Understanding the context of balanced scorecard implementation: a hospital-based case study in pakistan

Background: As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods: Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp\u27s context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation.Results: Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data networks. Conclusion: Variable levels of the BSC implementation were observed in this study. Those intending to apply the BSC in other hospital settings need to ensure a participatory culture, clear institutional mandate, appropriate leadership support, proper reward and recognition system, and sensitization to BSC benefits

Structural shape optimization using Cartesian grids and automatic h-adaptive mesh projection

[EN] We present a novel approach to 3D structural shape optimization that leans on an Immersed Boundary Method. A boundary tracking strategy based on evaluating the intersections between a fixed Cartesian grid and the evolving geometry sorts elements as internal, external and intersected. The integration procedure used by the NURBS-Enhanced Finite Element Method accurately accounts for the nonconformity between the fixed embedding discretization and the evolving structural shape, avoiding the creation of a boundary-fitted mesh for each design iteration, yielding in very efficient mesh generation process. A Cartesian hierarchical data structure improves the efficiency of the analyzes, allowing for trivial data sharing between similar entities or for an optimal reordering of thematrices for the solution of the system of equations, among other benefits. Shape optimization requires the sufficiently accurate structural analysis of a large number of different designs, presenting the computational cost for each design as a critical issue. The information required to create 3D Cartesian h- adapted mesh for new geometries is projected from previously analyzed geometries using shape sensitivity results. Then, the refinement criterion permits one to directly build h-adapted mesh on the new designs with a specified and controlled error level. Several examples are presented to show how the techniques here proposed considerably improve the computational efficiency of the optimization process.The authors wish to thank the Spanish Ministerio de Economia y Competitividad for the financial support received through the project DPI2013-46317-R and the FPI program (BES-2011-044080), and the Generalitat Valenciana through the project PROMETEO/2016/007.Marco, O.; Ródenas, J.; Albelda Vitoria, J.; Nadal, E.; Tur Valiente, M. (2017). 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Prospective study of morbidity of cancellous iliac bone harvesting in children for secondary alveolar cleft grafting

We present a theory of acoustic tomography based on data processing shear wave scattered field over an observational plane, including frequency and polarization diversities. The theory is based on the Gubernatis formulation of scattering and does not require solution of the Fredholm equation for material displacement u. An essential feature of the theory is an expansion of vjkuk in even powers of frequency to obtain an “equivalent frequency insensitive” source in the anomaly

Parallel solution of contact shape optimization problems based on Total FETI domain decomposition method

An application of a variant of the parallel domain decomposition method that we call Total FETI or TFETI (Total Finite Element Tearing and Interconnecting) for the solution of contact problems of elasticity to the parallel solution of contact shape optimization problems is described. A unique feature of the TFETI algorithm is its capability to solve large contact problems with optimal, i.e., asymptotically linear complexity. We show that the algorithm is even more efficient for the solution of the contact shape optimization problems as it can exploit effectively a specific structure of the auxiliary problems arising in the semi-analytic sensitivity analysis. Thus the triangular factorizations of the stiffness matrices of the subdomains are carried out in parallel only once for each design step, the evaluation of the components of the gradient of the cost function can be carried out in parallel, and even the evaluation of each component of the gradient itself can be further parallelized using the standard TFETI scheme. Theoretical results which prove asymptotically linear complexity of the solution are reported and documented by numerical experiments. The results of numerical solution of a 3D contact shape optimization problem confirm the high degree of parallelism of the algorithm