181,028 research outputs found
Assessing the value dimensions of outsourced maintenance services
Purpose
- The purpose of this paper is to investigate the diverse nature of tangible and intangible value dimensions that contribute to customers' perception of value from outsourced maintenance services.
Design/methodology/approach
- A multiple case study approach has been adopted. Repertory grid, an in-depth structured interviewing technique, has been used in order to draw out the respondents' hidden constructs in evaluating outsourced maintenance services. Data have been collected from four customer organizations of outsourced maintenance services, and a total of 33 interviews have been undertaken.
Findings
- The paper has identified a range of tangible and intangible value dimensions that are of importance in maintenance outsourcing decision making. The most important value dimensions for maintenance outsourcing were found to be specialist knowledge, accessibility (of the service provider), relational dynamic, range of products and services, delivery, pricing and locality. Although the paper has identified the most important value dimensions the paper also emphasizes the need to take into account the full range of value dimensions in order to understand the whole value pattern in an organization.
Practical implications
- The results will be of use for maintenance service providers to help them to improve value-adding capacity of maintenance services. The results can also be applied by customers to help them assess the value they receive from outsourced maintenance services.
Originality/value
- A different perspective on maintenance outsourcing value is provided. The value patterns in different organizations and the viewpoints of respondents in different organizational roles are described. The dynamic nature of these tangible or intangible values over time and their interrelationships has also been explored
Operational Plan for HMIS Rollout to be Read in Conjunction with the MoH&SW Document of October 2007
The MoH&SW, with a consortium of partners, in October 2007, developed a Proposal to Strengthen the HMIS in Tanzania. This document builds on that proposal to develop a budgeted 6‐month plan to kick‐start implementation of the Revised MTUHA in one region and at national level, to develop a replicable model that can be scaled up to other regions as additional funds become available. The overall HMIS revision process will ensure that, within a period of five years the HMIS will be functional in all 21 regions of the country, in a phased manner Six months intensive systems and database development in Mtwara region Eighteen months implementation in one region in each of the six zones Within 5 years, National rollout to every region The initial six months implementation process, described in depth in this document, will use action research and participatory development methodology that will integrate the six work packages in the HMIS document, in line with the HSSP III proposals for strengthening M&E. A number of dedicated teams will roll out the HMIS, develop a toolkit for implementation in other regions and produce a modern web based data warehouse. The project logframe aims to provide quality routine data for monitoring MDGs and the NHSSPIII by producing five outputs – HMIS revision, HMIS implementation, Capacity development, the DHIS software and action research. Terms of reference are developed for each of the HMIS teams, based on the activities in the logframe – Indicator and dataset revision, HMIS design, Database development and training team. An action‐based budget of US1,25 million for the first year, including the rollout activities, the development of training material, adaptation of software etc. The other six regions will cost 1,05million for first year; all regions will reduce to 300,000 in the third year. National level costs will reduce from 1,2 million for the first year, including the rollout activities, the development of training material, adaptation of software et
Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care
Examines the progress of an integrated healthcare delivery system in forming an accountable care organization with payer partners as part of the Brookings-Dartmouth ACO Pilot Program, including a focus on performance measurement and reporting
A safer place for patients: learning to improve patient safety
1 Every day over one million people are treated
successfully by National Health Service (NHS) acute,
ambulance and mental health trusts. However, healthcare
relies on a range of complex interactions of people,
skills, technologies and drugs, and sometimes things do
go wrong. For most countries, patient safety is now the
key issue in healthcare quality and risk management.
The Department of Health (the Department) estimates
that one in ten patients admitted to NHS hospitals will be
unintentionally harmed, a rate similar to other developed
countries. Around 50 per cent of these patient safety
incidentsa could have been avoided, if only lessons from
previous incidents had been learned.
2
There are numerous stakeholders with a role in
keeping patients safe in the NHS, many of whom require
trusts to report details of patient safety incidents and near
misses to them (Figure 2). However, a number of previous
National Audit Office reports have highlighted concerns
that the NHS has limited information on the extent and
impact of clinical and non-clinical incidents and trusts need
to learn from these incidents and share good practice across
the NHS more effectively (Appendix 1).
