Partially Flexible Operating Rooms for Elective and Emergency Surgeries

In hospitals, the management of operating rooms faces a trade‐off between the need to be responsive to emergency surgeries and to conduct scheduled elective surgeries efficiently. Operating rooms can be configured as flexible and handle both electives and emergencies, or as dedicated to focus on either electives or emergencies. With flexible rooms, the prioritization of emergencies over scheduled electives can lead to schedule disruptions. Focused rooms can lead to imbalances between capacity and surgery workload. Whereas hospital administrators typically handle this trade‐off by employing either flexible rooms (complete flexibility) or dedicated rooms (complete focus), we investigate whether a combination of flexible and dedicated rooms (partial flexibility) could be a preferable alternative. The ensuing question is what is the right combination of flexible and dedicated rooms? A versatile simulation model is developed to evaluate different resource allocation policies under various environmental parameters and performance metrics, including patient wait time, staff overtime, and operating room utilization. The main result is that partial flexibility configurations outperform both complete flexibility and complete focus policies by providing solutions with improved values of expected wait time for both emergency and elective patients.     

Point‐of‐Use Hybrid Inventory Policy for Hospitals

Modern point‐of‐use technology at hospitals has enabled new replenishment policies for medical supplies. One of these new policies, which we call the hybrid policy, is currently in use at a large U.S. Midwest hospital. The hybrid policy combines a low‐cost periodic replenishment epoch with a high‐cost continuous replenishment option to avoid costly stockouts. We study this new hybrid policy under deterministic and stochastic demand. We develop a parameter search engine using simulation to optimize the long‐run average cost per unit time and, via a computational study, we provide insights on the benefits (reduction in cost, inventory, and number of replenishments) that hospitals may obtain by using the hybrid policy instead of the commonly used periodic policies. We also use the optimal hybrid policy parameters from the deterministic analysis to propose approximate expressions for the stochastic hybrid policy parameters that can be easily used by hospital management.      

Alienation and its correlates: A meta-analysis

We provide a meta-analysis of alienation, outlining the extent to which it is predicted by individual differences (need for achievement), role stressors (role conflict), leader dimensions (initiating structure), and aspects of the work context (formalization). We also examine its relationship with outcomes such as employee attitudes (job satisfaction), performance (task performance), withdrawal (absenteeism), and side effects (drinking). We examined these relationships based on data from 45 primary studies and 227 statistically independent relationships. Our meta-analysis provides cumulative evidence for effect sizes across multiple settings and respondents, clarifies ambiguous aspects of the construct, and presents more information on the extent to which alienation can be seen as the opposite of job involvement.     

Values and Their Change During the Business Education – A Gender Perspective

Modern management and organization theory have been criticized for being based on masculine values and concepts. The theory and associated values influence not only managerial behavior in practice, but also business education's value system. In this study, we analyze the change in values during business education from a gender perspective. By values we mean feminine and masculine values. Our empirical study is based on the literature of cultural values and gender socialization theories. We surveyed 324 students. The result of our study lends support to earlier research: men are more masculine and women more feminine in their values. The change towards masculinity during business education is not supported statistically in this study. However, there may be a weak tendency towards masculinity, especially among female students. In addition, we propose that it is possible that business students have a tendency to try to fulfil masculine needs in their occupational choice. Further research is needed to investigate the empirical findings of our study. This revised version was published online in July 2006 with corrections to the Cover Date.     

Shortcomings in the Measurement of Innovation: Implications for Accounting Standard Setting

Innovation is nowadays a fundamental determinant of value creation in business companies and economic growth. Therefore, the measurement of innovation has become a significant concern both for business companies and governments. Traditionally, attempts to measure innovation have adopted a macroeconomic approach, as they have been largely based on broad surveys. However, no attempt has been made to date in order to complement the information provided by such surveys with aggregated data obtained from the financial reports of individual companies. This paper analyses the conceptual and methodological problems underlying the measurement of business innovation by means of surveys and discusses the lack of ability of accounting standards to accurately reflect innovative activities in the financial statements of business firms.In the light of the evidence provided by the empirical studies published to date, we analyse the Spanish situation by reviewing innovation studies conducted by the National Institute of Statistics (INE), and assessing the relationship between the value relevance of accounting information and the firm's technological level. Our results suggest that both, micro- and macroeconomic approaches towards the measurement of innovation have significant shortcomings. Thus, a joint effort seems to be needed in order to overcome the methodological limitations affecting innovation studies based on surveys and those relying on financial accounting information. Despite their limitations, surveys provide a sound basis for the identification of trends, key factors and explanatory variables. On the other hand, financial statements could provide a sound basis for the measurement of innovation if they included more relevant information on the intangible determinants of the value of companies. This has obvious implications for the standard setting process.     

