Operative level purchasing in pharmaceutical wholesale trade

Tämän tutkintotyön tavoitteena on selvittää operatiivista ostotoimintaa, joka sisältää oikea-aikaisen tilausrytmin ja tasapainoisen tilausmäärän määrityksen sekä saapuvan tavaravirran mukauttamisen myyntiin tai kulutukseen kokonaisuutena. Tässä tutkimuksessa tarkastellaan myös varastojen merkitystä ja ostotoiminnan kannalta keskeisimpiä tehokkaaseen varastonohjaukseen liittyviä tunnuslukuja. Tutkimus sisältää lääkkeiden toimitusketjun kuvauksen, koska se poikkeaa merkittävästi muista toimialoista. Tämä tutkintotyö on syntetisoiva kirjallisuustutkimus. Tutkintotyön empiirisessä osassa analysoidaan aluksi case-yrityksen vaihto-omaisuusvaraston ohjausta ostotoiminnan näkökulmasta ABC analyysiin pohjautuen. Tämän jälkeen ostotoimintaa analysoidaan tarkemmin tiettyjen toimittajien osalta. Lopuksi laaditaan optimaalinen tilausrytmi ja tilausmäärät sekä ostobudjetti yhden toimittajan tuotteille. ABC analyysia voidaan hyödyntää työkaluna määriteltäessä miten erilaisten tuotteiden materiaalivirtoja tulisi ostotoiminnan kannalta ohjata. Analyysi perustuu resurssien keskittämiseen sinne missä tuotto on suurin.

Managing through measurement : A framework for successful operative level performance measurement

The research around performance measurement and management has focused mainly on the design, implementation and use of performance measurement systems. However, there is little evidence about the actual impacts of performance measurement on the different levels of business and operations of organisations, as well as the underlying factors that lead to a positive impact of performance measurement. The study thus focuses on this research gap, which can be considered both important and challenging to cover. The first objective of the study was to examine the impacts of performance measurement on different aspects of management, leadership and the quality of working life, after which the factors that facilitate and improve performance and performance measurement at the operative level of an organisation were examined. The second objective was to study how these factors operate in practice. The third objective focused on the construction of a framework for successful operative level performance measurement and the utilisation of the factors in the organisations. The research objectives have been studied through six research papers utilising empirical data from three separate studies, including two sets of interview data and one of quantitative data. The study applies mainly the hermeneutical research approach. As a contribution of the study, a framework for successful operative level performance measurement was formed by matching the findings of the current study and performance measurement theory. The study extents the prior research regarding the impacts of performance measurement and the factors that have a positive effect on operative level performance and performance measurement. The results indicate that under suitable circumstances, performance measurement has positive impacts on different aspects of management, leadership, and the quality of working life. The results reveal that for example the perception of the employees and the management of the impacts of performance measurement on leadership style differ considerably. Furthermore, the fragmented literature has been reorganised into six factors that facilitate and improve the performance of the operations and employees, and the use of performance measurement at the operative level of an organisation. Regarding the managerial implications of the study, managers who operate around performance measurement can utilise the framework for example by putting the different phases of the framework into practice.

Developing the Sourcing with the Purchasing Tool in the Chemical Company

The aim of this research was to investigate Tikkurila Oyj's Vantaa factories' current status in procurement and to develop the reporting of purchases and purchase warehouses, and to measure the activities during the implementation of the new purchasing tool. The implemented purchasing tool was based on ABC-analysis. Based on its reports the importance of performance measurements for the operations of the company, and the purpose of getting transparency to the company's supply chain on the part of purchasing were examined. A successful purchase- and material operation calls for accurate knowledge and professional skills. The research proved that with a separate purchasing tool, that analyses the existing information of the company's production management system, it is possible to get added value to whole supply chain's needs. The analyses and reports of the purchasing tool enable a more harmonized purchasing process at the operative level, and create a basis for internal targets and to their follow-up. At the same time the analyses clarify the current status and development trends of procurement fresh to the management. The increase of the possibilities of exploitation of information technology enables a perfect transparency to the case company's purchase department.

