An enhanced framework for blood supply chain risk management

A blood supply chain (BSC) is a very long and complex sequence of processes heavily sequential. If one of them is executed in an incorrect way and this error is not detected, it leads to an incorrect transfusion outcome, that could seriously affect patients. For this reason, there is a strong need to identify and prevent adverse events along the entire BSC, in order to reduce their probability of occurrence. This also helps improving BSC sustainability from both the environmental and the social perspectives. The paper extends an existing healthcare supply chain risk management framework already applied to the blood transfusion process to address multiple BSC echelons and identify the cause and effect relationships among the adverse events that might occur. To this end, Fault Tree Analysis is added to the risk management tools part of the original framework as well as Key Performance Indicators are applied to detect risky event manifestation. The first application of the proposed approach to a blood bank and a hospital ward revealed its effectiveness in identifying the BSC activities most subjected to risk. Also, connections between adverse events and causal relationships among their sources were found, leading to understanding whether an adverse event is caused by a risk source in the same echelon where it occurs or by the concurrent manifestation of several adverse events upstream in the BSC. Future research will be devoted to numerically evaluate probability of occurrence and impact of risky events as well as integrating the framework with a classification of criticalities based on their severity

Circulating hematopoietic stem cells and putative intestinal stem cells in coeliac disease

Background: The intestinal stem cells (ISC) modulation and the role of circulating hematopoietic stem cells (HSC) in coeliac disease (CD) are poorly understood. Our aim was to investigate the longitudinal modifications in peripheral blood HSC traffic and putative ISC density induced by gluten-free diet (GFD) in CD. Methods: Thirty-one CD patients and 7 controls were enrolled. Circulating CD133+ and CD34+ HSC were measured by flow cytometry, at enrolment and after 7 days and 1, 3, 6, 12, and 24 months of GFD. Endoscopy was performed at diagnosis and repeated at 6, 12, and 24 months following GFD. We used the Marsh-Oberhuber score to evaluate the histological severity of duodenal damage; immunohistochemistry was employed to measure the intraepithelial lymphoid infiltrate (IEL, CD3+ lymphoid cells) and the putative ISC compartment (CD133+ and Lgr5+ epithelial cells). Results: At enrolment, circulating HSCs were significantly increased in CD patients and they further augmented during the first week of GFD, but progressively decreased afterwards. CD patients presented with villous atrophy, abundant IEL and rare ISC residing at the crypt base. Upon GFD, IEL progressively decreased, while ISC density increased, peaking at 12 months. After 24 months of GFD, all patients were asymptomatic and their duodenal mucosa was macroscopically and histologically normal. Conclusions: In active CD patients, the ISC niche is depleted and there is an increased traffic of circulating HSC versus non-coeliac subjects. GFD induces a precocious mobilization of circulating HSC, which is followed by the expansion of the local ISC compartment, leading to mucosal healing and clinical remission

Ambiguity in public sector performance measurement: a systematic literature review

Purpose – This paper presents a systematic literature review aiming at analysing how research has addressed performance measurement systems’ (PMSs) ambiguities in the public sector. This paper embraces the ambiguity perspective that PMSs in public sector coexist with and cope with existing ambiguities. Design/methodology/approach – The authors conducted a literature review in Scopus and ScienceDirect, considering articles published since 1985, and the authors selected articles published in the journals included in the Association of Business Schools’ Academic Journal Guide (Chartered ABS, 2018). Of the 1,278 abstracts that matched the study’s search criteria, the authors selected 131 articles for full reading and 37 articles for the final discussion. Findings – The study’s key findings concern the elements of ambiguity in PMSs discussed in the literature. The study’s results suggest that ambiguity is still a relevant problem in performance measurement, as a problem that is impossible to be solved and therefore needs to be better understood by researchers and public managers. The analysis allows us to summarize the antecedents and consequences of ambiguity in the public sector. Research limitations/implications – The key findings of the study concern the main sources of ambiguity in PMSs discussed in the literature, their antecedents and their consequences. The study results suggest that ambiguity exists in performance measurement and that is an issue to be handled with various strategies that can be implemented by managers and employees. Practical implications – Managers and researchers may benefit from this research as it may represent a guideline to understand ambiguities in their organizations or in field research. Researchers may also benefit from a summary list of the key issues that have been analysed in the empirical cases provided by this research. Social implications – This research may provide insights to limit ambiguity and thus contribute to improve performance measurement in the public sector. Originality/value – This research presents a comprehensive review on the topic. It provides insight that suggests what future research should attend to in helping to interpret ambiguity, considering also what should be done to influence ambiguity

Analisi dei processi e misurazione dei costi in sanità: il caso della prevenzione pubblica

