Dissertations / Theses on the topic 'Diagramme Causaux'
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Pressat-Laffouilhère, Thibaut. "Modèle ontologique formel, un appui à la sélection des variables pour la construction des modèles multivariés." Electronic Thesis or Diss., Normandie, 2023. http://www.theses.fr/2023NORMR104.
Responding to a causal research question in the context of observational studies requires the selection ofconfounding variables. Integrating them into a multivariate model as co-variables helps reduce bias in estimatingthe true causal effect of exposure on the outcome. Identification is achieved through causal diagrams (CDs) ordirected acyclic graphs (DAGs). These representations, composed of nodes and directed arcs, prevent theselection of variables that would introduce bias, such as mediating and colliding variables. However, existingmethods for constructing CDs lack systematic approaches and exhibit limitations in terms of formalism,expressiveness, and completeness. To offer a formal and comprehensive framework capable of representing allnecessary information for variable selection on an enriched CD, analyzing this CD, and, most importantly,explaining the analysis results, we propose utilizing an ontological model enriched with inference rules. Anontological model allows for representing knowledge in the form of an expressive and formal graph consisting ofclasses and relations similar to the nodes and arcs of Cds. We developed the OntoBioStat (OBS) ontology basedon a list of competency questions about variable selection and an analysis of scientific literature on CDs andontologies. The construction framework of OBS is richer than that of a CD, incorporating implicit elements likenecessary causes, study context, uncertainty in knowledge, and data quality. To evaluate the contribution of OBS,we used it to represent variables from a published observational study and compared its conclusions with thoseof a CD. OBS identified new confounding variables due to its different construction framework and the axiomsand inference rules. OBS was also used to represent an ongoing retrospective study analysis. The modelexplained statistical correlations found between study variables and highlighted potential confounding variablesand their possible substitutes (proxies). Information on data quality and causal relation uncertainty facilitatedproposing sensitivity analyses, enhancing the study's conclusion robustness. Finally, inferences were explainedthrough the reasoning capabilities provided by OBS's formal representation. Ultimately, OBS will be integratedinto statistical analysis tools to leverage existing libraries for variable selection, making it accessible toepidemiologists and biostatisticians
Cortes, Taísa Rodrigues. "Utilização de diagramas causais em confundimento e viés de seleção." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=8442.
Apesar do crescente reconhecimento do potencial dos diagramas causais por epidemiologistas, essa técnica ainda é pouco utilizada na investigação epidemiológica. Uma das possíveis razões é que muitos temas de investigação exigem modelos causais complexos. Neste trabalho, a relação entre estresse ocupacional e obesidade é utilizada como um exemplo de aplicação de diagramas causais em questões relacionadas a confundimento. São apresentadas etapas da utilização dos diagramas causais, incluindo a construção do gráfico acíclico direcionado, seleção de variáveis para ajuste estatístico e a derivação das implicações estatísticas de um diagrama causal. A principal vantagem dos diagramas causais é tornar explícitas as hipóteses adjacentes ao modelo considerado, permitindo que suas implicações possam ser analisadas criticamente, facilitando, desta forma, a identificação de possíveis fontes de viés e incerteza nos resultados de um estudo epidemiológico.
Despite the increasing recognition of the potential of causal diagrams by epidemiologists, this technique has not been widely used in epidemiological research. One possible reason is that many research topics require complex causal models. In this article, the relationship between occupational stress and obesity is used as an example of application of causal diagrams on confounding. Some steps are presented, including the construction of the directed acyclic graph, the selection of variables for statistical control and the derivation of the statistical implications of a causal diagram. The main advantage of causal diagrams is to make the assumptions explicit, thus facilitating critical evaluations and the identification of possible sources of bias and uncertainty in the results of an epidemiological study.
Madry, Martin. "Systémová dynamika: případ výkonnosti projektových týmů." Master's thesis, Vysoká škola ekonomická v Praze, 2014. http://www.nusl.cz/ntk/nusl-193285.
Arévalo, Mejía Julia Elvira, and Alania Macario charles Sobero. "“Incumplimiento con la calidad adecuada en los procesos constructivos de obras de edificación”, caso de estudio de centro comercial." Master's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/653704.
