Volume 3, Issue 3, July 2010 Edition
Goldratt’s Theory Applied to the Problems Associated with an
Emergency Department at a Hospital
Lloyd J. Taylor, III and Soumya Nayak
Abstract
Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED). It is at the emergency department that patients’ expectations regarding staff communication with patients, wait times, the triage process, capacity and payment will determine a significant part of a hospital’s revenue. Using Dr. Eliyahu M. Goldratt’s Thinking Process, we will determine what core problem(s) are causing a 362-bed regional West Texas hospital emergency department to lose revenue. Evaluation of the current emergency department will determine the Undesirable Effects (UDE). Using that information will lead to the construction of the Current Reality Tree (CRT), which will bring focus to the core problem(s). To break the constraints, which are the core problem(s), an Evaporative Cloud (EC) is generated. And, the end result will be to construct a Future Reality Tree (FRT), which will validate the idea(s) generated in the EC. It was determined that there are ten major UDE’s that affected this hospital’s emergency department. They were focused around staff communication, wait times, triage process, information management, service provided and bill collections. A conclusion was made that the core problem dealt with triaging patients and utilization of the services provided by the hospital. Since the reimbursement rate is affected by the patient’s satisfaction, the areas to focus on would be: triage, education, communication and retention. Although it may be neither feasible nor desirable to meet all the patient’s expectations, increased focus on those areas may increase the emergency department’s efficiency and the hospital’s bottom line.
Key words: emergency room management; constraint management; theory of constraints; Goldratt’s thinking and problem solving process
Ambiguity in Timber Trade Regarding Efforts to Combat Illegal Logging: Potential Impacts on Trade between South-East Asia and Europe
Alexandru Giurca, Ragnar Jonsson, Francesca Rinaldi, and Hari Priyadi
Abstract
Raised public concern in the European Union (EU) about the legality of its timber imports has pushed the European Commission to raise its standards and legality demands for wood imports. Combining literature reviews, structured interviews and trade data analyses, this study assesses the potential influence from Forest Law Enforcement Governance and Trade (FLEGT) (with its Voluntary Partnership Agreements (VPA) system and new legislation EU Timber Regulation (EUTR)), and third party verification schemes on the timber trade between tropical countries and Europe. These instruments have the potential to reduce the amount of illegally sourced timber being placed on the market, and they seem to have resulted in both increasing support of legality verification and certification uptake. However, there are signs of increased ambiguity in trade that could originate as a side effect of the transition towards a stricter regulation for tropical timber. Such ambiguity is explicitly taken into account here. Possible consequences from increased ambiguity are substitution of oak lumber for tropical hardwood lumber, and a diversion of exports of tropical timber to destinations with a less stringent regulatory framework than the EU. Evidence of these trade patterns in the literature reviews, interviews, and trade data analyses seems to confirm that ambiguity in international trade markets has actually increased since the introduction of these instruments.
Key words: FLEGT; EUTR; certification; illegal logging; ambiguity; timber trade
Analysis of Stimuli Attracting Customer Buying Behavior and their Satisfaction Level in Modern as Well as in Conventional Retail Stores
Dipin Mathur, Manoj Kumar Sharma
Abstract
The paper highlights the stimuli that attract a prospective buyer in modern retail mall and conventional stores and researcher made a comparative analysis of those variables between modern retail format and conventional retail store. The purpose of this research is specifically to compare the level of satisfaction of the customers with the offerings and attributes offered to them in modern retail formats vis-à-vis conventional shopping stores.
Key words: attracting, customer, behavior, satisfaction level
The Effectiveness of Drinking and Driving Policies for Different Alcohol-Related Fatalities: A Quantile Regression Analysis
Yung-Hsiang Ying, Chin-Chih Wu, and Koyin Chang
Abstract
To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles), people’s habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because “preemptive regulations” are more effective. For areas with high fatality rates (or high quantiles), “ex-post regulations” are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates.