Risk Estimation and Value-of-Information Analysis for Three Proposed Genetic Screening Programs for Chronic Beryllium Disease Prevention

Genetic differences (polymorphisms) among members of a population are thought to influence susceptibility to various environmental exposures. In practice, however, this information is rarely incorporated into quantitative risk assessment and risk management. We describe an analytic framework for predicting the risk reduction and value-of-information (VOI) resulting from specific risk management applications of genetic biomarkers, and we apply the framework to the example of occupational chronic beryllium disease (CBD), an immune-mediated pulmonary granulomatous disease. One described Human Leukocyte Antigen gene variant, HLA-DP beta 1*0201, contains a substitution of glutamate for lysine at position 69 that appears to have high sensitivity (approximately 94%) but low specificity (approximately 70%) with respect to CBD among individuals occupationally exposed to respirable beryllium. The expected postintervention CBD prevalence rates for using the genetic variant (1) as a required job placement screen, (2) as a medical screen for semiannual in place of annual lymphocyte proliferation testing, or (3) as a voluntary job placement screen are 0.08%, 0.8%, and 0.6%, respectively, in a hypothetical cohort with 1% baseline CBD prevalence. VOI analysis is used to examine the reduction in total social cost, calculated as the net value of disease reduction and financial expenditures, expected for proposed CBD intervention programs based on the genetic susceptibility test. For the example cohort, the expected net VOI per beryllium worker for genetically based testing and intervention is $13,000, $1,800, and $5,100, respectively, based on a health valuation of $1.45 million per CBD case avoided. VOI results for alternative CBD evaluations are also presented. Despite large parameter uncertainty, probabilistic analysis predicts generally positive utility for each of the three evaluated programs when avoidance of a CBD case is valued at $1 million or higher. Although the utility of a proposed risk management program may be evaluated solely in terms of risk reduction and financial costs, decisions about genetic testing and program implementation must also consider serious social, legal, and ethical factors.     

A Systematic Uncertainty Analysis of an Evaluative Fate and Exposure Model

Multimedia fate and exposure models are widely used to regulate the release of toxic chemicals, to set cleanup standards for contaminated sites, and to evaluate emissions in life-cycle assessment. CalTOX, one of these models, is used to calculate the potential dose, an outcome that is combined with the toxicity of the chemical to determine the Human Toxicity Potential (HTP), used to aggregate and compare emissions. The comprehensive assessment of the uncertainty in the potential dose calculation in this article serves to provide the information necessary to evaluate the reliability of decisions based on the HTP A framework for uncertainty analysis in multimedia risk assessment is proposed and evaluated with four types of uncertainty. Parameter uncertainty is assessed through Monte Carlo analysis. The variability in landscape parameters is assessed through a comparison of potential dose calculations for different regions in the United States. Decision rule uncertainty is explored through a comparison of the HTP values under open and closed system boundaries. Model uncertainty is evaluated through two case studies, one using alternative formulations for calculating the plant concentration and the other testing the steady state assumption for wet deposition. This investigation shows that steady state conditions for the removal of chemicals from the atmosphere are not appropriate and result in an underestimate of the potential dose for 25% of the 336 chemicals evaluated.     

Societal Response to Hurricane Mitch and Intra‐ versus Intergenerational Equity Issues: Whose Norms Should Apply?

Late in the 1998 hurricane season, Central America was slammed by a devastating hurricane. Honduras, Nicaragua, El Salvador, Guatemala, and Belize were greatly impacted by Hurricane Mitch, one of the deadliest storms to affect the region in the past 200 years. The economies of each of these countries were badly affected. In the case of Honduras — at the time the fourth‐poorest country in Latin America — its president suggested that 50 years of progress had been wiped out by the floods and mudslides associated with this relatively short‐lived storm system. Humanitarian assistance poured into the region in the first months following the disaster. As of mid‐2000, various national, bilateral, international, and nongovernmental programs were in progress or on the drawing board for recovery, reconstruction, and renewed development of the worst affected countries. Using Honduras as a case study, some of the ethical issues that abound in the decisions of whom to help, when, and how to help them in the wake of such an extreme climate‐related human tragedy are examined. Should development assistance be focused on those who have been directly and adversely affected by this storm, or should the emphasis be on reducing the risk of exposure by future generations to such disasters? Is there yet another approach that seeks to protect future generations from similar harm while at the same time assisting present‐day victims to get through their hardships?     

Evaluating the Simplified Conjoint Expected Risk Model: Comparing the Use of Objective and Subjective Information

The simplified Conjoint Expected Risk (CER) model by Holtgrave and Weber posits that perceived risk is a linear combination of the subjective judgments of the probabilities of harm, benefit, and status quo, and the expected harm and benefit of an activity. It modifies Luce and Weber's original CER model—that uses objective information to evaluate financial gambles—to accommodate activities such as health/technology activities where values of the model variables are subjective. If the simplified model is a valid modification of the original model, its performance should not be sensitive to the use of subjective information. However, because people may evaluate information differently when objective information is provided to them than when they generate information on their own, the performance of the simplified CER model may not be robust to the source of model-variable information. We compared the use of objective and subjective information, and results indicate that the estimates of the simplified CER model parameters and the proportion of variance in risk judgments accounted for by the model are similar under these two conditions. Thus, the simplified CER model is viable with activities for which harm and benefit information is subjective.