Towards locally based resource allocation in the NHS

In a health care system where resources are scarce and the principle of equity is of central concern, mechanisms for the appropriate allocation of resources based on the notion of relating resource use to some concept of need are essential. Two key issues raised in the UK government’s White Paper The New NHS: modern, dependable are the ability first to define health care budgets at a local level and second to integrate budgets to encompass all relevant aspects of health care delivery. This paper considers the theoretical and practical implications of devolving NHS budgets to primary care groups. The paper advocates the development of a patient-based survey of all NHS health care utilization, which could serve as the basis for integrated global budgets for use at a local level.resource allocation; health care budgets; primary care; health need; general practice

Determining Contingencies in the Management of Construction Projects

[EN] This research describes the managerial approaches that contractors follow to determine different types of contingencies in construction project management. Two large Spanish general contractors were selected for an in-depth analysis. Interviews and surveys were conducted with six additional companies to explore the external validity of the findings. Managers constrain time and cost buffers through project objectives, applying heuristics to determine inventory buffers. The management of capacity buffers is entrusted to subcontractors. The contractors take advantage of scope and quality buffers to meet project objectives but rarely share these buffers with the owner, unless the owner is an internal client.Ortiz-González, JI.; Pellicer, E.; Molenaar, KR. (2019). Determining Contingencies in the Management of Construction Projects. Project Management Journal. 50(2):226-242. https://doi.org/10.1177/8756972819827389S226242502Adafin, J., Wilkinson, S., Rotimi, J. O. B., & Odeyinka, H. (2014). Accuracy in Design Stage Cost Estimating through Risk-contingency Analysis: A Theoretical Exploration. Construction Research Congress 2014. doi:10.1061/9780784413517.151Ballard, G., & Howell, G. (1998). Shielding Production: Essential Step in Production Control. Journal of Construction Engineering and Management, 124(1), 11-17. doi:10.1061/(asce)0733-9364(1998)124:1(11)Barraza, G. A. (2011). Probabilistic Estimation and Allocation of Project Time Contingency. Journal of Construction Engineering and Management, 137(4), 259-265. doi:10.1061/(asce)co.1943-7862.0000280Blomquist, T., Hällgren, M., Nilsson, A., & Söderholm, A. (2010). Project-as-Practice: In Search of Project Management Research that Matters. Project Management Journal, 41(1), 5-16. doi:10.1002/pmj.20141Chan, E. H., & Au, M. C. (2009). Factors Influencing Building Contractors’ Pricing for Time-Related Risks in Tenders. Journal of Construction Engineering and Management, 135(3), 135-145. doi:10.1061/(asce)0733-9364(2009)135:3(135)De la Cruz, M. P., del Caño, A., & de la Cruz, E. (2006). Downside Risks in Construction Projects Developed by the Civil Service: The Case of Spain. Journal of Construction Engineering and Management, 132(8), 844-852. doi:10.1061/(asce)0733-9364(2006)132:8(844)Ford, D. N. (2002). Achieving Multiple Project Objectives through Contingency Management. Journal of Construction Engineering and Management, 128(1), 30-39. doi:10.1061/(asce)0733-9364(2002)128:1(30)González, V., Alarcón, L. F., & Molenaar, K. (2009). Multiobjective design of Work-In-Process buffer for scheduling repetitive building projects. Automation in Construction, 18(2), 95-108. doi:10.1016/j.autcon.2008.05.005Guest, G., Bunce, A., & Johnson, L. (2006). How Many Interviews Are Enough? Field Methods, 18(1), 59-82. doi:10.1177/1525822x05279903Günhan, S., & Arditi, D. (2007). Budgeting Owner’s Construction Contingency. Journal of Construction Engineering and Management, 133(7), 492-497. doi:10.1061/(asce)0733-9364(2007)133:7(492)Hällgren, M., & Wilson, T. L. (2008). The