Key words: quantile regression analysis; alcohol-related traffic fatalities; policies
There is Something about Marrying… The Case of Human Rights vs. Migration Regimes using the Example of Austria
Irene Messinger
Abstract
States pursue various juridical strategies to prevent ‘marriages of convenience’ seen as undermining tightening migration regimes. This article examines how Austrian Alien Law constitutes entering into such a marriage as a criminal offense and looks at the legal proceedings in district courts in Vienna where most cases of alleged ‘marriages of convenience’ are being dealt with. It also studies the work of the Viennese branch of alien police investigating into this offense. These practices are often in conflict with Article 8 and 12 of the European Convention of Human Rights, granting the right to respect for private and family life and the right to marry.
Key words: Austria; Alien Law Act; bi-national marriage; migration regulations; Article 8 ECHR; Article 12 ECHR; marriage of convenience
Assessing Outcomes of Online Training in Public Health: Changes in Individual and Organizational Knowledge and Capacity
John W. Wallace, Jennifer A. Horney, Rachel A. Wilfert, and Lorraine K. Alexander
Abstract
The need for a well-prepared public health workforce to prepare for and respond to threats of terrorism, infectious diseases, and other public health emergencies is well documented, as is the reality that the public health workforce in the United States is under-trained and unprepared to handle public health emergencies. The impact of training on the public health workforce is often measured by the volume of training completed and post-course evaluation data. A survey of current, high-volume users (n = 759) of the University of North Carolina Center for Public Health Preparedness Training Web Site, defined as individuals who had completed 12 or more training modules was conducted in order to determine if measurable changes in preparedness and response knowledge and capacity were brought about by the trainings. Two-hundred and seventy respondents completed the survey (response rate = 36%), with 52% reporting employment in governmental public health. Individual changes reported as a result of training included increased personal satisfaction (71%), increased job satisfaction (38%), and recognition by supervisors for training completion (23%); Organizational changes included updates to training plans (19%), making trainings mandatory (19%), and revising standard operating procedures (13%). Results from this survey indicate that the knowledge learned from completing online trainings led to changes in individuals and, to a lesser extent, changes in organizations.
Key words: online; training; public health; preparedness; individual knowledge; organizational change
Religious Observance and Well-Being among Israeli Jewish Adults: Findings from the Israel Social Survey
Jeff Levin
Abstract
This study reports on analyses of Jewish respondents (N = 6,056) from the 2009 Israel Social Survey. Multivariable methods were used to investigate whether religiously observant Jews have greater physical and psychological well-being. After adjustment for age and other sociodemographic correlates of religion and well-being and for a measure of Israeli Jewish religious identity (i.e., secular, traditional, religious, ultra-Orthodox), two findings stand out. First, greater Jewish religious observance is significantly associated with higher scores on indicators of self-rated health, functional health, and life satisfaction. Second, there is a gradient-like trend such that greater religiousness and life satisfaction are observed as one moves “rightward” across religious identity categories. These findings withstand adjustment for effects of all covariates, including Israeli nativity and Jewish religious identity.
Key words: religion; health; well-being; Judaism; Israel
Locally Based Development—Tools for Identifying Opportunities and Evaluating Port Area Strategies of Rijeka
Iva Mrak
Abstract
Cities are traditionally considered as centers of prosperity, but after a long process of deindustrialization, the classical opportunities presented by cities as administrative, production, financial and cultural hot spots can no longer be taken for granted without questioning the present organizational and spatial models. After an introduction to the decision-aid tools and processes needed to orient development in a sustainable way, the paper describes the characteristics and an application of the decision-aid tool created for analysis, diagnosis and evaluation of opportunities. The proposal briefly considers the reconnection of the city with its region, urban renewal, creative and productive activities, necessary support institutions, contemporary sustainable economic approaches and infrastructure. This approach is illustrated on the case of the incubator proposal for the City of Rijeka, Croatia, once an important port and industrial city with a long history. The technological modifications in the functioning of the port and abandoning of industrial production in the proximity, but also geological formation and prevalent building typologies, make the case exemplary of the problems faced in contemporary cities. The paper proposes a process and tools for analysis and evaluation and indicators for the sustainability of the proposal.
