Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care

Objectives: To compare the recognized defined daily dose per 100 bed-days (DDD/100 bed-days) measure with the defined daily dose per finished consultant episode (DDD/FCE) in a group of hospitals with a variety of medicines management strategies. To compare antibiotic usage using the above indicators in hospitals with and without electronic prescribing systems. Methods: Twelve hospitals were used in the study. Nine hospitals were selected and split into three cohorts (three high-scoring, three medium-scoring and three low-scoring) by their 2001 medicines management self-assessment scores (MMAS). An additional cohort of three electronic prescribing hospitals was included for comparison. MMAS were compared to antibiotic management scores (AMS) developed from a questionnaire relating specifically to control of antibiotics. FCEs and occupied bed-days were obtained from published statistics and statistical analyses of the DDD/100 bed-days and DDD/FCE were carried out using SPSS. Results: The DDD/100 bed-days varied from 81.33 to 189.37 whilst the DDD/FCE varied from 2.88 to 7.43. The two indicators showed a high degree of correlation with r = 0.74. MMAS were from 9 to 22 (possible range 0-23) and the AMS from 2 to 13 (possible range 0-22). The two scores showed a high degree of correlation with r = 0.74. No correlation was established between either indicator and either score. Conclusions: The WHO indicator for medicines utilization, DDD/100 bed-days, exhibited the same level of conformity as that exhibited from the use of the DDD/FCE indicating that the DDD/FCE is a useful additional indicator for identifying hospitals which require further study. The MMAS can be assumed to be an accurate guide to antibiotic medicines management controls. No relationship has been found between a high degree of medicines management control and the quantity of antibiotic prescribed. © The British Society for Antimicrobial Chemotherapy; 2004 all rights reserved.

Nations and organizations:a comparative study of English and Indian work-related attitudes and values in matched manufacturing firms

This thesis reports a cross-national study carried out in England and India in an attempt to clarify the association of certain cultural and non-cultural characteristics with people's work-related attitudes and values, and with the structure of their work organizations. Three perspectives are considered to be relevant to the objectives of the study. The contingency perspective suggests that a 'fit' between an organization's context and its structural arrangements will be fundamentally necessary for achieving success and survival. The political economy perspective argues for the determining role of the social and economic structures within which the organization operates. The culturalist perspective looks to cultural attitudes and values of organizational members for an explanation for their organization's structure. The empirical investigation was carried out in three stages in each of the two countries involved by means of surveys of cultural attitudes, work-related attitudes and organizational structures and systems. The cultural surveys suggested that Indian and English people were different from one another with regard to fear of, and respect and obedience to, their seniors, ability to cope with ambiguity, honesty, independence, expression of emotions, fatalism, reserve, and care for others; they were similar with regard to tolerance, friendliness, attitude to change, attitude to law, self-control and self-confidence, and attitude to social differentiation. The second stage of the study, involving the employees of fourteen organizations, found that the English ones perceived themselves to have more power at work, expressed more tolerance for ambiguity, and had different expectations from their job than did the Indian equivalents. The two samples were similar with respect to commitment to their company and trust in their colleagues. The findings also suggested that employees' occupations, education and age had some influences on their work-related attitudes. The final stage of the research was a study of structures, control systems, and reward and punishment policies of the same fourteen organizations which were matched almost completely on their contextual factors across the two countries. English and Indian organizations were found to be similar in terms of centralization, specialization, chief executive's span of control, height and management control strategies. English organizations, however, were far more formalized, spent more time on consultation and their managers delegated authority lower down the hierarchy than Indian organizations. The major finding of the study was the multiple association that cultural, national and contingency factors had with the structural characteristics of the organizations and with the work-related attitudes of their members. On the basis of this finding, a multi-perspective model for understanding organizational structures and systems is proposed in which the contributions made by contingency, political economy and cultural perspectives are recognized and incorporated.

Bureaucratic reform in post-Asian crisis Indonesia:the Directorate General of Tax

Our research examines a key aspect of the extensive bureaucratic reform program that was applied to the Indonesian public sector following the Asian Economic crisis. The organisation we focus on is the Indonesian Directorate of Tax. The reforms moved the case organisation towards more bureaucratic organisational arrangements. The most notable elements of the reforms related to the organisational efficiency and changes in administrative style and culture. An ethnographic approach was adopted, in which the researcher was immersed in the life of the selected case organisation over an extended period of time. This research extends a thin literature on the topic of management control and culture in the Indonesian context. Also, this paper fills a gap in the theoretic approaches for studying bureaucracy, which is dominated by western conceptualisations. This paper provides a reminder to policy makers (including organisation such as the World Bank and the International Monetary Fund) of the consequences of neglecting cultural influences when conducting bureaucratic reform.

