Planning ambulatory health care delivery systems

This paper develops an optimal ambulatory health care delivery system for a community, by determining the optimal number, size and location of health centers. The demand for ambulatory health care services is given. The objective is to maximize the difference between the benefits of the patients receiving treatment and the total cost of the system. Utilization of facilities, which is a function of distance, is expressed in terms of benefits and incorporated into the cost-benefit analysis. The model is illustrated by a numerical example.     

Divesting losers: chipping away at integrated delivery systems

Integrated health systems are rapidly divesting earlier acquisitions to beef up their bottom lines. Take an in-depth look at what the future may hold as the health systems battle to reorganize and reap greater profits.     

The Evolving Field of Risk Communication

The 40th Anniversary of the Society for Risk Analysis presents an apt time to step back and review the field of risk communication. In this review, we first evaluate recent debates over the field's current state and future directions. Our takeaway is that efforts to settle on a single, generic version of what constitutes risk communication will be less productive than an open-minded exploration of the multiple forms that comprise today's vibrant interdisciplinary field. We then review a selection of prominent cognitive, cultural, and social risk communication scholarship appearing in the published literature since 2010. Studies on trust in risk communication messengers continued to figure prominently, while new research directions emerged on the opportunities and critical challenges of enhancing transparency and using social media. Research on message attributes explored how conceptual insights particularly relating to framing, affective and emotional responses, and uncertainty might be operationalized to improve message effectiveness. Studies consistently demonstrated the importance of evaluation and how varying single attributes alone is unlikely to achieve desired results. Research on risk communication audiences advanced on risk perception and multiway engagement with notable interest in personal factors such as gender, race, age, and political orientation. We conclude by arguing that the field's interdisciplinary tradition should be further nurtured to drive the next evolutionary phase of risk communication research.     

The relative importance of planning and control systems in achieving good delivery performance

Amongst factors such as quick changeovers and workforce flexibility, managers in 533 UK manufacturing plants ranked a responsive planning and control system as the most important facilitator of good delivery performance on products made-to-order or assembled-to-order. The rankings indicate greater importance to companies in the Household and Engineering sectors than in Process and Electronics, where other factors are dominant. These results are combined with data such as customer lead times and item variety, to characterize and explain differences between the plants in these four sectors. Collectively the results indicate considerable differences in the production planning and control tasks. This implies that general statements on the importance of planning and control systems are inadequate. Practitioners need contextual information in order to ascertain when research is applicable to their circumstances.     

基于交易量的供应链网络演化模型研究

将加权网络演化理论引入到供应链网络领域,在具体分析供应链网络动态演化特征、供应链网络演化影响因素和加权网络演化模型的基础上,提出了基于交易量的供应链网络演化模型,刻画了供应链网络形成和演化机理,为正确认识、管理、控制和协调供应链网络提供了新的思路,为进一步深化研究供应链网络弹性提供了理论基础.     

Integrated Ant Colony and Tabu Search approach for time dependent vehicle routing problems with simultaneous pickup and delivery

Today manufacturers have become much more concerned with the coordination of both manufacturing (of new products) and recycling (of reusable resources) operations. This requires simultaneous scheduling of both forward and reverse flows of goods over a supply chain network. This paper studies time dependent vehicle routing problems with simultaneous pickup and delivery (TD-VRPSPD). We formulate this problem as a mixed integer programming model, where the time step function is used to calculate the travel time. To efficiently solve this complex problem, we develop a hybrid algorithm that integrates both Ant Colony System (ACS) and Tabu Search (TS) algorithms. Our algorithm uses the pheromones, travel time and vehicle residual loading capacity as a factor structure according to the characteristics of TD-VRPSPD. In our computational experiments, 56 groups of benchmark instances are used to evaluate the performance of our hybrid algorithm. In addition, we compare the performance of our hybrid algorithm with those of individual ACS and TS algorithms. The computational results suggest that our hybrid algorithm outperform stand-alone ACS and the TS algorithms.     