This work focuses on quality improvement concerning the structural elements of a shopping center, in order to reduce and minimize the most relevant Non-Conformities that occurred on site. The project was based on the construction and expansion of tenants of a shopping center that will be rented as its purpose. By applying the Root Cause Analysis and using the Ishikawa diagram and Pareto diagram tools, it was possible to find the possible causes of quality noncompliance in the structural elements, which were subsequently validated in order to determine corrective actions. In the first chapter the problem statement, main and secondary problems, justification for the study, limitation and general and specific objectives are indicated. In the Second Chapter the theoretical framework is pointed out, where it mentions the quality in Peru, the total quality management, the costs of quality in construction, quality engineering and definitions. The third chapter indicates the use of Root Cause Analysis, the Cause Effect Diagram and Pareto Diagram tools. In the fourth chapter, the development of root cause analysis is presented using a sequence of steps. In the fifth chapter, The Economic Evaluation, Construction Budget, Repair Cost and Incurred Expense Analysis. Finally, in chapter six, the conclusions and recommendations of this work will be presented.
Trabajo de investigación
Laurenti, Rafael. "The Karma of Products : Exploring the Causality of Environmental Pressure with Causal Loop Diagram and Environmental Footprint." Doctoral thesis, KTH, Industriell ekologi, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-184223.
Jury committee
Henrikke Baumann, Associate Professor
Chalmers University of Technology
Department of Energy and Environment
Division of Environmental System Analysis
Joakim Krook, Associate Professor
Linköpings Universitet
Department of Management and Engineering (IEI) / Environmental Technology and Management (MILJÖ)
Karl Johan Bonnedal, Associate Professor
Umeå University
Umeå School of Business and Economics (USBE)
Sofia Ritzén, Professor
KTH Royal Institute of Technology
School of Industrial Engineering and Management
Department of Machine Design
Integrated Product Development
QC 20160405
Ziebart, Brian D. "Modeling Purposeful Adaptive Behavior with the Principle of Maximum Causal Entropy." Research Showcase @ CMU, 2010. http://repository.cmu.edu/dissertations/17.
Ström, Simon. "Samrådsunderlag för Lysekilsprojektet : Forskning och utveckling av vågkraft." Thesis, Stockholms universitet, Institutionen för naturgeografi, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-114303.
Lysekilsprojektet
OLIVEIRA, Felipe Andrade Gama de. "Avaliação probabilística de risco via modelo causal híbrido em cirurgia: o caso da histerectomia vaginal." Universidade Federal de Pernambuco, 2006. https://repositorio.ufpe.br/handle/123456789/5851.
A análise probabilística de risco é uma metodologia que identifica, avalia e quantifica os riscos nos mais diversos procedimentos, desde de sistemas de alta complexidade tecnológica a sistemas onde só existe o homem executando tarefas. Esta análise tem como objetivo melhorar a segurança e o desempenho destes processos. A área de saúde ainda encontra-se bastante carente de estudos que analisem e quantifiquem os riscos envolvidos nos seus procedimentos. E é com este intuito, que este trabalho propõe uma metodologia de avaliação probabilística de risco para cirurgias, sendo apresentado o caso da histerectomia vaginal. Esta análise aborda tanto os aspectos da confiabilidade humana como a confiabilidade dos equipamentos utilizados. No modelo híbrido proposto, a análise de riscos é baseada na integração dos diagramas de seqüências de eventos, árvore de falhas e redes Bayesianas. Na modelagem os eventos pivotais dos diagramas de seqüência de eventos relacionados a erros humanos, ou seja, resultantes diretamente de ações humanas, são modelados via redes Bayesianas, proporcionando uma representação mais realista da natureza dinâmica destas ações, enquanto que os eventos pivotais relacionados à falha de equipamentos são modelados via árvores de falhas. Assim esta metodologia contribui para a melhoria do processo de gerenciamento dos riscos envolvidos durante a execução da atividade cirúrgica
Arias, Trujillo Milagros. "Aplicación del diagrama causa-efecto para identificar los principales riesgos ante un posible siniestro en el planeamiento de una auditoría de procesos." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2008. https://hdl.handle.net/20.500.12672/12652.
Trabajo de suficiencia profesional
Rawlins, Jonathan Mark. "Exploring the suitability of causal loop diagrams to assess the value chains of aquatic ecosystem services: a case study of the Baviaanskloof, South Africa." Thesis, Rhodes University, 2017. http://hdl.handle.net/10962/4909.