3 In 2000, the Chief Medical Officer’s report An
organisation with a memory
1
, identified that the key
barriers to reducing the number of patient safety incidents
were an organisational culture that inhibited reporting and
the lack of a cohesive national system for identifying and
sharing lessons learnt.
4 In response, the Department published Building a
safer NHS for patients3 detailing plans and a timetable
for promoting patient safety. The goal was to encourage
improvements in reporting and learning through the
development of a new mandatory national reporting
scheme for patient safety incidents and near misses. Central
to the plan was establishing the National Patient Safety
Agency to improve patient safety by reducing the risk of
harm through error. The National Patient Safety Agency was
expected to: collect and analyse information; assimilate
other safety-related information from a variety of existing
reporting systems; learn lessons and produce solutions.
5 We therefore examined whether the NHS has
been successful in improving the patient safety culture,
encouraging reporting and learning from patient safety
incidents. Key parts of our approach were a census of
267 NHS acute, ambulance and mental health trusts in
Autumn 2004, followed by a re-survey in August 2005
and an omnibus survey of patients (Appendix 2). We also
reviewed practices in other industries (Appendix 3) and
international healthcare systems (Appendix 4), and the
National Patient Safety Agency’s progress in developing its
National Reporting and Learning System (Appendix 5) and
other related activities (Appendix 6).
6 An organisation with a memory1
was an important
milestone in the NHS’s patient safety agenda and marked
the drive to improve reporting and learning. At the
local level the vast majority of trusts have developed a
predominantly open and fair reporting culture but with
pockets of blame and scope to improve their strategies for
sharing good practice. Indeed in our re-survey we found
that local performance had continued to improve with more
trusts reporting having an open and fair reporting culture,
more trusts with open reporting systems and improvements
in perceptions of the levels of under-reporting. At the
national level, progress on developing the national reporting
system for learning has been slower than set out in the
Department’s strategy of 2001
3
and there is a need to
improve evaluation and sharing of lessons and solutions by
all organisations with a stake in patient safety. There is also
no clear system for monitoring that lessons are learned at the
local level. Specifically:
a The safety culture within trusts is improving, driven
largely by the Department’s clinical governance
initiative
4
and the development of more effective risk
management systems in response to incentives under
initiatives such as the NHS Litigation Authority’s
Clinical Negligence Scheme for Trusts (Appendix 7).
However, trusts are still predominantly reactive in
their response to patient safety issues and parts of
some organisations still operate a blame culture.
b All trusts have established effective reporting systems
at the local level, although under-reporting remains
a problem within some groups of staff, types of
incidents and near misses. The National Patient Safety
Agency did not develop and roll out the National
Reporting and Learning System by December 2002
as originally envisaged. All trusts were linked to the
system by 31 December 2004. By August 2005, at
least 35 trusts still had not submitted any data to the
National Reporting and Learning System.
c Most trusts pointed to specific improvements
derived from lessons learnt from their local incident
reporting systems, but these are still not widely
promulgated, either within or between trusts.
