Conservation and laundry: using outside vendors to clean reusable linens

Using outside laundry facilities is a viable and efficient means for hospitals to clean and sanitize soiled linens. Such services also allow hospitals to achieve cost-effective linen systems. All kinds of linen products, including gowns, sheets, blankets, pillowcases, mops, diapers, and surgical textiles, are easily processed through such purveyors. Even newer fabrics with improved barrier protection qualities can be serviced. The three elements that make up the laundry cost equation are purchasing, processing, and usage. Improvements and reductions in any one of these areas positively affect the other two. With this in mind, a hospital and an outside laundry service should work closely together to improve linen management, to control usage, and to remove waste, thus reducing hospitals' per-patient-day costs. Close interaction and teamwork will make the relationship work with dynamic results. Together, both parties will grow and meet the ever-evolving needs of the health care industry.     

The determinants of nursing home costs in Nebraska's proprietary nursing homes.

In the past few years nursing home care expenditures in Nebraska and the U.S. have been the fastest growing component of total health care expenditures. This rate of increase is particularly alarming in view of the fact that nursing home care is financed primarily by the Medicaid program or direct out-of-pocket payments. In fact, given the cutbacks in federal and state funds for this program, consumers will be forced to allocate a larger share of their income to meet the costs of nursing home care. Although nursing home expenditures have grown at an extremely rapid rate, relatively few empirical studies exist which analyze the cost function of nursing home providers. The purpose of this study is to identify factors which have directly influenced the cost of nursing home care in Nebraska and to evaluate the current Nebraska Medicaid reimbursement system in terms of its impact upon nursing home costs. The study was limited to a sample of 40 nursing homes in Nebraska which represents 42% of the total proprietary nursing homes in the state. The sample was limited to those facilities licensed only as an Intermediate Care Facility--I and they had to be receiving some Medicaid revenue. The data were averaged over the period of 1977-79, but the year of analysis corresponded to 1978. Multiple regression analysis was used to measure the effect of the hypothesized independent variables upon two different measures of cost--the average total cost per patient day and the average variable cost per patient day. In the first regression model 76% of the variance was explained and 71% was explained in the second equation. The results of this analysis are basically consistent with the findings of other studies and indicate that the number of staffing hours, patient mix, facility age, administrator experience and administrative intensity are significant determinants of nursing home costs. The most important finding from a policy perspective is that the current retrospective cost-related Medicaid reimbursement system does not provide incentives for minimizing costs. In fact, the present system encourages administrators to overutilize resources and charge higher prices. Considerable evidence exists which suggests that a prospective system would encourage a more efficient allocation of resources without adversely affecting the quality of care. Given the increase in the state's share of the total Medicaid budget, it would appear that a change to a prospective system is critical in order to maintain the financial accessibility to nursing home care by all Nebraska residents.     

Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains

Over the past 10 years, merger activities in the private for-profit nursing home industry have been increasing in Europe. In this paper, we investigate chain affiliation’s influence on the performance of lucrative nursing homes. We measure performance using a cost frontier estimated by stochastic analysis on a sample of 370 French for-profit nursing homes. We find that cost efficiency decreases with the number of facilities in a chain. We also identify different external actor types in nursing homes’ institutional environment and test their influence. We show that nursing home chains’ cost efficiency improves when local governments and shareholders exert pressure. Our results are robust to alternative model specifications and another definition of costs. Overall, our findings inform researchers, as well as standards setters, of the relevance of chain affiliation and of the role of institutional pressures regarding cost containment at the nursing home level.     

Materiel management reengineering: value creation through innovation

By reengineering their department's core processes, materiel managers can expand their role in the health care setting while realizing significant cost savings. Using a team model, Inova Health System materiel management staff integrated their processes for vendor selection, purchasing, inventory reduction, and utilization across three hospitals and ancillary services. An integrated approach at all levels of the organization gained buy-in from administrators and staff systemwide.     