nature and management of crises in construction projects: Projects-as-practice observations. International Journal of Project Management, 26(8), 830-838. doi:10.1016/j.ijproman.2007.10.005Harbuck R. H. (2004). Competitive bidding for highway construction projects (pp. ES91–ES94). Morgantown, WV: AACE International Transactions.HORMAN, M., & KENLEY, R. (1998). Process Dynamics: Identifying a Strategy for the Deployment of Buffers in Building Projects. International Journal of Logistics Research and Applications, 1(3), 221-237. doi:10.1080/13675569808962049Horman, M. J., & Thomas, H. R. (2005). Role of Inventory Buffers in Construction Labor Performance. Journal of Construction Engineering and Management, 131(7), 834-843. doi:10.1061/(asce)0733-9364(2005)131:7(834)Howell, G., Laufer, A., & Ballard, G. (1993). Interaction between Subcycles: One Key to Improved Methods. Journal of Construction Engineering and Management, 119(4), 714-728. doi:10.1061/(asce)0733-9364(1993)119:4(714)Howell, G., Laufer, A., & Ballard, G. (1993). Uncertainty and project objectives. Project Appraisal, 8(1), 37-43. doi:10.1080/02688867.1993.9726884Idrus, A., Fadhil Nuruddin, M., & Rohman, M. A. (2011). Development of project cost contingency estimation model using risk analysis and fuzzy expert system. Expert Systems with Applications, 38(3), 1501-1508. doi:10.1016/j.eswa.2010.07.061Laryea, S., & Hughes, W. (2011). Risk and Price in the Bidding Process of Contractors. Journal of Construction Engineering and Management, 137(4), 248-258. doi:10.1061/(asce)co.1943-7862.0000293Leach, L. (2003). Schedule and Cost Buffer Sizing: How to Account for the Bias between Project Performance and Your Model. Project Management Journal, 34(2), 34-47. doi:10.1177/875697280303400205Lee, S., Peña-Mora, F., & Park, M. (2006). Reliability and Stability Buffering Approach: Focusing on the Issues of Errors and Changes in Concurrent Design and Construction Projects. Journal of Construction Engineering and Management, 132(5), 452-464. doi:10.1061/(asce)0733-9364(2006)132:5(452)Oviedo-Haito, R. J., Jiménez, J., Cardoso, F. F., & Pellicer, E. (2014). Survival Factors for Subcontractors in Economic Downturns. Journal of Construction Engineering and Management, 140(3), 04013056. doi:10.1061/(asce)co.1943-7862.0000811Pellicer, E., Sanz, M. A., Esmaeili, B., & Molenaar, K. R. (2016). Exploration of Team Integration in Spanish Multifamily Residential Building Construction. Journal of Management in Engineering, 32(5), 05016012. doi:10.1061/(asce)me.1943-5479.0000438Pellicer, E., & Victory, R. (2006). IMPLEMENTATION OF PROJECT MANAGEMENT PRINCIPLES IN SPANISH RESIDENTIAL DEVELOPMENTS. International Journal of Strategic Property Management, 10(4), 233-248. doi:10.3846/1648715x.2006.9637555Rooke, J., Seymour, D., & Fellows, R. (2004). Planning for claims: an ethnography of industry culture. Construction Management and Economics, 22(6), 655-662. doi:10.1080/014461904200026324Slauson N. P. (2005). The effectiveness of the construction contract (pp. PM121–PM127). Morgantown, WV: AACE International Transactions.Tah, J. H. M., Thorpe, A., & McCaffer, R. (1993). Contractor project risks contingency allocation using linguistic approximation. Computing Systems in Engineering, 4(2-3), 281-293. doi:10.1016/0956-0521(93)90052-xTaylor, J. E., Dossick, C. S., & Garvin, M. (2011). Meeting the Burden of Proof with Case-Study Research. Journal of Construction Engineering and Management, 137(4), 303-311. doi:10.1061/(asce)co.1943-7862.0000283Thal, A. E., Cook, J. J., & White, E. D. (2010). Estimation of Cost Contingency for Air Force Construction Projects. Journal of Construction Engineering and Management, 136(11), 1181-1188. doi:10.1061/(asce)co.1943-7862.0000227Thamhain, H. (2013). Managing Risks in Complex Projects. Project Management Journal, 44(2), 20-35. doi:10.1002/pmj.21325Yeo, K. T. (1990). Risks, Classification of Estimates, and Contingency Management. Journal of Management in Engineering, 6(4), 458-470. doi:10.1061/(asce)9742-597x(1990)6:4(458

