How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

制造系统生产单元碳排放核算模型

制造业是我国国民经济的支柱产业，但也是环境污染物排放的主要来源、能源消耗主体和温室气体排放大户。制造系统高能耗、高物耗、高碳排放的加工过程是造成制造业碳排放量大的重要原因。生产单元作为制造系统的加工的主体，其碳排放量的核算是确定整个制造系统乃至制造业碳排放总量的关键。本文首先对生产单元的原材料、电能、辅助物料及废屑处理所引起的碳排放进行分析，确定生产单元的碳排放源；其次，产品合格率的不同会造成生产单元输入及输出的成品/半成品数量的差异，进而影响生产单元单位产品的碳排放量，在此基础上，综合考虑了原材料、电能、辅助物料及废屑处理的碳排放情况，构建了给定工艺流程下生产单元碳排放核算模型。最后，结合一汽车排气装置加工实例，分别核算加工过程中九个生产单元的碳排放量，验证了模型的可行性。     

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

Integrating risk and performance management in quality management systems for the development of complex bespoke systems (CBSs)

Abstract

Risk and performance management are at the core of complex bespoke systems (CBSs). CBSs are developed to customer–specified requirements in terms of structure, functionality and conformance. This article examines how risk and performance management are integrated as essential systems in the successful development of projects across multi-organizational functions in complex bespoke system (CBS) organizations. The article argues for the development of a quality management system that consists of two sub-processes: quality control and quality development. Using three case studies from engineering companies, we provide evidence and insights of the way change control, quality development and quality performance are developed in innovating business solutions.     

信息不对称下价格随机的应急数量折扣契约研究

以市场需求和市场价格随机波动的二级供应链为研究对象，寻找其在信息不对称条件下绩效优化的路径。通过显示原理分别构建生产成本和销售成本信息不对称时应急供应链的数量折扣契约模型，得到最优订货量与最佳批发价策略。通过具体的算例加以验证，分析了信息不对称程度对供应链上成员及整个供应链绩效的影响。研究结果表明：当突发事件造成市场价格随机波动和市场需求变化时，供应链上的跟随者能从隐瞒私人信息中获利。但当市场需求增大时，整个供应链绩效受损，反之则反是。这与以往研究在市场需求随机、市场价格固定和信息不对称条件下的结论迥异。     

Applying a Treatment Effects Model to Investigate Public Amenity Effect on Physical Activity of the Elderly

The increasing elderly population puts significant health, economic, and social burdens on society. Physical activity is one of the most cost-effective ways to maintain the health of the elderly. This study adopts a treatment effects model to investigate the causal relationship between environment attributes and physical activity among the elderly, while taking endogeneity into account. The data were collected from 274 participants by face-to-face interviews in Taichung, Taiwan. Performing physical activity regularly in parks is the most important measure of the amount of physical activity by the elderly. Providing sufficient and accessible parks in metropolitan residential neighborhoods could be one of the most cost-effective ways to promote physical activity for the elderly living in midsize Asian cities.     

No Mind Reading Necessary: Conducting Evidence-Based Electronic Resource Marketing and Outreach Using Marketing Research Assessment

Abstract

In her presentation entitled “No Mind Reading Necessary: Conducting Evidence-Based Electronic Resource Marketing and Outreach” at the North Carolina Serials Conference April 2019, Kate Hill discussed marketing research strategies and outreach tools used to increase online users’ access to electronic resources and primary resources. In an effort to connect users to seldom-used resources, Jackson Library collaborated with university partners to develop surveys to identify the information-seeking behavior of its users and apply the gathered marketing research to strategically plan outreach activities.     

Measuring and Achieving Equity in Multiperiod Emergency Material Allocation

Emergency material allocation is an important part of postdisaster emergency logistics that is significant for improving rescue effectiveness and reducing disaster losses. However, the traditional single‐period allocation model often causes local surpluses or shortages and high cost, and prevents the system from achieving an equitable or optimal multiperiod allocation. To achieve equitable allocation of emergency materials in the case of serious shortages relative to the demand by victims, this article introduces a multiperiod model for allocation of emergency materials to multiple affected locations (using an exponential utility function to reflect the disutility loss due to material shortfalls), and illustrates the relationship between equity of allocations and the cost of emergency response. Finally, numerical examples are presented to demonstrate both the feasibility and the usefulness of the proposed model for achieving multiperiod equitable allocation of emergency material among multiple disaster locations. The results indicate that the introduction of a nonlinear utility function to reflect the disutility of large shortfalls can make the material allocation fairer, and minimize large losses due to shortfalls. We found that achieving equity has a significant but not unreasonable impact on emergency costs. We also illustrate that using differing utility functions for different types of materials adds an important dimension of flexibility.     

Children in immediate danger: Emergency removals in Finnish and Irish child protection

This paper presents a qualitative analysis of front‐line practices regarding emergency removals in Finnish and Irish child protection. It examines how the responses to children's immediate danger are framed by legislation and how front‐line practitioners assess the child's situation and make emergency placement decisions. The data consist of interviews with 16 Irish and 33 Finnish social workers. These child welfare protection systems respond differently to a task that appears to be similar. The Irish team‐based practice rests on the social workers' shared assessment of the child's needs, and the formal decision is made by the courts (or police officers at night‐time); and the Finnish practice involves only one single social worker who makes both the assessment and the removal decision. The Irish system is tightly time regulated, whereas the Finnish system provides a more flexible time frame. Both approaches put a lot of stress on social workers' practice, which also includes creative workarounds (e.g., “planned emergency removals” in Finland). Future research will need to explore these features from the point of view of a child's right to protection.     

沙水游戏在幼儿科学教育中的运用

沙水游戏包括玩沙游戏、玩水游戏、沙水结合的游戏。沙水游戏在幼儿科学教育中的价值主要体现在激发幼儿对自然界的好奇心,培养其专注度；激发其探究欲望，培养其探究能力；积累科学经验和感性认识，促进科学认知发展；帮助建立正确的科学前概念等方面。因此，应该积极利用沙水游戏来开展幼儿科学教育。