Sedlacko, Michal, Robert-Andre Martinuzzi, Inge Røpke, Nuno Videira, and Paula Antunes. "Participatory systems mapping for sustainable consumption: Discussion of a method promoting systemic insights." Elsevier, 2014. http://dx.doi.org/10.1016/j.ecolecon.2014.11.020.
Walliah, Jerry Jimmy. "Understanding the behaviour of the Australian retirement village industry: A system dynamics modelling approach." Thesis, Queensland University of Technology, 2021. https://eprints.qut.edu.au/225902/1/Jerry_Walliah_Thesis.pdf.
Jaboinski, Nelson Jerônimo. "Avaliação da eficiência produtiva da cultura da erva-mate no Alto Uruguai gaúcho através da utilização de um diagrama de causa e efeito." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2003. http://hdl.handle.net/10183/5941.
Campos, Marcos Rogério Ribeiro. "Melhorias no sistema de planejamento, programação e controle da produção : um estudo de caso em empresa eletroeletrônica." Universidade de Taubaté, 2009. http://www.bdtd.unitau.br/tedesimplificado/tde_busca/arquivo.php?codArquivo=339.
The flexibility of the production systems became indispensable for the survival of the companies of manufacture in the global market, who stimulated for the increasing advance of the technologies used in the processes, nor always find resonance in the systems of PPCP (planning, programming and control of the production) existing. In this direction, this dissertation display the study of case in a eletroeletrônic company who even though disposing of high technology in your process of manufacture, if came across with the necessity of implementation of techniques that could provide to improvements in the captation and attendance of order with short term of deliveries or placed alterations of placed order. Looking for the flexibilization of production process through new-positioning of the PPCP taking on a more analytical position with the use of new tools of work with had half to act decisively for the attainment of better resulted. No disposing of much time to act, the searched company would have to adopt tools of work of low cost and complexity that could make possible its fast implantation. The kind of fulfilled inquiry was the case study, favored by the participation of the author along the process of study. To produce subsidies for this dissertation inquiry were done in books, dissertations, monographs, theories, articles, sites of the Internet, and several reports and documents of the investigated enterprise. The methodology applied for the analysis and solution of the problem was prepared through the cycle PDCA and diagram of cause-effect. The detailing of the case study, the use of the techniques, your process of implantation and results will be described in this dissertation.
Salim, Hengky K. "Rooftop photovoltaic product stewardship transition in Australia using a novel systems approach and serious game." Thesis, Griffith University, 2021. http://hdl.handle.net/10072/410160.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Eng & Built Env
Science, Environment, Engineering and Technology
Full Text
Campanale, Letizia. "Integrated study and modelling of the factors affecting small-scale subsistence farming in eSwatini (southern Africa) through the use of causal diagrams and agent-based models." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2021. http://amslaurea.unibo.it/23940/.
Comrie, Emma L. "Explaining the role of Twitter in the amplification and attenuation of risk during health risk events through causal loop diagrams : a comparative study of Nova Scotia and Scotland." Thesis, University of Strathclyde, 2015. http://oleg.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=24950.
Andrade, Fabrício Luís de. "Movimento de blocos rochosos: um estudo acerca do risco e sua percepção no Morro do Cristo em Juiz de Fora-MG." Universidade Federal de Juiz de Fora, 2015. https://repositorio.ufjf.br/jspui/handle/ufjf/308.