Tree Island Response to Fire and Flooding in the Short-Hydroperiod Marl Prairie Grasslands of the Florida Everglades

Within the marl prairie grasslands of the Florida Everglades, USA, the combined effects of fire and flooding usually lead to very significant changes in tree island structure and composition. Depending on fire severity and post-fire hydroperiod, these effects vary spatially and temporally throughout the landscape, creating a patchy post-fire mosaic of tree islands with different successional states. Through the use of the Normalized Difference Vegetation Index (NDVI) and three predictor variables (marsh water table elevation at the time of fire, post-fire hydroperiod, and tree island size), along with logistic regression analysis, we examined the probability of tree island burning and recovering following the Mustang Corner Fire (May to June 2008) in Everglades National Park. Our data show that hydrologic conditions during and after fire, which are under varying degrees of management control, can lead to tree island contraction or loss. More specifically, the elevation of the marsh water table at the time of the fire appears to be the most important parameter determining the severity of fire in marl prairie tree islands. Furthermore, in the post-fire recovery phase, both tree island size and hydroperiod during the first year after the fire played important roles in determining the probability of tree island recovery, contraction, or loss.

"Biggest Scandal in Canadian History": HRDC Audit Starts Probity War (Working Paper 23)

The article describes the nearly year-long political and media uproar that followed on the release in January, 2000 of a qualitative or soft “audit” of management control in the federal government department, Human Resources Development Canada, and analyses the contributing factors. The article argues that the auditors’ examination of project files for programs delivered by grants and contributions was so abstract and poorly executed that nothing whatever can be concluded from the work. Factors that favoured the “scandal” interpretation include across-government New Public Management reforms where accountability has not been re-theorized for Canada’s Westminster system of government; Canada’s electoral volatility that starves the country of experienced politicians and spurs the tradition of political compensation for electoral support; and the political role of the Office of the Auditor General. This paper has been accepted for publication by the journal Critical Perspectives on Accounting, which holds copyright.

Veranderende rol van de controller. Balans tussen het toepassen van hard en soft controls

Het doel van dit onderzoek is om inzicht te geven in de ontwikkeling van de rol van de controller en te onderzoeken hoe de rol van de controller zich verhoudt tot het gebruik van hard en soft controls. Het onderzoek is uitgevoerd in de vorm van een case study waarbij de onderzoeksdata op twee manieren is verzameld. Ten eerste is door middel van desk research op basis van brondocumenten een overzicht in de tijd gemaakt van de gehanteerde management control systemen bij de casusorganisatie, zijnde vier lokale Rabobank vestigingen. Ten tweede is voor het beantwoorden van de deelvragen en hoofdvraag gebruik gemaakt van semigestructureerde interviews. De ontwikkelingen binnen management control laten zien dat de invulling hiervan bij de casusorganisatie veranderd is en dat management control niet meer alleen vraagt om hard controls. In de casusorganisatie zijn de hard controls duidelijk ingericht en laten de onderzoeksresultaten zien dat soft controls wel worden uitgevoerd maar niet concreet zijn geformuleerd en ingericht. Ten aanzien van het toepassen van hard of soft controls blijkt dat de nadruk ligt op hard controls. De verhouding lijkt samen te hangen met de verschillen in inrichting van de control afdeling en fase waarin de vier verschillende lokale banken zich bevinden. De ontwikkeling die reeds heeft plaatsgevonden en de verwachte ontwikkelingen ten aanzien van de taken van de controller en het toepassen van het type controls, duiden op een verschuiving van traditioneel controlewerk naar een controller die steeds meer betrokken is bij de business en gesprekspartner is van management en directie. De rol van de controller heeft zich doorontwikkeld en is veranderd van achteraf controle uitvoeren (controleur-rol) naar een veel bredere partner-rol die ook aan de voorkant met de business probeert mee te denken en management en directie ondersteunt bij organisatieveranderingen. Het bewustzijn ten aanzien van het inzetten van verschillende type controls, passend bij de doelstelling en situatie, is de laatste jaren toegenomen. Naast sturing op resultaat-, vindt nu ook actiesturen en medewerker- en leiderschapssturing plaats. De rol van de controller is over tijd veranderd, maar er heeft geen duidelijke verschuiving plaatsgevonden in het toepassen van het type controls van hard naar soft.

