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.
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