Henkilötason suorituskykymittariston suunnittelu asiantuntijayrityksessä

Suorituskyvyn mittaaminen on tehokas työkalu yrityksen toiminnan kehittämiseen. Mittarit ohjaavat yritystä keskittymään strategian ja tavoitteiden toteuttamiseen. Yrityksen suorituskykyä tarkastellaan usein erityisesti yritystasolla, mutta mittarit voidaan myös kohdentaa yksittäisille työntekijöille. Työn tavoitteena oli löytää jo suunnitteluvaiheessa huomioitavia menestystekijöitä pienen asiantuntijayrityksen henkilötason suorituskykymittaristolle. Tutkimuskysymyksiin vastaamiseksi käytettiin kirjallisuuden lisäksi kohdeyritykselle toteutettua suunnitteluprosessia, jossa hyödynnettiin myös yrityksen henkilöstön näkemyksiä. Merkittävimmät erityispiirteet mittariston suunnittelussa liittyivät asiantuntijatyön mittaukseen, mittariston resurssitarpeen minimoimiseen ja palkitsemiseen suorituskyvyn perusteella. Lisäksi työssä pohdittiin suunnitellun mittariston laajentamismahdollisuuksia yritystason mittaristoksi. Suorituskyvyn mittaaminen tehostaa yrityksen päätöksentekoa sekä viestintää. Laadukas mittaristo edellyttää myös hyvää suunnittelua, joka voidaan perustaa kirjallisuuden malleihin. Johdon ja henkilöstön sitoutuminen suunnitteluprosessiin on kriittistä onnistuneen mittariston kannalta. Mittariston suunnittelussa mittarit johdetaan yleensä yrityksen visiosta strategian, mittausalueiden ja menestystekijöiden kautta. Mittareiden painotuksia muuttamalla voidaan hienosäätää mittariston vaikutusta. Mittariston koekäyttövaiheessa todetaan mittariston toimivuus ennen mittareiden kytkemistä tulospalkkioihin. Asiantuntijatyön mittauksessa on kiinnitettävä huomiota toimivien mittareiden löytämiseen, sillä tietopohjaista asiantuntijatyötä on haastava mitata. Lisäksi palkitsemisjärjestelmän liittäminen mittaristoon edellyttää mittareilta ehdotonta oikeudenmukaisuutta ja tuloksia ei saa pystyä manipuloimaan. Pienen yrityksen mittaristo ei saa kuluttaa liikaa resursseja, joten kannattaa suosia mahdollisimman itsenäisesti toimivia mittareita. Henkilöstön motivointi tietojen syöttöön on olennaista. Lisäksi objektiivisten ja olennaisten mittareiden käyttö vähentää mittariston ylläpitoon käytettyjä työtunteja. Henkilötason mittaristo voidaan laajentaa helposti myös yritystasolle, mikäli suunnittelussa on kiinnitetty huomiota huolelliseen dokumentointiin.

Entrepreneurial orientation in small and medium-sized enterprises during economic crisis

The economic importance of small and medium-sized enterprises (SMEs) and entrepreneurship has increased significantly in recent decades and entrepreneurial activity and SMEs are deemed vital to economic progress. Therefore, it is justifiable to study how small firms and entrepreneurs can enhance their performance and emergence in the turbulent economic environment. The concept of entrepreneurial orientation (EO) has recently attracted considerable attention in the field of entrepreneurship research. EO generally refers to a firm’s propensity to be innovative, to be proactive and to take risks. A majority of EO studies so far have found that adopting EO associated entrepreneurial behaviors will help firms to create or sustain a high level of performance. This dissertation explores the main drivers and performance implications of EO for SMEs in time of economic crisis. Hence the first objective of this dissertation is to examine the performance implications of EO and to test the role of EO on how firms are treated by the crisis at operative level. The second objective is to expand the prevailing understanding of determinants of EO by exploring the relationship between owner's work related values, attitudes, demographic characteristics, firm’s financial resources and EO. EO was found to be a significant and positive factor behind a firm’s long run growth. Hence it can be said that EO has positive implications for firm performance. But on the other hand, during a time of economic crisis the different dimensions of EO had both positive and negative effects on performance of SMEs. The performance implications varied across different stages of the crisis and were also dependent on what measure was used for measuring the performance. The main drivers of EO in SMEs were the personal work related values of the entrepreneur and his/her prior experience as an entrepreneur. The intrinsic work values related to interest, responsibility, challenge, self-development or intellectual stimulation and values related to status, power, achievement and recognition had a positive effect on the level of EO. On the other hand, extrinsic values related to high income, material possessions, benefits such as generous holidays, job security, and comfort through good working conditions decreased the level of EO

