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 Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians’ or patients’ perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important. Objective The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations. Methods Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis. Results Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R2 of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians’ willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians’ answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient’s health and patient management, National Health System costs reduction, and reciprocity relative to patients’ willingness to engage in teleconsultations. Conclusions To promote the use of home teleconsultations for DM, decision makers should improve patients’ health literacy so the physician–patient communication is more effective; explore information and communication technology developments to reduce current limitations of non–face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians.

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