Assessing the Effectiveness of a Performance Evaluation System in the Public Health Care Sector: Some Novel Evidence from the Tuscany Region Experience

Since 80's the introduction of New Public Management principles has promoted the use of performance measurement to drive a more efficient, effective and accountable public sector. The adoption of a sophisticated and comprehensive multidimensional performance measurement system, which looks beyond traditional financial measures, based on organization strategies, such as the balanced scorecard, has thus been suggested. This revolution in the public management came together with the devolution processes that involved most European public health systems. Set within this context, in the last decade, each of the twenty Italian regions developed its own management tools. Among others, the Tuscan performance evaluation system (PES) has been valued as a particularly innovative and comprehensive system. This paper reports the novel experience of the Tuscan PES; in particular, it measures PES effectiveness and discusses the critical factors that could have led to the PES success. Five are the critical success factors identified by researchers: the visual reporting system, the linkage between PES and CEO's reward system, the public disclosure of data, the high level of employees and managers involvement into the entire process and the strong political commitment. All those factors run together to achieve better results; however, the process of development of the system plays a pivotal role. Scholars suggest the use of a constructive approach in order to gain effective changes in human organization. According to this stream of literature, this paper contributes by the novel experience of the Tuscan PES in addressing as a further fruitful application of the constructivist approach in healthcare

Design, techno-economic and environmental risk assessment of aero-derivative industrial gas turbine

Increased availability of natural gas has boosted research and development efforts to further increase gas turbine performance. Performance has been increased remarkably and unit cost reduced due to achievements gained in improving thermodynamic cycles and cooling technologies. However, increased complexity in power industry regulations and fluctuations in fuel price have indicated that all the aforementioned improvements in gas turbine performance could not cope with the increased competition in the gas turbine industrial market. Innovation within the aero-derivative concept has enabled further significant improvement in the performance of industrial gas turbines. It allows a more beneficial approach than developing new designs of industrial gas turbines owing to reduced designing time and cost. Objectives in this project focus on developing a methodology of design and assessing aeroderivative gas turbine engines derived from a 130-seat aircraft engine. Developed methodology includes techno-economic and environmental assessment, conducted through further developments of models based on Techno-economic and Environmental Risk Assessment (TERA) philosophy, to be applied in further industrial applications. Tools used in this investigation include a significant literature research on the development of aero-derivative gas turbine technologies, including thermodynamic cycles and its land-based applications. Turbomatch is a homebased code developed in Cranfield University, used in calculating design point and predicting off-design performance of parent aero-engine and the aeroderivative engines developed. Excel and FORTRAN code are also used in calculating engine’s design parameters, and creating a model of life estimation Creep. Moreover, FORTRAN code is used for building emission and economic models for power generation and combined heat and power applications. Finally, MATLAP code is used in creating a small model for generating performance TXT files, and running marine integrated models platform. All models needed to develop the methodology have been created, and calculations of an engine’s performance and assessment were conducted based on this developed methodology. Sensible results are generated from the investigated methodology and they show acceptable designs of aero-derivative engines on different thermodynamic cycles. Based on the acceptable level of technology and material thermal barriers, all design and off-design performance limitations of new developed aero-derivative engines have been determined for a wide range of ambient conditions. Techno-economic and environmental assessment performed through implementing the developed aero-derivative engines on power generation and marine applications under different operating scenarios. Results of operating the engines on power generation and marine applications have been investigated and compared. It is observed that engines respond differently when operating under different environmental profiles, depending on the number of units engaged and their thermodynamic cycle as well as mechanical configurations. Also, the selected specific gas turbine engine can be the best economical choice for operating on determined scenario, while it cannot be when operating in different scenarios. Assessment of developed engines on the investigated application shows how the lowest specific cost (small engine size) can constitute important criteria in engine selection

Phenotypic plasticity in wild marine fishes associated with fish-cage aquaculture

16 pages, 5 figures, 3 tablesTwo opportunistic fish species associated with fish farms, bogue (Boops boops) and salema (Sarpa salpa), were studied to infer whether changes in their feeding habits may cause a phenotypic response in body and otolith shape. Specimens were collected close to aquaculture cage sites, called ‘wild-farmed fish’, and from control sites far away from these areas, called ‘wild fish’. The fish body shapes were examined with geometric morphometric analysis using 21 landmarks. The otolith contours were analysed using wavelet function, whereas otolith weights were used as indicators of fish growth rates. Statistically significant differences were observed in body shape between wild-farmed fish and wild fish of both species. The wild-farmed fish had a smaller head and eye, and in bogue also a slighter snout curvature and head depth. Otolith shape and weight did not differ between groups in bogue. By contrast, there were significant differences in otolith shape and weight between groups in salema. A complementary study in salema indicated that the wild-farmed fishes grew more in weight and accumulated higher concentrations of ‘terrestrial fatty acids’ (linoleic and alpha-linolenic acids), which are used in fish feeds. Our findings clearly demonstrated an influence of coastal sea cages on metabolism of some wild fishesThe research staff of ULPGC was partially supported by the Campus Atlántico TricontinentalPeer Reviewe

Identification and ranking of specific balanced scorecard performance measures for hospitals: a case study of private hospitals in the Klang Valley area, Malaysia

Performance measurement is a necessity for private hospitals as they need to be efficient, attract customers, increase profitability, and survive in the competitive environment of the health care industry. Hospitals typically struggle to identify appropriate performance measures because of lack of reliable source of performance measures for private hospitals. Despite numerous studies on performance measurement, few studies have focused on performance measures in private hospitals. This paper aims to fill that gap by identifying and ranking a specific set of performance measures that are feasible and relevant for private hospitals. Forty-four health care performance measures in four balanced scorecard (BSC) performance perspectives (financial, customer, internal business processes, and learning and growth) were compiled and filtered based on “feasibility” and “relevance” criteria using a questionnaire survey in private hospitals in the Klang Valley area, Malaysia. Since all collected data were in numeric format, data analysis was performed quantitatively. Consequently, 31 BSC performance measures were identified for private hospitals. Next, the 31 performance measures went through a ranking survey in Klang Valley private hospitals. Therefore, a weight between 0 and 1 with a range of 0.095 to 0.207 was obtained for each performance measure to help hospitals quantify their overall performance more accurately