This paper presents an innovative and flexible approach for recommending the number, size and composition of purchasing groups, for a set of hospitals willing to cooperate, while minimising their shared supply chain costs. This approach makes the financial impact of the various cooperation alternatives transparent to the group and the individual participants, opening way to a negotiation process concerning the allocation of the cooperation costs and gains. The approach was developed around a hybrid Variable Neighbourhood Search (VNS)/Tabu Search metaheuristic, resulting in a flexible tool that can be applied to purchasing groups with different characteristics, namely different operative and market circumstances, and to supply chains with different topologies and atypical cost characteristics. Preliminary computational results show the potential of the approach in solving a broad range of problems.

Purpose The purpose of this paper is to identify patterns of project risk management (PRM) practices’ adoption, and provides empirical evidence concerning the importance (and key attributes) of organizational PRM maturity to the use of risk-related practices and project performance. Design/methodology/approach The research involved two phases: interviews with five project managers, and a worldwide survey of project managers that resulted in the analysis of 865 valid questionnaire responses. Cluster analysis was used to classify PRM practices’ use, factor analysis to detect the structure of the relationship between the variables measuring PRM practices’ use and a multiple regression analysis (with canonical correlation) to further reveal the different degrees to which PRM practices and organizational maturity are associated. Findings The identified patterns of risk practices’ adoption indicate that different contexts of organization PRM maturity and project complexity influence practices selection. The PRM practices related with targets (e.g. time-phased budget plan) are the most used, and those related to tools and techniques (e.g. S-curve) are the least used. Additionally, the obtained results confirm that organizational PRM maturity influences risk practices’ usage, moderated by project complexity, and organizational PRM maturity influences project performance. Originality/value Empirical methods were used to investigate the relationship between organizational PRM maturity and a large set of PRM practices with project complexity as a moderator. Gaps in the use of PRM practices (i.e. areas where more PRM knowledge and training are needed) were identified. Finally, this work identifies the attributes of organizational maturity with implications in practices’ usage and project performance.

Aim To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self‐care. Background Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments. Methods Cross‐sectional descriptive analysis. Results Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high. Conclusions The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders. Implications for Nursing Management Health telephone‐based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity.

This paper presents an innovative approach to support the definition of strategies for the design of alternative configurations of hospital supply chains. This approach was developed around a hybrid Tabu Search / Variable Neighbourhood Search metaheuristic, that uses several neighbourhood structures. The flexibility of the procedure allows its application to supply chains with different topologies and atypical cost characteristics. A preliminary computational experience shows the approach potential in solving large scale supply chain configuration problems. The future incorporation of this approach in a broader Decision Support System (DSS) will provide a tool that can significantly contribute to an increase of healthcare supply chains efficiency and encourage the establishment of collaborative partnerships between their members.

A virtual enterprise (VE) is a temporary organisation that pools the core competencies of its member enterprises in order to exploit fast-changing market opportunities. Making successful collaborative partnerships is, in this context, a major challenge in today's competitive business environments. The success of such a 'virtual' organisation is strongly dependent on its composition, and the selection of partners becomes therefore a crucial issue. This problem is particularly difficult because of the uncertainties related to information, market dynamics, customer expectations and technology speedup, with a strongly stochastic decision-making context. In this paper, a chance-constrained approach to rank alternative VE configurations in business environments with uncertainty, and vague and random information, is proposed. This approach is based on a two-stage model: a chance-constraint multi-objective directional Tabu Search metaheuristic, complemented by a 2-tuple fuzzy linguistic representation model. Preliminary computational results clearly demonstrate the potential of the approach for practical application.

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Background Development has promoted longer and healthier lives, but the rise in the proportion of older adults poses new challenges to health systems. Susceptibilities of older persons resulting from lower knowledge about services availability, health illiteracy, lower income, higher mental decline, or physical limitations need to be identified and monitored to assure the equity and quality of health care. The aim of this study was to develop equity indicators for the Assessing Care of Vulnerable Elders (ACOVE)-3 checklist and perform the first cross-cultural adaptation and validation of this checklist into Portuguese. Methods A scoping literature review of determinants or indicators of health (in)equity in the care of older people was performed. A total of 5 language experts and 18 health professionals were involved in the development and validation of the equity and quality indicators through expert opinion and focus groups. Data collected from focus groups was analyzed through directed or conventional content analysis. The usefulness of the indicators was assessed by analyzing the clinical records of 30 patients. Results The literature review revealed that there was a worldwide gap concerning equity indicators for older people primary health care. A structured and complete checklist composed of equity and quality indicators was obtained, validated and assessed. A significant number of non-screened quality or equity related potential occurrences that could have been avoided if the proposed indicators were implemented were detected. The percentage of non-registered indicators was 76.6% for quality and 96.7% for equity. Conclusions Applying the proposed checklist will contribute to improve the monitoring of the clinical situation of vulnerable older people and the planning of medical and social actions directed at this group.

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