Operatiivisen tason suorituskyvyn mallimittariston kehittäminen logistiikkapalveluyritykselle

Tutkimuksen tavoitteena oli kehittää mallimittaristo logistiikkapalvelualalla toimivan yrityksen operatiivisen tason suorituskyvyn seurantaan ja toiminnanohjausta varten, päivittäisen johtamisen tueksi. Tutkimus suoritettiin pääosin toiminta-analyyttisena, yhden yrityksen empiirisenä tapaustutkimuksena. Tutkimuksen kohdeyrityksen toiminnanmittaus perustuu tällä hetkellä pääasiassa taloudellisiin mittareihin ja muutamaan kyselyyn. Toiminnanohjauksen ja – kehittämisen, päätöksenteon tueksi tarvitaan, taloudellisten mittareiden lisäksi, mittareita, joilla pystytään seuraamaan suorituskyvyn taustalla vaikuttavien tekijöiden kehittymistä. Tutkimuksen kohdeyrityksen operatiivisen tason suorituskyvyn mallimittariston suunnittelussa haluttiin varmistaa, että jatkossa mittaamisella vaikutettaisiin seuraustekijöiden lisäksi myös syytekijöihin, selkiyttää liiketoiminnan tavoitteet, operatiivisen tason näkökulmasta, ja mittaamisen tavoite. Tutkimuksessa esitelty mallimittaristo on suunniteltu, tasapainotetun mittariston viitekehyksen avulla. Mittariston näkökulmiksi valittiin: talous, sidosryhmä (asiakas), prosessi ja henkilöstö. Mittariston tuottaman tiedon tavoitteena on toiminnanohjauksen, -kehittämisen ja päätöksenteon tukeminen, kun mittaustulokset ja trendi ovat yhdessä paikassa, on tiedonhaku ja - hyödyntäminen helpompaa. Mallimittaristoa ei testattu eikä käyttöönotettu tutkimuksessa.

Customer orientation of sales personnel: Implications for service quality

Prior customer orientation research has concentrated mainly on studying the economical potential of customer orientation to companies. Service quality research instead has concentrated on emphasizing the evaluation of service quality from the customer’s perspective. This means that the service providers lack important information regarding customer orientation and service quality they would need for managerial purposes such as selecting and training employees. Therefore, there is an emerging need to study how customer orientation and service quality relate to company processes, policies and employees, and this study answers to those calls. The objective of this study was to examine what is the role of sales personnel’s’ customer orientation in quality of service delivery and what features support the development of customer orientation among sales personnel. Also the components customer orientation were studied extensively in order to understand how they relate to service quality. The empiric part of the study was conducted as a qualitative research by interviewing seven sales people from operative, tactical and strategic levels of the case corporation in order to get a broader view for customer orientation. The findings propose that both organizational factors and individual factors are affecting customer orientation construct inseparably. Organizational factors are bundled in this study under standards, support and systems, whereas individual factors are formed of employees’ personal attributes, motivation and self-perceived decision making authority. The findings suggest that in the service delivery process at an operative level, customer orientation appears largely in the employees’ individualistic characteristics. Their social and technical skills and motivation to serve customers are the most identifiable factors for customer orientation and consequently, quality service. However, organizational standards, support and systems are strongly dictating the frames the operative sales people operate in, having an influence on how the employees are experiencing their decision making authority and in the end, customer orientation. When looking at the service delivery process at tactical and strategic levels, customer orientation is affecting mainly in the organizational constructs through setting standards, support and systems. However, tactical and strategic level employees influence the operative level through individual customer orientation components as well. The findings indicate that their emotion and personal interaction skills are affecting the overall service delivery process mainly through supervisor support and motivation of the operative level employees. Based on this study it can be argued that an organization can operate as a facilitator and create certain frames for customer oriented sales behavior through standards, support and systems. However, as the impact of individual customer orientation factors on sales people’s service quality seems decisive, from an organizational perspective it puts pressures on the recruitment.

