Devolved governance systems

This article assesses the extent, nature and outcomes of the recently devolved health service governance in the four countries which comprise the United Kingdom. This four-part configuration can be seen as a natural experiment in comparative governance which could therefore carry important lessons not only for the UK but in other countries too. While remaining under the aegis of the National Health Service, each constituent devolved administration has a developed a substantially different governance system. These systems reflect fundamental issues and priorities concerning the decentring of authority, the production and deployment of authority, the suite of incentives required and the preferred role of quasi-market mechanisms. The paper makes an evaluation of the strengths and weaknesses of each governance regime

Integrated Management of Emergency Vehicle Fleet

The growing public concerns for safety and the advances in traffic management systems, that have made the availability of real-time traffic information a reality, have created an opportunity to build integrated decision support systems that can improve the coordination and sharing of information between agencies that are responsible for public safety and security and transportation agencies to provide more efficient Emergency Response Service. In an Emergency Response System, reduction of the duration of response time can yield substantial benefits. The response time plays a crucial role in minimizing the adverse impacts: fatalities and loss of property can be greatly reduced by reducing the response time for emergencies. In this dissertation, we have developed an integrated model that can assist emergency response fleet dispatchers in managing the fleet. This model can help reduce the response time and improve service level by specifically accounting for the following: Vehicle Deployment: given real-time information about the status of the emergency response fleet, traffic information and the status of emergency calls, select proper fleet assignment schemes that satisfy various operation requirements. Vehicle Routing: given real-time traffic information, provide real-time route guidance for drivers of dispatched vehicles. This goal is achieved by applying various shortest path algorithms into the solution procedure. Planning and Evaluation: given the status of the fleet and the frequency of emergency calls in various areas of a region, the model can help evaluate the performance of the current system and help plan for potential sites for the relocation of vehicles and allocate an appropriate fleet of vehicles to these sites. The vehicle deployment problem is formulated as an integer optimization problem. Since this problem has been shown to be NP-hard and because of the nature of emergency response, we developed heuristics which can provide quality solutions with short computational times. Several test algorithms are proposed to solve the emergency response vehicle deployment problem. Different methods for obtaining lower bounds for the value of objective function are analyzed in this dissertation. To evaluate the performance of the system under various scenarios, a simulation model is developed. The simulation system is calibrated based on real-world data. The results of simulation and analysis show the proposed system can effectively improve the emergency response service level. Application of this model in facility allocation illustrates its usage in other relevant operational scenarios

A STOCHASTIC PROGRAMMING APPROACH TO ANALYZE DESIGN AND MANAGEMENT OF FLEXIBILITY IN INFRASTRUCTURE SYSTEMS OPERATING UNDER LONG-TERM UNCERTAINTY

Ph.DDOCTOR OF PHILOSOPH

Dynamic vehicle routing problems: Three decades and counting

Since the late 70s, much research activity has taken place on the class of dynamic vehicle routing problems (DVRP), with the time period after year 2000 witnessing a real explosion in related papers. Our paper sheds more light into work in this area over more than 3 decades by developing a taxonomy of DVRP papers according to 11 criteria. These are (1) type of problem, (2) logistical context, (3) transportation mode, (4) objective function, (5) fleet size, (6) time constraints, (7) vehicle capacity constraints, (8) the ability to reject customers, (9) the nature of the dynamic element, (10) the nature of the stochasticity (if any), and (11) the solution method. We comment on technological vis-à-vis methodological advances for this class of problems and suggest directions for further research. The latter include alternative objective functions, vehicle speed as decision variable, more explicit linkages of methodology to technological advances and analysis of worst case or average case performance of heuristics.© 2015 Wiley Periodicals, Inc

How valuable is the concept of resilience in understanding how paramedics 'survive' their work

AbstractThis study was prompted by the reflective essays submitted by paramedics in which they recounted traumatic experiences from work which seemed unprocessed. I subsequently became interested in how paramedics maintained their resilience and ‘survived’ their work as measured by for example, job satisfaction, morale, attrition and mental and physical well-being. A qualitative research design was adopted which used a psycho-social interview technique called ‘free association narrative interviewing’ (FANI) as the means of data collection. Data collection included a one hour biographical interview initially and a second follow up 45 minute semi structured interview with seven participants recruited from a trust in England. In all instances data was collected at the university or participant’s home and interviews were digitally recorded. The interviews were transcribed and analysed thematically. The study was approved by UWE and NHS ethics committees.The analysis explored the key findings within the context of contemporary resilience theory drawing on psychological, sociological and psycho-social literature. However the main focus of the work was from a psycho-social perspective which is psycho-dynamically informed and uses psychoanalytic concepts and principles to explore core issues. The themes captured respondents’ motivations to become a paramedic, which embraced notions of gender differences and the ‘wounded healer’. The hidden toll of the work in relation to health, and the impact of recent performance targets and changes to skill mix which appeared to threaten traditional protective methods of support, emerged as other themes. Support from within the organisation was explored, focusing on the role of management, debriefing, peer support, humour, time out and the culture of shame and denial within the organisation. Outside support explored the role of friends, family and referral to outside agencies. In dealing with unprocessed encounters, paramedics appeared to use other strategies including emotional detachment, dissociation, displays of anger and inappropriate professional behaviour. Despite limitations to the study, the findings unveil a unique account of how paramedics survive and become resilient

System-focused risk identification and assessment for disaster preparedness: Dynamic threat analysis

AbstractCurrent approaches to risk management stress the need for dynamic (i.e. continuous, ongoing) approaches to risk identification as part of a planned resource application aimed at reducing the expected consequences of undesired outcomes for the object of the assessment. We contend that these approaches place insufficient emphasis on the system knowledge available to the assessor, particularly in respect of three factors, namely the dynamic behavior of the system under threat, the role of human agents and the knowledge availability to those agents.In this paper we address the first of these shortcomings, namely the mobilization of explicit system knowledge in the identification of risks. We present a procedure for mobilizing quantitative and qualitative dynamic system knowledge using the case of flood threat to an electricity substation as a worked example. We assert that the approach described offers the potential of improving risk cognition by mobilizing system knowledge