Key words: sustainability; renewal; decision-aid tools; analysis tools; monitoring tools
Lloyd J. Taylor, III and Soumya Nayak
Abstract
Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED). It is at the emergency department that patients’ expectations regarding staff communication with patients, wait times, the triage process, capacity and payment will determine a significant part of a hospital’s revenue. Using Dr. Eliyahu M. Goldratt’s Thinking Process, we will determine what core problem(s) are causing a 362-bed regional West Texas hospital emergency department to lose revenue. Evaluation of the current emergency department will determine the Undesirable Effects (UDE). Using that information will lead to the construction of the Current Reality Tree (CRT), which will bring focus to the core problem(s). To break the constraints, which are the core problem(s), an Evaporative Cloud (EC) is generated. And, the end result will be to construct a Future Reality Tree (FRT), which will validate the idea(s) generated in the EC. It was determined that there are ten major UDE’s that affected this hospital’s emergency department. They were focused around staff communication, wait times, triage process, information management, service provided and bill collections. A conclusion was made that the core problem dealt with triaging patients and utilization of the services provided by the hospital. Since the reimbursement rate is affected by the patient’s satisfaction, the areas to focus on would be: triage, education, communication and retention. Although it may be neither feasible nor desirable to meet all the patient’s expectations, increased focus on those areas may increase the emergency department’s efficiency and the hospital’s bottom line.
Key words: emergency room management; constraint management; theory of constraints; Goldratt’s thinking and problem solving process
 [Abstract-PDF]
|
[References]
|
3.3.7.2010.1
|
Ambiguity in Timber Trade Regarding Efforts to Combat Illegal Logging: Potential Impacts on Trade between South-East Asia and Europe
Alexandru Giurca, Ragnar Jonsson, Francesca Rinaldi, and Hari Priyadi
Abstract
Raised public concern in the European Union (EU) about the legality of its timber imports has pushed the European Commission to raise its standards and legality demands for wood imports. Combining literature reviews, structured interviews and trade data analyses, this study assesses the potential influence from Forest Law Enforcement Governance and Trade (FLEGT) (with its Voluntary Partnership Agreements (VPA) system and new legislation EU Timber Regulation (EUTR)), and third party verification schemes on the timber trade between tropical countries and Europe. These instruments have the potential to reduce the amount of illegally sourced timber being placed on the market, and they seem to have resulted in both increasing support of legality verification and certification uptake. However, there are signs of increased ambiguity in trade that could originate as a side effect of the transition towards a stricter regulation for tropical timber. Such ambiguity is explicitly taken into account here. Possible consequences from increased ambiguity are substitution of oak lumber for tropical hardwood lumber, and a diversion of exports of tropical timber to destinations with a less stringent regulatory framework than the EU. Evidence of these trade patterns in the literature reviews, interviews, and trade data analyses seems to confirm that ambiguity in international trade markets has actually increased since the introduction of these instruments.
Key words: FLEGT; EUTR; certification; illegal logging; ambiguity; timber trade
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.2
|
Analysis of Stimuli Attracting Customer Buying Behavior and their Satisfaction Level in Modern as Well as in Conventional Retail Stores
Dipin Mathur, Manoj Kumar Sharma
Abstract
The paper highlights the stimuli that attract a prospective buyer in modern retail mall and conventional stores and researcher made a comparative analysis of those variables between modern retail format and conventional retail store. The purpose of this research is specifically to compare the level of satisfaction of the customers with the offerings and attributes offered to them in modern retail formats vis-à-vis conventional shopping stores.
Key words: attracting, customer, behavior, satisfaction level
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.3
|
The Effectiveness of Drinking and Driving Policies for Different Alcohol-Related Fatalities: A Quantile Regression Analysis
Yung-Hsiang Ying, Chin-Chih Wu, and Koyin Chang
Abstract
To understand the impact of drinking and driving laws on drinking and driving fatality rates, this study explored the different effects these laws have on areas with varying severity rates for drinking and driving. Unlike previous studies, this study employed quantile regression analysis. Empirical results showed that policies based on local conditions must be used to effectively reduce drinking and driving fatality rates; that is, different measures should be adopted to target the specific conditions in various regions. For areas with low fatality rates (low quantiles), people’s habits and attitudes toward alcohol should be emphasized instead of transportation safety laws because “preemptive regulations” are more effective. For areas with high fatality rates (or high quantiles), “ex-post regulations” are more effective, and impact these areas approximately 0.01% to 0.05% more than they do areas with low fatality rates.