Making the health care delivery system accountable.

Accountability has become the fact of life for the health care provider and the delivery system. Until recently, accountability has been viewed primarily through the judicial process as issues of fraud and liability, or by managed care entities through evaluation of the financial bottom line. It is this second consideration and its ramifications that will be explored in this article. Appropriate measurement tools are needed to evaluate services, delivery, performance, customer satisfaction, and outcomes assessment. Measurement tools will be considered in light of the industry's unique considerations and realities. All participants, including insurers, employers, management, and health care providers and recipients, bear responsibilities which necessitate assessment and analysis. However, until the basic question, "Who is the customer?" is resolved, accountability issues remain complex and obscured. Accountability costs and impacts must be evaluated over time. They go way beyond bottom line cost containment and reduction. Accountability will be accomplished when the health care industry implements quality and measurement concepts that yield the highest levels of validity and appropriateness for health care delivery.     

平台组织交互设计 及演化机制探究

  信息技术的高速发展对现有产业生态和企业组织方式产生重大影响,一些新兴的组织形态不断产生,其中探索和构建平台组织理论尤其重要。平台组织作为一种近解构系统,已有研究多侧重对演化能力和模块化作用的分析,对近解构系统的纵向维度(即权力维度)缺乏足够关注。         从平台组织管理实践中遇到的困惑出发,针对平台组织中以交互部分设计为代表的控制与演化的平衡问题,结合NK模型表达平台组织中的现实关系,进行仿真建模实验,依次探究平台组织在不同时期对小微模块适合的控制程度、小微模块不同演化方式对平台组织绩效的作用效果,以及不同维度环境变化中平台组织交互部分和演化机制的设计思路。         研究结果表明,①平台组织在发展初期对小微模块弱控制、强演化有利于取得更快的绩效提升,在发展成熟期对小微模块采取较强控制有利于取得更好的整体绩效;②平台组织本地搜寻与跨企业重构演化方式结合能够协同提升整体绩效,进入发展成熟期后采用跨模块重构方式不利于整体绩效提升;③比较环境变化的频率与影响范围两个维度,在频繁环境变化中平台组织本地搜寻演化方式对企业绩效的提升作用被更大程度地减弱,在大范围的环境变化中重构演化方式对企业绩效的提升作用被更大程度地减弱;④平台组织在高频环境变化中弱化对小微模块的控制,在低频环境变化中对小微模块实施较强控制有利于提升企业整体绩效。         利用复杂性方法建构平台组织的正式模型,从组织设计和演化机制两方面发展和丰富了平台组织理论,推动理论更进一步向实证检验的方向发展。研究中强调演化优势之外的权力维度对平台组织的重要性,发现平台组织在多种演化方式的协同上展现出相对于纯模块化组织的优势。建议管理者对组织架构和权力结构区分看待,并在模仿实践后兼顾学习和探索。     

集群演化网络模型与仿真研究

从网络视角研究集群的演化,应用一个小世界演化模型与选择价值函数演化模型相结合的双重网络演化模型,研究集群网络的演化特征和集群网络的演化过程.此模型可反映集群网络从形成期到成熟期的演化进程,应用该模型对集群网络形成期和成熟期的网络密集性、连通性和中心性进行了仿真试验,并对集群网络的形成机制给出了解释和分析.研究表明,小世界网络模型模拟的集群网络具有集群形成期网络整体密集性和连通性剧烈变化的特征,而个体选择价值函数模型可以解释集群网络的成长期、成熟期的密集性和连通性趋于稳定的特征,将2种演化规则相结合,则可以反映集群网络从形成期到成熟期的各生命周期特征.最后,由小世界和价值函数演化机理出发,给出集群网络演化进程中生命周期各阶段的内因解释和政策启示.     