Questo capitolo presenta il caso del Progetto Prodotti Finiti (PPFF) attuato nella Regione Friuli Venezia Giulia (FVG). I PPFF rappresentano le prestazioni erogate dai Dipartimenti di Prevenzione, costituiti da processi, descritti da diagrammi di flusso, e composti da attività collegate da relazioni logiche. Rispetto alle attività sono inoltre indicati gli attori coinvolti e i tempi di svolgimento. Il Progetto PPFF in Regione FVG è stato diretto alla rappresentazione, analisi e valorizzazione economica dei diversi processi messi in atto nei Dipartimenti preposti all’area della prevenzione collettiva e della sanità pubblica nella Regione oggetto di studio. L’approccio utilizzato è stato di tipo quali-quantitativo, e comprende action research e questionario. Ciò ha portato allo sviluppo di un sistema contabile che descrive in modo chiaro le attività dei Dipartimenti e permette di determinare il consumo di risorse in modo puntuale, fornendo così un contributo rispetto alle valutazioni di efficienza e alla definizione di linea guida per i professionisti. In particolare, il Sistema PPFF permette di effettuare un confronto fra le risorse consumate ed i processi che risultano dall’attività del settore, mettendo quindi in relazione gli input e gli output. Consente inoltre di discutere le specifiche caratteristiche dei processi del settore della prevenzione, ponendo le basi per supportare anche le decisioni inerenti il finanziamento degli stessi

Il problema dell’ambiguità nei sistemi di misurazione della performance nel settore pubblico: un’analisi della letteratura internazionale

This paper aims at examining how the issue of ambiguity in performance measurement systems in the public sector has been addressed in international literature. Particularly, the research highlights the variables of ambiguity that the literature reports at an organizational and an individual level, with reference to two perspectives: an objective perspective related to certain characteristics of the performance measurement systems, and a subjective perspective referring to the perceptions of the actors who are the recipients of these objectives. The authors conducted a systematic literature review in Scopus and ScienceDirect. Of the 1,148 abstracts analyzed, the authors selected 126 articles for full reading and accepted 27 for final discussion. The research presents the antecedents and the consequences for each ambiguity variable, reporting the factors that enable and inhibit ambiguity in the design and application of performance measurement systems in the public sector. This paper not only analyzes and interprets ambiguity in the public sector, but also summarizes the main indications for future research, contributing to the research in an area that is poorly investigated and that has significant relevance for the effectiveness of performance measurement systems in the public sector

Analisi dei processi e misurazione dei costi in sanità: il caso della prevenzione pubblica

none3Questo capitolo presenta il caso del Progetto Prodotti Finiti (PPFF) attuato nella Regione Friuli Venezia Giulia (FVG). I PPFF rappresentano le prestazioni erogate dai Dipartimenti di Prevenzione, costituiti da processi, descritti da diagrammi di flusso, e composti da attività collegate da relazioni logiche. Rispetto alle attività sono inoltre indicati gli attori coinvolti e i tempi di svolgimento. Il Progetto PPFF in Regione FVG è stato diretto alla rappresentazione, analisi e valorizzazione economica dei diversi processi messi in atto nei Dipartimenti preposti all’area della prevenzione collettiva e della sanità pubblica nella Regione oggetto di studio. L’approccio utilizzato è stato di tipo quali-quantitativo, e comprende action research e questionario. Ciò ha portato allo sviluppo di un sistema contabile che descrive in modo chiaro le attività dei Dipartimenti e permette di determinare il consumo di risorse in modo puntuale, fornendo così un contributo rispetto alle valutazioni di efficienza e alla definizione di linea guida per i professionisti. In particolare, il Sistema PPFF permette di effettuare un confronto fra le risorse consumate ed i processi che risultano dall’attività del settore, mettendo quindi in relazione gli input e gli output. Consente inoltre di discutere le specifiche caratteristiche dei processi del settore della prevenzione, ponendo le basi per supportare anche le decisioni inerenti il finanziamento degli stessi.mixedLino Cinquini; Cristina Campanale; Chiara OppiCinquini, Lino; Campanale, Cristina; Oppi, Chiar

Il problema dell’ambiguità nei sistemi di misurazione della performance nel settore pubblico: un’analisi della letteratura internazionale

This paper aims at examining how the issue of ambiguity in performance measurement systems in the public sector has been addressed in international literature. Particularly, the research highlights the variables of ambiguity that the literature reports at an organizational and an individual level, with reference to two perspectives: an objective perspective related to certain characteristics of the performance measurement systems, and a subjective perspective referring to the perceptions of the actors who are the recipients of these objectives. The authors conducted a systematic literature review in Scopus and ScienceDirect. Of the 1,148 abstracts analyzed, the authors selected 126 articles for full reading and accepted 27 for final discussion. The research presents the antecedents and the consequences for each ambiguity variable, reporting the factors that enable and inhibit ambiguity in the design and application of performance measurement systems in the public sector. This paper not only analyzes and interprets ambiguity in the public sector, but also summarizes the main indications for future research, contributing to the research in an area that is poorly investigated and that has significant relevance for the effectiveness of performance measurement systems in the public sector