Managing the performance of outsourced customer contact centers

This research focuses specifically on customer contact services that have been outsourced to external suppliers. The performance of the contact services supplier directly affects end customer satisfaction which underlines the need for appropriate management of customer contacts and consideration of the end customer's perspective in designing appropriate key performance indicators (KPIs). This research draws on various streams of literature including services purchasing, performance management and service quality to derive propositions on how to manage customer contact services suppliers. These propositions are subsequently investigated in an in-depth case study. The results of the case study show that managing customer contact services suppliers on effectiveness rather than efficiency benefits the overall performance of the supplier. This research shows that quality improvements in both process and service delivery ultimately lead to decreased costs. These improvements will furthermore enhance customer satisfaction and improve buying company performance. The current trend in selecting and managing suppliers for outsourced business processes is on efficiency improvements and cost savings. However, this research shows that this type of focus can actually decrease customer satisfaction and increase costs.     

基于合作博弈的环保设备选择成本分摊问题研究

环保设备往往无法完全治理污染,导致生产企业不仅要承担环保设备的购置成本,还要交纳未治理污染产生的排污费。越先进的环保设备污染治理率越高,但越先进的环保设备购置成本也就越高。本文将环保设备的购置成本与排污费结合起来,应用合作博弈理论,将环保设备选择问题构造为成本分摊博弈。在环保设备污染治理能力足够大的假设下,该成本分摊博弈的核非空,具有次可加性、凹性等性质,并讨论了核、夏普利值等解。     

Preferred supplier programs for consulting services: An exploratory study of German client companies

Research has recently provided evidence that at least some companies have involved purchasing departments in buying professional services such as management consulting services. Some departments have established preferred supplier programs (PSPs) for consulting services, i.e., programs for consultancies with whom a company seeks to build up long-term relationships. While there are several studies that analyze such programs for suppliers of goods, research on business services is limited. Our aim is to present an exploratory analysis of PSPs for consulting services. Based on a survey of German client companies, we found that the most important reason for establishing PSPs is to reduce costs and transaction costs. Furthermore, our findings revealed that companies with and without PSPs for consulting services apply high significance to relational selection criteria. Moreover, in companies with PSPs, purchasing departments are more frequently involved in selecting consultancies compared to companies without PSPs. Finally, we found that companies with and without PSPs do not differ in their assessment of problems associated with the purchasing of consulting services. The study contributes to research on the purchasing of consulting services by indicating that the consultant–manager relationship should be extended to a service triad, involving purchasing professionals, managers, and consultants. Moreover, we contribute to research on PSPs by extending the focus to PSPs for knowledge-intensive service providers.     

The path to outcome delivery: Interplay of service market strategy and open business models

Firms in a variety of manufacturing sectors as well as the software industry have increasingly embraced services alongside their product portfolios in order to improve financial performance. Yet, the key question “How do service market strategy change and the accompanying business model change interact, and how does their interplay affect value creation?” remains open. Relying on twelve case studies of firms that have shifted towards providing highly advanced services (e.g. outcome-based contracts), theoretical propositions concerning the interplay of market strategy and business model on value creation are derived. The firms studied report two interdependent changes: first, they evolve the market strategy from provision of pure products to provision of services and then outcomes, in order to achieve a better fit with customer needs and to grow their service businesses. Second, they rely increasingly on partners and suppliers to provide new activities that are outside their competence base. This 'open business model' allows them to grow their new service businesses effectively and efficiently. At the same time, however, the shift to a service market strategy requires enhanced accountability to customers and increases the threat of penalties in the case of failure, while reliance on partners and suppliers leads to loss of control over the activity system and increases the threat of failure due to third party dependency. Thus, this paper finds that the success of firms that shift to services and outcomes hinges on their ability to balance the trade-off between increased value (i.e. growth, efficiency and effectiveness) and increased uncertainty associated with service market strategy/open business model interplay.     