Função simbólica e desenvolvimento da noção temporal em surdos e ouvintes: análise na perspectiva de Jean Piaget

In a previous research, it was observed that are symbolic exchanges established between the persons and the environment they live in that allow them to interact with others, leading them to reorganize their internal cognitive structures, reaching more elaborated stages. In the case of a person with deafness, the possibility of exchange can be compromised and knowledge about the construction of the temporal notion seems to be essential to enable a path of explanation about the difficulties they have regarding their cognitive development. Thus, based on the theory of Jean Piaget, the study intended to understand how the temporal notion constitutes as possible subject to the process of building the real, and examine, through empirical evaluation, if the difficulty in establishing symbolic exchanges caused by deafness would compromise the development of this notion. For this purpose, bibliographical research and empirical research were made, by the comparative evaluating between the performance of deaf and hearing subjects in relation to the construction of temporal notion. Two groups of subjects aged between 10 and 12 years were composed: one with three deaf subjects and another with 3 listeners. The assessment and analysis of the data were based on an experiment created by Piaget and his staff. The results showed that the listeners present responses from operative level, compatible with the age range in which they found themselves. In contrast, the deaf subjects showed responses of transition level, which indicates a situation of cognitive delay. We conclude that the potential compromise linguistic presented by deaf people, can hinder the activity representative causing delay in construction of temporal notion and consequently the development of thought. We conclude that the possible linguistic committal presented by deaf people can hinder the representative activity, causing delay in construction of temporal notion and consequently in the development of thought. In this sense, it seems that the Sign Language constitutes an important tool for deaf people because it allows symbolic exchanges that favor the cognitive development.

Increasing value add in white collar work using lean methods

The efficient indirect office work brings competitive advantage for companies in a rapidly changing business environment. The direct work methods in factory floors have been developed already for decades, but the office work is an area where the potential to improve the value add has not been studied and utilized systematically so far. The first objective of the thesis work is to find useful method for identifying and managing value add using literature. The usefulness of the method is validated in the case company`s environment. The second objective of the work is to understand what kind of effort is required to create more efficient target setting for the white collar employees. The operative level targets should be linked more tightly to the company strategy. Lean methods are selected as a tool for the improvement, since they are widely used in all kinds of industries and they are already familiar in other functions in the case company. Based on the literature review, suitable improvement methods are selected. The core of the lean is to identify the value add of a customer and eliminate the waste. Also visual control, cross functional work team, flow office and continuous improvement are used. The methods are tested in one production line and the results and feedback indicate that methods are useful in the studied environment.

Post-Operative Pain Scores and Level of Regional Anesthesia Expertise: Using Clinical Outcomes to Assess Procedural Proficiency

Background and Objectives: Peripheral nerve blockade requires regional anesthesia skills that trainees learn in several formats. Technical proficiency has shifted from a quota to comprehensive procedural evaluation. Successful nerve blockade is the clinical endpoint validating proficiency but patient, technical and procedural factors influence this result. The purpose of this study was to determine if procedural expertise for sciatic nerve blockade influenced postoperative pain scores and opioid requirements and if patient factors, technique and repetition influenced this outcome. Method: Sciatic nerve blockade by nerve stimulation and ultrasound guidance and training level of the resident performing the procedure were recorded. Patient obesity, trauma, chronic pain, opioid use and preoperative pain scores were compared to post-procedure pain scores and opioid analgesic requirements. Results: 102 patients received sciatic nerve blockade from 47 trainees over a 36 month interval. A significant relation between training level and improved pain scores was not demonstrated but transition from nerve stimulation to ultrasound guidance lowered scores in all groups. Nerve blockade failure was frequent with chronic opioid use and trauma. Conclusion: Analgesic outcomes should be an integral part of assessment of proficiency in regional anesthesia techniques. Evaluating outcomes of procedures throughout training will longitudinally assess technical expertise.