Perceptie van de rol van de controller

De rol van de controller behelst een grote verscheidenheid aan activiteiten. Er is veel over deze rol geschreven, dat resulteerde in verschillende gezichtspunten over en categorieën van controller activiteiten. In het algemeen kan gesteld worden dat de controller de manager ondersteunt bij de uitvoering van zijn besluitvormingsproces. Er is niet veel geschreven over perceptieverschillen over de rol van de controller. Omdat dat wel nuttig kan zijn voor de werkrelatie tussen manager en controller is onderzocht of er perceptieverschillen bestaan en bij welke controller activiteiten deze zich voordoen. Het onderzoek naar perceptieverschillen tussen managers en controllers over de rol van de controller is uitgevoerd door een kwalitatief onderzoek, een gevalsstudie, bij een universitair medisch centrum. Drie manager-controller koppels zijn geïnterviewd aan de hand van een door hen ingevulde lijst met controller activiteiten. De resultaten van de interviews zijn de belangrijkste bron voor het onderzoek. Er komen drie verklaringscategorieën naar voren voor de perceptieverschillen, namelijk 1. een perceptieverschil veroorzaakt door een interpretatieverschil over het hiërarchische niveau waarop de activiteit wordt uitgevoerd; 2. een perceptieverschil veroorzaakt door een interpretatieverschil over de betekenis van de woorden waarmee de activiteit is omschreven; 3. een perceptieverschil veroorzaakt door een interpretatieverschil over het kwaliteitsniveau waarop de activiteit wordt uitgevoerd. De controller kent in het algemeen een hogere score toe aan het belang van het uitvoeren van de controlling activiteit dan de manager. Er bestaan veel perceptieverschillen, maar het patroon tussen de 3 onderzochte koppels met betrekking tot hun perceptie van het al dan niet uitvoeren van de controller activiteit en met betrekking tot het belang dat zij aan het uitvoeren van de activiteit hechten is te grillig om een gelegitimeerde conclusie te trekken over het daadwerkelijke bestaan van perceptieverschillen of over de importantie van een activiteit als moderator voor de verklaring van het perceptieverschil. De meeste perceptieverschillen worden verklaard door een interpretatieverschil over het hiërarchisch niveau waarop de activiteit wordt uitgevoerd. In deze gevallen die liggen op het gebied van interne analyse, risico management en management control systemen, is de manager meestal van mening dat een controller activiteit wordt uitgevoerd, terwijl de controller van mening is dat deze niet wordt uitgevoerd. Dit verschil kan te maken hebben met de afstand van de beoordelaar tot de uit te voeren activiteit. Bij de meeste perceptieverschillen percipieert de manager de activiteit als uitgevoerd en de controller percipieert deze als niet uitgevoerd. Naast de afstand tot de uit te voeren activiteit, kan ook het professioneel oogpunt meespelen als verklarende factor voor deze perceptieverschillen. Dit speelt met name een rol bij activteiten op het gebied van interne analyse, leiding geven en veranderen en onderhoud van systemen. Over activteiten behorend bij het controllertype business partner bestaan meer perceptieverschillen dan die behorend bij het type policeman. Dit kan betekenen dat de business partner activiteiten van de onderzochte controllers niet of minder zichtbaar worden uitgevoerd. De perceptie er over verschilt zeker.

Paradoxos num Sistema de Gestão de Vendas na Perspetiva dos seus Agentes

O departamento de vendas de uma organização é, de fato, uma porta aberta de comunicação com o ambiente circundante. São os interlocutores desta comunicação, ou seja, quem vende e quem compra, que marcam de uma forma decisiva o (in)sucesso empresarial num mundo globalizado. É com base neste cenário que surge a intenção de analisar um sistema de gestão de vendedores/as e compreender, afinal, se a performance de vendedores/as é mais determinada pela forma como o sistema de gestão funciona do que pela própria responsabilidade de quem vende. Através de entrevistas semiestruturadas a um grupo de vendedores/as e gestor e consequente análise de conteúdo, procurei responder às premissas perspetivadas. Concluí que, muito embora advogada a existência do modelo soft selling por parte da gestão, na realidade o que se verifica é o estímulo para o hard selling. O sistema analisado funciona com uma comunicação deficitária que contribui para algumas anomalias no sistema de vendas, como são as queixas de clientes. Acredito que o estudo efetuado pode contribuir para a deteção de pontos-chave a melhorar no processo de sales management control e, globalmente, para o aumento da produtividade com qualidade.

Manufacturing Performance Reporting For Continuous Quality Improvement

Recently many plants have implemented the new manufacturing strategy of continuous quality improvement. The central hypothesis in this paper is that the implementation of a policy of continuous quality improvement results in a shift in the management control system. This article tests this hypothesis by examining the shop floor reporting policies of forty-two plants located in the United States. The paper documents that the extent of information concerning the current status of manufacturing, such as charts on defect rates or schedule compliance and productivity information, provided to workers on the shop floor is positively related to the implementation of continuous quality improvement programs.

Reordenamento viário da Rua da República e acompanhamento da instalação da Biblioteca Ary dos Santos em Sacavém

Relatório de estágio para obtenção do grau de Mestre em Engenharia Civil na Área de Especialização de Edificações

Estudo sobre a memória longa na volatilidade das rendibilidades do índice Nasdaq 100: uma abordagem com base nos modelos tipo Arch

Mestrado em Controlo de Gestão e dos Negócios

Accountability, rendición de cuentas y controles a la administración. ¿Cómo funcionan en Argentina según el ordenamiento jurídico vigente?

En América Latina diversos escándalos de corrupción y malversaciónde recursos públicos están minando la confianza de la ciudadaníaen las instituciones democráticas, en todos los países de la región.La impunidad existente en casos de corrupción y la falta deaccountability dejan en duda a la democracia y la legitimidad delas instituciones. El presente artículo tiene por objetivo analizar,primero, la importancia del fortalecimiento del accountability enAmérica Latina para mejorar la calidad de la democracia en la regiónpara, después, analizar específicamente el caso de Argentina,buscando identificar cuáles son los vacíos dentro del ordenamientojurídico que generan grandes riesgos de corrupción y evaluar cómosería posible mejorar esta situación.

A mensuração e articulação de objetivos qualitativos na avaliação de desempenho : o caso do Grupo Pestana

Mestrado em Contabilidade, Fiscalidade e Finanças Empresariais