The National Patient Safety Agency has provided
only limited feedback to trusts of evidence-based
solutions or actions derived from the national
reporting system. It published its first feedback report
from the Patient Safety Observatory in July 2005
Promoting the Readiness of Minors in Supplemental Security Income (PROMISE) [CFDA 84.418P]
Over the past two decades, New York State (NYS) has been actively and collaboratively engaged in systems change across three primary domains: 1) to develop a comprehensive employment system to reduce barriers to work and improve employment outcomes of individuals with disabilities; 2) to enhance the post-school adult outcomes of youth with disabilities, by collaboratively advancing evidence-based secondary transition practices at the regional, school district and individual student levels; and, 3) to support the return-to-work efforts of individuals with disabilities who receive Social Security Administration (SSA) disability benefits under the Supplemental Security Income (SSI) program and Social Security Disability Insurance (SSDI). These domains have been supported by numerous federal and state initiatives including: the US Department of Education’s Office of Special Education and Rehabilitation Services (OSERS)-sponsored Transition Systems Change grant; the SSA-sponsored State Partnership Initiative (NYWORKS); two Youth Transition Demonstrations (YTD); the Benefits Offset National Demonstration (BOND); and, three cycles of funding for the National Work Incentives Support Center (WISC); the US Department of Labor (DOL)-sponsored Work Incentive Grant, Disability Program Navigator Initiative, and Disability Employment Initiative; three rounds of funding from the Center for Medicaid and Medicare Services (CMS) for Medicaid Infrastructure Grants (MIG, NY Makes Work Pay); the NYS Education Department (NYSED) sponsored Model Transition Program (MTP); and three multi-year cycles of the statewide Transition Coordination Site network. Most recently, NYS has sponsored the Statewide Transition Services Professional Development Support Center (PDSC); the NYS Developmental Disability Planning Council (DDPC)-sponsored Transition Technical Assistance Support Program (T-TASP), NYS Work Incentives Support Center (NYS WISC), and NYS Partners in Policy Making (PIP); the NYS Office of Mental Health (OMH)-sponsored Career Development Initiative; and others. The growing statewide and gubernatorial emphasis on employment for New Yorkers with disabilities developed over the past two decades stemming from these initiatives, supported by service innovations and shared vision across state agencies and employment stakeholders, establishes a strong foundation for implementing and sustaining a research demonstration to “Promote the Readiness of Minors in Supplemental Security Income” (PROMISE). The NYS PROMISE will build upon NYS’ past successes and significantly support NYS in removing systems, policy and practice barriers for transition-age youth who receive SSI and their families. The NYS OMH through the Research Foundation for Mental Hygiene (RFMH), with their management partners the New York Employment Support System (NYESS) Statewide Coordinating Council (SCC) and Cornell University Employment and Disability Institute, along with the proposed research demonstration site community, join the NYS Governor’s Office in designing and implementing a series of statewide strategic service interventions to support the transition and employment preparation of youth ages 14-16 who receive SSI
Results readiness in social protection and labor operations : technical guidance notes for labor markets task teams
Labor allocation to its most efficient use, promoting employment and human capital investment as well as functioning labor markets can contribute to long?term economic growth, poverty reduction and to help workers manage their risks. A labor market policy framework includes both regulations and programs. However, the optimal framework is not standard and universal but varies country by country depending on the level of economic and financial development, culture and other structural characteristics. Labor market projects are equally concentrated in Latin America and the Caribbean and Eastern Europe and Central Asia regions and one is China. Interestingly, the number of projects having'improving labor market'as the primary component has increased over time. All project development objectives in the cohort of projects reviewed focus on promoting higher employment and increasing economic opportunities as the main objective especially via training programs. About half of the projects also seek to reach specific vulnerable groups by improving targeting mechanisms and to improve the quality of social assistance services by reducing the cost of job search through access to enhanced employment services and by improving employability.Safety Nets and Transfers,Labor Markets,Labor Policies,Housing&Human Habitats,Poverty Monitoring&Analysis
Managing at the Speed of Light: Improving Mission-Support Performance
The House and Senate Energy and Water Development Appropriations Subcommittees requested this study to help DOE's three major mission-support organizations improve their operations to better meet the current and future needs of the department. The passage of the Recovery Act only increased the importance of having DOE's mission-support offices working in the most effective, efficient, and timely manner as possible. While following rules and regulations is essential, the foremost task of the mission-support offices is to support the department's mission, i.e., the programs that DOE is implementing, whether in Washington D.C. or in the field. As a result, the Panel offered specific recommendations to strengthen the mission-focus and improve the management of each of the following support functions based on five "management mandates":- Strategic Vision- Leadership- Mission and Customer Service Orientation- Tactical Implementation- Agility/AdaptabilityKey FindingsThe Panel made several recommendations in each of the functional areas examined and some overarching recommendations for the corporate management of the mission-support offices that they believed would result in significant improvements to DOE's mission-support operations. The Panel believed that adopting these recommendations will not only make DOE a better functioning organization, but that most of them are essential if DOE is to put its very large allocation of Recovery Act funding to its intended uses as quickly as possible