Internationalization of Digital Innovations: A Rapidly Evolving Research Stream

This perspective paper synthesizes the burgeoning literature on internationalization of digital innovations to identify promising areas for future research. We first integrate multiple perspectives on digital innovations to offer a coherent and unified definition of digital innovations. Next, we synthesize digital innovation research into a theoretical framework that discusses the interrelationship between digital innovations and international business environment and its implications for international penetration of digital innovations. Our synthesis of literature highlights the increased research focus on demand-side perspective as an appropriate theoretical framework to explain the unique dynamics of digital internationalization. Finally, we take account of recent trends in digital economy as well as important gaps in current literature to propose promising avenues for future research. We particularly emphasize the need to integrate current institutional transitions of a digital era as well as emerging theoretical perspectives such as demand-side perspective and opportunity logic in digital internationalization research. We hope our perspective paper will contribute toward a more systematic and theoretically grounded advancement of digital internationalization research.     

Evolving Perceptions of Clinical Management in Acute Hospitals in England

Clinical management is at the centre of organizational change in the contemporary British hospital sector, and throws up important questions about the relationship between medicine and management. Through the analysis of business planning as a key organizational process the interpretative frameworks which guide the perceptions of the roles of clinical directors and directorate managers can be understood. This paper presents empirical material from a study of an acute hospital trust going through a full business planning cycle, and traces the evolving interpretations of the nature, content and form of clinical management. It also provides insights into the changing face of the medical profession and its place within the health services domain.     

Selection of Business Practices in the Midst of Evolving Complexity

I admire leaders who, with little experience and training, create organizations that make major contributions in their industries, especially given that a great number of businesses fail. Some fail spectacularly, in headline-grabbing fashion, but most failed businesses implode quietly. In the United States alone, half of small businesses do not survive beyond 5 years; each year more than 1 million file for bankruptcy, and another 1.5 million-plus await bankruptcy resolution. For an organization to survive, the recurring and nonrecurring interlocking behavior of the organization members must ultimately adapt to the complex and dynamic demands of the organization’s external environments. Based on an understanding of behavioral dynamics, this article offers a perspective on how leaders can identify realistic improvements inside their organizations and orchestrate their implementation to better adapt to the requirements of the external environment.     

Microbiota and Dose Response: Evolving Paradigm of Health Triangle

SRA Dose‐Response and Microbial Risk Analysis Specialty Groups jointly sponsored symposia that addressed the intersections between the “microbiome revolution” and dose response. Invited speakers presented on innovations and advances in gut and nasal microbiota (normal microbial communities) in the first decade after the Human Microbiome Project began. The microbiota and their metabolites are now known to influence health and disease directly and indirectly, through modulation of innate and adaptive immune systems and barrier function. Disruption of healthy microbiota is often associated with changes in abundance and diversity of core microbial species (dysbiosis), caused by stressors including antibiotics, chemotherapy, and disease. Nucleic‐acid‐based metagenomic methods demonstrated that the dysbiotic host microbiota no longer provide normal colonization resistance to pathogens, a critical component of innate immunity of the superorganism. Diverse pathogens, probiotics, and prebiotics were considered in human and animal models (in vivo and in vitro ). Discussion included approaches for design of future microbial dose–response studies to account for the presence of the indigenous microbiota that provide normal colonization resistance , and the absence of the protective microbiota in dysbiosis. As NextGen risk analysis methodology advances with the “microbiome revolution,” a proposed new framework, the Health Triangle, may replace the old paradigm based on the Disease Triangle (focused on host, pathogen, and environment) and germophobia. Collaborative experimental designs are needed for testing hypotheses about causality in dose–response relationships for pathogens present in our environments that clearly compete in complex ecosystems with thousands of bacterial species dominating the healthy superorganism.     

Evolving the latent variable model as an environmental DEA technology

This article tests several nonparametric DEA models for their ability to accurately decompose CO₂ emissions change using a Malmquist styled decomposition framework. This production oriented activity analysis involves panel data and two data sets from the literature for comparison. A new Latent Variable radial input-oriented technology is introduced that is closely associated with a Koopmans Efficient Slacks Based Model. The Latent Variable technology simultaneously reduces inputs and undesirable outputs in a single Multiple Objective Linear Program. This production theoretic methodology is adapted to preserve both scale efficiency and causality within the envelopment framework. Finally, the application studies demonstrate the internal consistency of the Latent Variable reduction coefficients, which overturns previous results and paves the way for further research into undesirable externalities.     