Influence of Cost Overruns on Risk Perception

Cost overruns are a common problem in project management and can significantly impact project outcomes. While previous research has focused on accurately estimating project risks, less attention has been paid to understanding the relationship between cost overruns and risk perception. This study aims to improve risk management practices by modeling the dynamic relationship between cost overruns and risk perception. Specifically, a project system is represented as a causal loop diagram that incorporates short- and long-term cost variances, work performed, and risk perception. The model shows that unmitigated short-term cost overruns can lead to long-term cost overruns and demonstrates how responses in the project monitoring system can mitigate this effect. By providing a basis for simulating the impact of responses to cost overruns, this study offers insights into how to improve risk management practices. The findings contribute to a better understanding of how risk perception influences decision-making in response to cost overruns and highlight the importance of proactive risk management strategies in project management

DEFENSE BUDGET FLEXIBILITY AND CONTROL: HOW THE U.S. AND BRAZILIAN SYSTEMS STRIKE A BALANCE BETWEEN THE TWO

A recurrent challenge affecting defense budgeting systems across federalist nations is balancing budget flexibility and legislative control of military appropriations execution. There has been considerable debate over the unique nature of defense expenditure and how it reflects fiscal considerations. While budget revisions are necessary to maintain flexibility due to the broad scope of the defense budget and the handling of unforeseen events, adherence to financial goals and accountability for what was allowed by the legislative impose control over military expenditures, restricting the military's versatility in carrying out its appropriations. This project offers why balancing flexibility and control is crucial for both parties to achieve their objectives during the budget execution stage. Then, it determines the attributes that indicate an effective control system and adequate budget flexibility. Finally, it contrasts flexibility tools and control activities between the United States and Brazil. This project analyzes constitutional or other legal authority disparities between the legislature, chief executive, military, treasury, and other actors involved in budgeting systems and defense budget implementation to accomplish these goals. The Congressional Budget Office (CBO), Congressional Research Service (CRS), Office of Management and Budget (OMB), the National Treasury of Brazil (STN), the Federal Budget Secretary (SOF), and other reports are reviewed.Capitao-Tenente, Brazilian NavyApproved for public release. Distribution is unlimited

Estimating Required Contingency Funds for Construction Projects using Multiple Linear Regression

Cost overruns are a critical problem for construction projects. The common practice for dealing with cost overruns is the assignment of an arbitrary flat percentage of the construction budget as a contingency fund. This research seeks to identify significant factors that may influence, or serve as indicators of, potential cost overruns. The study uses data on 243 construction projects over a full range of project types and scopes gathered from an existing United States Air Force construction database. The author uses multiple linear regression to analyze the data and compares the proposed model to the common practice of assigning contingency funds. The multiple linear regression model provides better predictions of actual cost overruns experienced. Based on the performance metric used, the model sufficiently captures 44% of actual cost overruns versus current practices capturing only 20%. The proposed model developed in this study only uses data that would be available prior to the award of a construction contract. This allows the model to serve as a planning tool throughout the concept and design phases. The model includes project characteristics, design performance metrics, and contract award process influences. This research supports prior findings of a relationship between design funding and design performance as well as the influence of the contract award process on cost overruns. While the proposed model captures 44% of actual cost overruns, its application reduces average contingency budgeting error from -11.2% to only -0.3% over the entire test sample

Earned value and cost contingency management: A framework model for risk adjusted cost forecasting

This paper proposes a novel framework model that considers different behaviors of cost contingency (CC) consumption in forecasting risk adjusted fi nal cost during the project execution. The model integrates the dynamics of how project managers can spend their contingencies into three S-shaped cost growth profi les to compute risk adjusted cost estimates at completion (CEAC). The three cost curves are modeled by the Gompertz growth model using nonlinear regression. Respectively, the framework embeds three different CC consumption rates to represent three main categories of aggressive, neutral or passive managerial attitudes in responding to project risk. The usage and viability of the model is demonstrated via a earned value management (EVM) dataset. The paper contributes to the body of knowledge by bridging the gap between the theories of EVM and CC management and provides project managers with a model to estimate the range of possible cost estimates at completion depending on the managerial policies that can be activated driven by different risk attitudes

The Litigation Budget

Because of fears that litigation is too costly, reduction of litigation expenses has been the touchstone of procedural reform for the past thirty years. In certain circumstances, however, the parties have incentives—both rational and irrational—to spend more on a lawsuit than the social benefits that the case provides. Present and proposed reform efforts do not adequately address these incentives, and, in some instances, exacerbate the parties’ incentives to overspend. The best way to ensure that the cost of a lawsuit does not exceed the benefits that it provides to the parties and society is to control spending directly: to require the parties to file and live within litigation budgets. These “costs budgets,” which are already in use in the United Kingdom, help to ensure that the costs of litigation remain less than the benefits. After describing the workings of a costs-budget system, the Article considers practical, political, and constitutional critiques. None of these concerns is disabling. American rulemakers who are serious about containing the litigation costs should grant courts the power to use costs budgets

The Litigation Budget

Because of fears that litigation is too costly, reduction of litigation expenses has been the touchstone of procedural reform for the past thirty years. In certain circumstances, however, the parties have incentives—both rational and irrational—to spend more on a lawsuit than the social benefits that the case provides. Present and proposed reform efforts do not adequately address these incentives, and, in some instances, exacerbate the parties’ incentives to overspend. The best way to ensure that the cost of a lawsuit does not exceed the benefits that it provides to the parties and society is to control spending directly: to require the parties to file and live within litigation budgets. These “costs budgets,” which are already in use in the United Kingdom, help to ensure that the costs of litigation remain less than the benefits. After describing the workings of a costs-budget system, the Article considers practical, political, and constitutional critiques. None of these concerns is disabling. American rulemakers who are serious about containing the litigation costs should grant courts the power to use costs budgets