中亚区域经济合作5号公路物流走廊性能检测

中亚区域经济合作有4条国际运输通道穿越新疆和中亚,这些通道的运输性能决定丝绸之路是否畅通。建立时间-距离-成本(TCD)的调查表和EXCEL的TCD模型,收集汽车跨国运输每段的运行费用、时间;活动费用、时间;输入模型计算走廊5的各项性能指标:通道的无延误速度SWOD、有延误速度SWD、每500公里的运行成本和活动成本。重点对走廊5的过境点活动成本(换装成本、报关报检费用、过境费用和运输检查费用)和延误时间进行识别,从而识别跨国运输的瓶颈所在。依此作为中国通往中亚国家、乃至上合组织成员国之间实现国际道路运输便利化提供依据。     

Risk allocation in service triads – The case of Dutch and Finnish home care procurement

We compare how Finland and the Netherlands organize home care services, both in legislation and in procurement practices, from a service triad risk perspective. We find Finnish public bodies rely to a great extent on inhouse provision and hybrid outsourcing. Dutch public bodies rely completely on outsourcing, using framework agreements with many care providers in parallel. Incentives used in contracts affect financial and service quality risks assumed by buyers, suppliers, and end-customers in the triad. This research improves our understanding of risk allocation among the actors in the service triad based on buyer decisions on outsourcing and supply market conditions. The risk profiles for all three actors in the home care service triad are affected by the manner in which public bodies outsource home care services: the purchasing practices. The delivery method (whether public and private or all private) and the number of providers impact the information position of the municipality versus the care provider in the triad.     

Restructuring materiel management functions: a method for prioritizing changes and reducing costs

The success of any manager depends highly on the ability to seize on opportunities that will achieve the organization's goals. Hospitals are currently searching for ways to reduce costs while maintaining or enhancing the quality of services. Quality services are increasingly being defined as those that are most responsive to customer needs. It is important, as hospital management restructures materiel systems or methods of operation for reduced costs, to focus on the user departments as the customers. The consolidation of materiel management activity should not be seen as a loss of control at the user department level. Instead it can be seen as a new way of providing service with higher quality. User departments should see concrete benefits on a weekly basis, including reduced time spent on materiel management functions; increased planning of purchasing, inventory, and distribution functions; and assistance in meeting restricted supply budgets.     

购房者认知价值对“小产权房”购买行为的影响——以武汉市为例

研究目的：揭示购房者认知价值对“小产权房”购买行为的影响，测度购房者认知价值各类因子对“小产权房”购买行为的影响方向和程度。研究方法：文献资料法、问卷调查法、因子分析法、结构方程模型法。研究结论：1．“小产权房”购房者认知价值因子可分为功能服务、购买成本、持有风险、心理诉求。2．功能服务、购买成本、心理诉求对“小产权房”购买行为动机层面有正向影响，其中功能服务的影响程度最大；购买成本、功能服务对“小产权房”购买行为决策层面有正向影响，持有风险对“小产权房”购买行为决策层面有负向影响，其中购买成本的影响程度最大。     

Low cost country sourcing and its effects on the total cost of ownership structure for a medical devices manufacturer

In this paper, we describe a total cost of ownership (TCO) method as an activity-based costing (ABC) application along the value chain to measure and analyse the costs of international sourcing activities. We further describe the method's implementation for a manufacturer of high-tech medical devices. For this case study, we analyse the effects of shifting purchasing volume from traditional procurement market suppliers to low cost country suppliers on the cost structure of purchasing projects. We find that particularly costs at component and supplier level gain importance over traditionally dominating unit level costs. Furthermore, we identify low cost country sourcing as a decision with extensive impact on value chain entities other than purchasing. Finally, a considerable part of costs in low cost country sourcing accrue at the beginning of a purchasing project due to problems stemming from unsatisfactory initial quality, language barriers and intercultural communication.     