基于随机Petri网的突发事件信息演化模型

突发事件爆发后通常会引发事件信息的演化现象,而信息演化可能导致的负面舆情危机严重影响社会生活秩序,如何准确把握突发事件信息的演化规律是社会发展新形势下公共事务风险治理的重要内容。首先采用案例分析和结构化描述方法提取突发事件信息演化现象的内外部属性,并提出其演化系统。进而,构建该系统的随机Petri网模型及其同构的马尔可夫链。最后,通过情景仿真研究系统的均衡状态变动规律及其调控问题。研究过程中,提出突发事件信息演化现象的结构化描述、演化系统及不同演化状态,得出系统均衡状态变动规律及其调控机制。在此基础上,指出未来应考虑带有碰撞和耦合机制的多种信息演化规律及其调控问题。     

An Agent‐Based Model of Evolving Community Flood Risk

Although individual behavior plays a major role in community flood risk, traditional flood risk models generally do not capture information on how community policies and individual decisions impact the evolution of flood risk over time. The purpose of this study is to improve the understanding of the temporal aspects of flood risk through a combined analysis of the behavioral, engineering, and physical hazard aspects of flood risk. Additionally, the study aims to develop a new modeling approach for integrating behavior, policy, flood hazards, and engineering interventions. An agent‐based model (ABM) is used to analyze the influence of flood protection measures, individual behavior, and the occurrence of floods and near‐miss flood events on community flood risk. The ABM focuses on the following decisions and behaviors: dissemination of flood management information, installation of community flood protection, elevation of household mechanical equipment, and elevation of homes. The approach is place based, with a case study area in Fargo, North Dakota, but is focused on generalizable insights. Generally, community mitigation results in reduced future damage, and individual action, including mitigation and movement into and out of high‐risk areas, can have a significant influence on community flood risk. The results of this study provide useful insights into the interplay between individual and community actions and how it affects the evolution of flood risk. This study lends insight into priorities for future work, including the development of more in‐depth behavioral and decision rules at the individual and community level.     

Life-Cycle Assessment in Relation to Risk Assessment: An Evolving Perspective

A life-cycle approach takes a cradle-to-grave perspective of a product's numerous activities from the raw material extraction to final disposal. There have been recent efforts to develop life-cycle assessment (LCA) to assess both environmental and human health issues. The question then arises: what are the capabilities of LCA, especially in relation to risk assessment? To address this question, this paper first describes the LCA mass-based accounting system and then analyzes the use of this approach for environmental and human health assessment. The key LCA limitations in this respect are loss of spatial, temporal, dose-response, and threshold information. These limitations affect LCA's capability to assess several environmental issues, and human health in particular. This leads to the conclusion that LCA impact assessment does not predict or measure actual effects, quantitate risks, or address safety. Instead, LCA uses mass loadings with simplifying assumptions and subjective judgments to add independent effects and exposures into an overall score. As a result, LCA identifies possible human health issues on a systemwide basis from a worst case, hypothetical hazard perspective. Ideally, the identified issues would then be addressed by more detailed assessment methods, such as risk assessment.     

The remote practice network: new concept in health care delivery.

It is widely acknowledged that a trend toward greater competition is creating dramatic changes in the way that health care is provided in the United States. Physicians and hospitals, in particular, face a difficult period of adjustment as the nation's health care system increasingly turns toward the competitive model. Physicians, particularly those in leadership positions, must meet the challenge of competition by developing and implementing effective coping strategies. Medical directors and other physicians in key leadership and decision-making positions have a responsibility to their institutions, their patients, and indeed their own careers to recognize and understand the implications of current trends in health care delivery. This article discusses an innovative approach to competition in today's challenging health care marketplace.