verfahren zur Selbstorganisation beispielhaft für das SLM konkreter Komponenten vorgestellt. Zur Untersuchung der Management-Kooperation in größeren Szenarien wird ein hybrider Simulationsansatz verwendet. Im Rahmen der Evaluation werden Untersuchungen zur Skalierbarkeit des Ansatzes durchgeführt. Schwerpunkt ist hierbei die Betrachtung eines Systems aus kooperierenden Management-Komponenten, insbesondere im Hinblick auf den Kommunikationsaufwand. Die Evaluation zeigt, dass ein dienstübergreifendes, autonomes Performance-Management in SOA-Umgebungen möglich ist. Die Ergebnisse legen nahe, dass der entwickelte Ansatz auch in großen Umgebungen erfolgreich angewendet werden kann.