Purchasing in a supply chain environment

Why the interest in purchasing? In the typical company, material costs are 40% to 75% of the cost of goods sold, labor is 5% to 15%, and the balance is burden. The typical company has $4-$5 in purchased cost to $1 in labor. Most companies are implementing material requirements planning (MRP II) and enterprise resource planning systems to control the $1 in labor and have little expectation in the area of purchasing savings. Yet a dollar saved in purchasing goes directly to the bottom line. I ran a survey of 100 Class A users of MRP II; in all 100 of the companies, the biggest payback was in the area of purchasing.     

Specialized Careers

An agent has different abilities in two types of tasks. These tasks are revealed over time through his performance. The agent initially decides whether to engage in only one task (specialize) or to take on any task that arises (be a generalist). This decision trades off the cost of being idle against staying available for relatively lucrative tasks. We compare specializing with acting as a generalist in an infinite‐horizon model and provide complete characterizations of efforts. We show how specializing acts as a means of committing to exert more effort. In a two‐period version of the model, this implies that positive costs for switching strategies, through license fees, for example, may be socially desirable.     

An Experimental Analysis of the Effects of Non‐audit Services on Auditor Independence in Appearance in the European Union: Evidence from Germany

The provision of non‐audit services by the statutory auditor may have a negative impact on auditor independence. Therefore, the European Union decided to prevent auditors from offering a significant extent of non‐audit services to audit clients. Prior research has revealed that different advisory services have different effects on perceived auditor independence. This could be caused by differences in number and intensity of independence threats (self‐interest, familiarity, self‐review, advocacy). Therefore, this experimental study investigates the effect of such threats on independence perceptions in the case of German individual investors. Multivariate analyses indicate that a high self‐interest and a high‐familiarity threat may impair auditor independence in appearance. On the other hand, our findings do not reveal a significant effect of an existing advocacy threat on investors’ trust in auditor independence. A negative effect of a self‐review threat is not directly confirmed. However, the provision of services with regard to internal controls, and thus the self‐review threat, interacts with the self‐interest threat. They potentially impact perceived auditor independence negatively when non‐audit fees are high. In contrast, no significant interactions with familiarity are found. Based on these findings, a general prohibition of non‐audit services does not seem to be necessary. On the other hand, a non‐audit fees cap might be reasonable.     

Research Forum: cross border comparisons Introduction

This paper investigates the effect of non-audit services on audit quality. Following the announcement of the requirement to disclose non-audit fees, approximately one-third of UK quoted companies disclosed before the requirement became effective. Whilst distressed companies were more likely to disclose early, auditor size, directors' shareholdings and non-audit fees were not significantly correlated with early disclosure. These results cast doubt on the view that voluntary disclosure of non-audit fees was used to signal audit quality. The evidence also indicates a positive weakly significant relationship between disclosed non-audit fees and audit qualifications. This suggests that when non-audit fees are disclosed, the provision of non-audit services does not reduce audit quality.     

某集团电力物流研究

企业物流成本的高低与企业的效益密切相关,文章结合当前的物流资源整合在降低物流成本、提高资源效率方面的优势,提出了通过整合资源实现物流作业活动改进以降低物流成本的思路,并且通过具体的案例对运输成本、库存成本、采购成本等进行比较计算,以说明通过有效的资源整合可以实现物流成本的降低。     

城市污水处理厂在BOT特许经营模式下的探讨

BOT(build-operate-transfer)即建设—经营—转让,是指政府通过契约授予私营企业(包括外国企业)以一定期限的特许专营权,许可其融资建设和经营特定的公用基础设施,并准许其通过向用户收取费用或出售产品以清偿贷款,回收投资并赚取利润;特许权期限届满时,该基础设施无偿移交给政府。     

Effective alliance--hospital partnering: beyond price

By looking beyond alliances and groups as simply a "vendor" of group purchasing contracts, a hospital can realize significant additional value beyond acquisition price. Doing so takes an attitude conducive to partnership on both sides. When this occurs, the value delivered from these services can often exceed the savings from the group contracts themselves.