Defining a role for the subthalamic nucleus within operative theoretical models of subcortical participation in language

Objective:To investigate the effects of bilateral, surgically induced functional inhibition of the subthalamic nucleus (STN) on general language, high level linguistic abilities, and semantic processing skills in a group of patients with Parkinson’s disease. Methods:Comprehensive linguistic profiles were obtained up to one month before and three months after bilateral implantation of electrodes in the STN during active deep brain stimulation (DBS) in five subjects with Parkinson’s disease (mean age, 63.2 years). Equivalent linguistic profiles were generated over a three month period for a non-surgical control cohort of 16 subjects with Parkinson’s disease (NSPD) (mean age, 64.4 years). Education and disease duration were similar in the two groups. Initial assessment and three month follow up performance profiles were compared within subjects by paired t tests. Reliability change indices (RCI), representing clinically significant alterations in performance over time, were calculated for each of the assessment scores achieved by the five STN-DBS cases and the 16 NSPD controls, relative to performance variability within a group of 16 non-neurologically impaired adults (mean age, 61.9 years). Proportions of reliable change were then compared between the STN-DBS and NSPD groups. Results:Paired comparisons within the STN-DBS group showed prolonged postoperative semantic processing reaction times for a range of word types coded for meanings and meaning relatedness. Case by case analyses of reliable change across language assessments and groups revealed differences in proportions of change over time within the STN-DBS and NSPD groups in the domains of high level linguistics and semantic processing. Specifically, when compared with the NSPD group, the STN-DBS group showed a proportionally significant (p

Automatic versus manual pressure support reduction in the weaning of post-operative patients: a randomised controlled trial

Introduction Reduction of automatic pressure support based on a target respiratory frequency or mandatory rate ventilation (MRV) is available in the Taema-Horus ventilator for the weaning process in the intensive care unit (ICU) setting. We hypothesised that MRV is as effective as manual weaning in post-operative ICU patients. Methods There were 106 patients selected in the postoperative period in a prospective, randomised, controlled protocol. When the patients arrived at the ICU after surgery, they were randomly assigned to either: traditional weaning, consisting of the manual reduction of pressure support every 30 minutes, keeping the respiratory rate/tidal volume (RR/TV) below 80 L until 5 to 7 cmH(2)O of pressure support ventilation (PSV); or automatic weaning, referring to MRV set with a respiratory frequency target of 15 breaths per minute (the ventilator automatically decreased the PSV level by 1 cmH(2)O every four respiratory cycles, if the patient`s RR was less than 15 per minute). The primary endpoint of the study was the duration of the weaning process. Secondary endpoints were levels of pressure support, RR, TV (mL), RR/TV, positive end expiratory pressure levels, FiO(2) and SpO(2) required during the weaning process, the need for reintubation and the need for non-invasive ventilation in the 48 hours after extubation. Results In the intention to treat analysis there were no statistically significant differences between the 53 patients selected for each group regarding gender (p = 0.541), age (p = 0.585) and type of surgery (p = 0.172). Nineteen patients presented complications during the trial (4 in the PSV manual group and 15 in the MRV automatic group, p < 0.05). Nine patients in the automatic group did not adapt to the MRV mode. The mean +/- sd (standard deviation) duration of the weaning process was 221 +/- 192 for the manual group, and 271 +/- 369 minutes for the automatic group (p = 0.375). PSV levels were significantly higher in MRV compared with that of the PSV manual reduction (p < 0.05). Reintubation was not required in either group. Non-invasive ventilation was necessary for two patients, in the manual group after cardiac surgery (p = 0.51). Conclusions The duration of the automatic reduction of pressure support was similar to the manual one in the postoperative period in the ICU, but presented more complications, especially no adaptation to the MRV algorithm. Trial Registration Trial registration number: ISRCTN37456640