Key words: quantile regression analysis; alcohol-related traffic fatalities; policies
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.4
|
There is Something about Marrying… The Case of Human Rights vs. Migration Regimes using the Example of Austria
Irene Messinger
Abstract
States pursue various juridical strategies to prevent ‘marriages of convenience’ seen as undermining tightening migration regimes. This article examines how Austrian Alien Law constitutes entering into such a marriage as a criminal offense and looks at the legal proceedings in district courts in Vienna where most cases of alleged ‘marriages of convenience’ are being dealt with. It also studies the work of the Viennese branch of alien police investigating into this offense. These practices are often in conflict with Article 8 and 12 of the European Convention of Human Rights, granting the right to respect for private and family life and the right to marry.
Key words: Austria; Alien Law Act; bi-national marriage; migration regulations; Article 8 ECHR; Article 12 ECHR; marriage of convenience
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.5
|
Assessing Outcomes of Online Training in Public Health: Changes in Individual and Organizational Knowledge and Capacity
John W. Wallace, Jennifer A. Horney, Rachel A. Wilfert, and Lorraine K. Alexander
Abstract
The need for a well-prepared public health workforce to prepare for and respond to threats of terrorism, infectious diseases, and other public health emergencies is well documented, as is the reality that the public health workforce in the United States is under-trained and unprepared to handle public health emergencies. The impact of training on the public health workforce is often measured by the volume of training completed and post-course evaluation data. A survey of current, high-volume users (n = 759) of the University of North Carolina Center for Public Health Preparedness Training Web Site, defined as individuals who had completed 12 or more training modules was conducted in order to determine if measurable changes in preparedness and response knowledge and capacity were brought about by the trainings. Two-hundred and seventy respondents completed the survey (response rate = 36%), with 52% reporting employment in governmental public health. Individual changes reported as a result of training included increased personal satisfaction (71%), increased job satisfaction (38%), and recognition by supervisors for training completion (23%); Organizational changes included updates to training plans (19%), making trainings mandatory (19%), and revising standard operating procedures (13%). Results from this survey indicate that the knowledge learned from completing online trainings led to changes in individuals and, to a lesser extent, changes in organizations.
Key words: online; training; public health; preparedness; individual knowledge; organizational change
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.6
|
Religious Observance and Well-Being among Israeli Jewish Adults: Findings from the Israel Social Survey
Jeff Levin
Abstract
This study reports on analyses of Jewish respondents (N = 6,056) from the 2009 Israel Social Survey. Multivariable methods were used to investigate whether religiously observant Jews have greater physical and psychological well-being. After adjustment for age and other sociodemographic correlates of religion and well-being and for a measure of Israeli Jewish religious identity (i.e., secular, traditional, religious, ultra-Orthodox), two findings stand out. First, greater Jewish religious observance is significantly associated with higher scores on indicators of self-rated health, functional health, and life satisfaction. Second, there is a gradient-like trend such that greater religiousness and life satisfaction are observed as one moves “rightward” across religious identity categories. These findings withstand adjustment for effects of all covariates, including Israeli nativity and Jewish religious identity.
Key words: religion; health; well-being; Judaism; Israel
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.7
|
Locally Based Development—Tools for Identifying Opportunities and Evaluating Port Area Strategies of Rijeka
Iva Mrak
Abstract
Cities are traditionally considered as centers of prosperity, but after a long process of deindustrialization, the classical opportunities presented by cities as administrative, production, financial and cultural hot spots can no longer be taken for granted without questioning the present organizational and spatial models. After an introduction to the decision-aid tools and processes needed to orient development in a sustainable way, the paper describes the characteristics and an application of the decision-aid tool created for analysis, diagnosis and evaluation of opportunities. The proposal briefly considers the reconnection of the city with its region, urban renewal, creative and productive activities, necessary support institutions, contemporary sustainable economic approaches and infrastructure. This approach is illustrated on the case of the incubator proposal for the City of Rijeka, Croatia, once an important port and industrial city with a long history. The technological modifications in the functioning of the port and abandoning of industrial production in the proximity, but also geological formation and prevalent building typologies, make the case exemplary of the problems faced in contemporary cities. The paper proposes a process and tools for analysis and evaluation and indicators for the sustainability of the proposal.
Key words: sustainability; renewal; decision-aid tools; analysis tools; monitoring tools
| [Abstract-PDF]
|
[References]
|
3.3.7.2010.8
|