Performance-Based Financing: Report on Feasibility and Implementation Options Final September 2007
This study examines the feasibility of introducing a performance-related bonus scheme in the health sector. After describing the Tanzania health context, we define “Performance-Based Financing”, examine its rationale and review the evidence on its effectiveness. The following sections systematically assess the potential for applying the scheme in Tanzania. On the basis of risks and concerns identified, detailed design options and recommendations are set out. The report concludes with a (preliminary) indication of the costs of such a scheme and recommends a way forward for implementation. We prefer the name “Payment for Performance” or “P4P”. This is because what is envisaged is a bonus payment that is earned by meeting performance targets1. The dominant financing for health care delivery would remain grant-based as at present. There is a strong case for introducing P4P. Its main purpose will be to motivate front-line health workers to improve service delivery performance. In recent years, funding for council health services has increased dramatically, without a commensurate increase in health service output. The need to tighten focus on results is widely acknowledged. So too is the need to hold health providers more accountable for performance at all levels, form the local to the national. P4P is expected to encourage CHMTs and health facilities to “manage by results”; to identify and address local constraints, and to find innovative ways to raise productivity and reach under-served groups. As well as leveraging more effective use of all resources, P4P will provide a powerful incentive at all levels to make sure that HMIS information is complete, accurate and timely. It is expected to enhance accountability between health facilities and their managers / governing committees as well as between the Council Health Department and the Local Government Authority. Better performance-monitoring will enable the national level to track aggregate progress against goals and will assist in identifying under-performers requiring remedial action. We recommend a P4P scheme that provides a monetary team bonus, dependent on a whole facility reaching facility-specific service delivery targets. The bonus would be paid quarterly and shared equally among health staff. It should target all government health facilities at the council level, and should also reward the CHMT for “whole council” performance. All participating facilities/councils are therefore rewarded for improvement rather than absolute levels of performance. Performance indicators should not number more than 10, should represent a “balanced score card” of basic health service delivery, should present no risk of “perverse incentive” and should be readily measurable. The same set of indicators should be used by all. CHMTs would assist facilities in setting targets and monitoring performance. RHMTs would play a similar role with respect to CHMTs. The Council Health Administration would provide a “check and balance” to avoid target manipulation and verify bonus payments due. The major constraint on feasibility is the poor state of health information. Our study confirmed the findings of previous ones, observing substantial omission and error in reports from facilities to CHMTs. We endorse the conclusion of previous reviewers that the main problem lies not with HMIS design, but with its functioning. We advocate a particular focus on empowering and enabling the use of information for management by facilities and CHMTs. We anticipate that P4P, combined with a major effort in HMIS capacity building – at the facility and council level – will deliver dramatic improvements in data quality and completeness. We recommend that the first wave of participating councils are selected on the basis that they can first demonstrate robust and accurate data. We anticipate that P4P for facilities will not deliver the desired benefits unless they have a greater degree of control to solve their own problems. We therefore propose - as a prior and essential condition – the introduction of petty cash imprests for all health facilities. We believe that such a measure would bring major benefits even to facilities that have not yet started P4P. It should also empower Health Facility Committees to play a more meaningful role in health service governance at the local level. We recommend to Government that P4P bonuses, as described here, are implemented across Mainland Tanzania on a phased basis. The main constraint on the pace of roll-out is the time required to bring information systems up to standard. Councils that are not yet ready to institute P4P should get an equivalent amount of money – to be used as general revenue to finance their comprehensive council health plans. We also recommend that up-to-date reporting on performance against service delivery indicators is made a mandatory requirement for all councils and is also agreed as a standard requirement for the Joint Annual Health Sector Review. P4P can also be applied on the “demand-side” – for example to encourage women to present in case of obstetric emergencies. There is a strong empirical evidence base from other countries to demonstrate that such incentives can work. We recommend a separate policy decision on whether or not to introduce demand-side incentives. In our view, they are sufficiently promising to be tried out on an experimental basis. When taken to national scale (all councils, excepting higher level hospitals), the scheme would require annual budgetary provision of about 6 billion shillings for bonus payments. This is equivalent to 1% of the national health budget, or about 3% of budgetary resources for health at the council level. We anticipate that design and implementation costs would amount to about 5 billion shillings over 5 years – the majority of this being devoted to HMIS strengthening at the facility level across the whole country
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