The use of different doses of metamizol for post-operative analgesia in dogs

Objective To evaluate the post-operative analgesic effect of metamizol (dipyrone) administered intravenously at three different doses (15 mg kg(-1), 25 mg kg(-1) and 35 mg kg(-1)) compared to placebo in dogs undergoing ovariohysterectomy. Study design Prospective, comparative, randomized. blinded trial. Animals Forty healthy bitches, aged 1-6 years, weighing 10-35 kg Methods The animals were randomly divided into four groups and received their respective treatments immediately after surgery: placebo group (0.9% saline solution), D15 group (metamizol 15 mg kg(-1) IV), D25 group (metamizol 25 mg kg(-1) IV), D35 group (metamizol 35 mg kg(-1) IV). The following variables were measured: sedation, pulse rate (PR). respiratory rate (f(R)). arterial blood pressure (ABP), plasma catecholamines. serum cortisol, blood urea nitrogen (BUN) and creatinine metabolites. albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP). hemogram. platelet counts and level of analgesia which was assessed by visual analog (VAS). descriptive and behavioral scales. Patients were monitored for 48 hours after the administration of the analgesic agent. Rescue analgesia (tramadol, 2 mg kg(-1), intramuscularly) was provided for animals with pain scores >= 4, as determined by the VAS or descriptive scale. Results The D25 and D35 groups showed equivalent post-operative analgesia, as shown by decreased pain scores, according to the three different pain scales, and fewer animals that required rescue analgesia. Significantly lower serum cortisol concentrations were observed in the D25 and D35 groups when compared to the placebo and D15 groups. No hematologic, renal, hepatic or clinical adverse effects were observed during the treatment. Conclusions and clinical relevance Metamizol administered intravenously at 25 or 35 mg kg(-1) can provide adequate post-operative analgesia in bitches undergoing ovariohysterectomy.

Surgery information reduces anxiety in the pre-operative period

PURPOSE: Patients preparing to undergo surgery should not suffer needless anxiety. This study aimed to evaluate anxiety levels on the day before surgery as related to the information known by the patient regarding the diagnosis, surgical procedure, or anesthesia. METHOD: Patients reported their knowledge of diagnosis, surgery, and anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure patient anxiety levels. RESULTS: One hundred and forty-nine patients were selected, and 82 females and 38 males were interviewed. Twenty-nine patients were excluded due to illiteracy. The state-anxiety levels were alike for males and females (36.10 ± 11.94 vs. 37.61 ± 8.76) (mean ± SD). Trait-anxiety levels were higher for women (42.55 ± 10.39 vs. 38.08 ± 12.25, P = 0.041). Patient education level did not influence the state-anxiety level but was inversely related to the trait-anxiety level. Knowledge of the diagnosis was clear for 91.7% of patients, of the surgery for 75.0%, and of anesthesia for 37.5%. Unfamiliarity with the surgical procedure raised state-anxiety levels (P = 0.021). A lower state-anxiety level was found among patients who did not know the diagnosis but knew about the surgery (P = 0.038). CONCLUSIONS: Increased knowledge of patients regarding the surgery they are about to undergo may reduce their state-anxiety levels.

The occurrence of intra-operative hypotension varies between hospitals: observational analysis of more than 147,000 anaesthesia.

BACKGROUND: Hypotension, a common intra-operative incident, bears an important potential for morbidity. It is most often manageable and sometimes preventable, which renders its study important. Therefore, we aimed at examining hospital variations in the occurrence of intra-operative hypotension and its predictors. As secondary endpoints, we determined to what extent hypotension relates to the risk of post-operative incidents and death. METHODS: We used the Anaesthesia Databank Switzerland, built on routinely and prospectively collected data on all anaesthesias in 21 hospitals. The three outcomes were assessed using multi-level logistic regression models. RESULTS: Among 147,573 anaesthesias, hypotension ranged from 0.6% to 5.2% in participating hospitals, and from 0.3% up to 12% in different surgical specialties. Most (73.4%) were minor single events. Age, ASA status, combined general and regional anaesthesia techniques, duration of surgery and hospitalization were significantly associated with hypotension. Although significantly associated, the emergency status of the surgery had a weaker effect. Hospitals' odds ratios for hypotension varied between 0.12 and 2.50 (P < or = 0.001), even after adjusting for patient and anaesthesia factors, and for type of surgery. At least one post-operative incident occurred in 9.7% of the procedures, including 0.03% deaths. Intra-operative hypotension was associated with a higher risk of post-operative incidents and death. CONCLUSION: Wide variations remain in the occurrence of hypotension among hospitals after adjustment for risk factors. Although differential reporting from hospitals may exist, variations in anaesthesia techniques and blood pressure maintenance may also have contributed. Intra-operative hypotension is associated with morbidities and sometimes death, and constant vigilance must thus be advocated.