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FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais
Esta pesquisa teve como objetivo identificar e detalhar pontos com risco para movimentos de massa - na tipologia movimento de blocos rochosos - na área tombada do Morro do Cristo em Juiz de Fora, MG, bem como a percepção deste risco por parte da população residente nas áreas consideradas mais vulneráveis junto ao sopé da mesma. O estudo foi desenvolvido na porção compreendida pelo polígono estabelecido pelas ruas Espírito Santo e São Sebastião, sentido N-S e pela vertente tombada do Morro do Cristo e a Av. Olegário Maciel, sentido WE. O estudo foi dividido em quatro etapas: na primeira etapa buscou-se identificar e avaliar a estabilidade dos blocos de rocha com dimensões iguais ou superiores a 100x100x100cm. Para tanto, foi utilizada a ficha de avaliação de estabilidade de blocos rochosos (BRASIL, 2011). Na segunda etapa identificou-se as tipologias dos movimentos dos blocos classificados como instáveis e muito instáveis (INFANTI e FORNASARI, 1998). Na terceira etapa verificou-se a percepção de risco que os moradores das áreas mais vulneráveis possuem, por meio de entrevistas semi-estruturadas, que foram transcritas e tiveram seu conteúdo analisado conforme Bardin (1977). Na quarta e última etapa foram elaboradas uma árvore de falhas e um diagrama de causa e consequência (ROCHA, 2005). Um total de trinta (30) blocos foram identificados e avaliados, sendo que destes, três (3) se encontravam instáveis e dez (10) muito instáveis. As quedas e rolamentos mostraram-se como os movimentos comuns no local. Os resultados das entrevistas revelaram uma baixa percepção do risco por parte dos moradores. Consequências naturais e/ou antrópicas são as causas possíveis para as quedas e/ou rolamentos de blocos de rocha. As medidas para a redução da instabilidade dos blocos de rocha e conseqüente redução do risco no local consistem em intervenções de responsabilidade do poder público. A partir desses dados é possível apontar a condição de alto risco para movimento de blocos de rocha na área de estudo.
This research had as its objective to identify and detail risky points for mass movements – in the rock block movement typology – in the protected area of Morro do Cristo in Juiz de Fora, MG, as well as the perception of this risk by part of the population residing in the areas considered to be more vulnerable by its foothills. The study was developed in the part surrounded by the polygon made by the streets Espírito Santo and São Sebastião, running N-S and by the protected slope of Morro do Cristo and Av. Olegário Maciel, running W-E. the study was divided in four stages: on the first stage we sought to identify and evaluate the stability of the rock blocks with dimensions of or above 100x100x100cm. For that we used the rock block stabilization evaluation form (BRASIL, 2011). On the second stage we identified the movement typology of the blocks classified as unstable and very unstable (INFANTI and FORNASARI, 1998). On the third stage we elaborated a tree of faults and a diagram of cause and effect (ROCHA, 2005). On the fourth and last stage we verified the perception of risk that the residents of the more vulnerable areas suffer by means of semistructured interview, which were transcribed and had their content analyzed according to Bardin (1977). A total of thirty (30) were identified and evaluated, out of them, three (3) were found unstable and ten (10) very unstable. The falls and rolls presented themselves as common movements in the place. The results of the interviews revealed a low perception of risk by part of the residents. Natural and/or man-made consequences are the possible causes for the falls and/or rolls of rock blocks. The measures for the reduction of the instability of the rock blocks and consequent reduction of risk in the place are interventions liable to the public authorities. From this data it is possible to point out a high-risk condition for the rock block movements in the studied area.
Nunes, Paula Barr?to Maia. "Gest?o de materiais do Instituto Federal de Educa??o, Ci?ncia e Tecnologia da Para?ba - Campus Picu?: uma proposta de interven??o." PROGRAMA DE P?S-GRADUA??O EM GEST?O P?BLICA, 2018. https://repositorio.ufrn.br/jspui/handle/123456789/25020.
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Este trabalho apresenta uma an?lise do setor de almoxarifado do IFPB ? Picu? ? por meio de ferramentas da Gest?o da Qualidade, a fim de levantar os problemas encontrados em todas as suas etapas de trabalho, identificar as poss?veis causas e, atrav?s da ferramenta 5W3H, propor solu??es para resolver esses problemas, tornar o setor mais eficiente e, consequentemente, com menos desperd?cio do dinheiro p?blico. O almoxarifado tem o papel de planejar aquisi??es comuns, acompanhar o pedido de material, receb?-lo, confer?-lo e guard?-lo at? que seja distribu?do para o usu?rio final. Foi elaborado um fluxograma de cada etapa de trabalho nesse setor, que ? analisado conforme as normas vigentes e o Manual de Almoxarifado da institui??o. Foram identificados os problemas de cada etapa e selecionado um como prioridade para encontrar suas causas, usando-se ferramentas como o diagrama de causa e efeito ou diagrama de Ishikawa e os 5W3H. Para propor solu??es para os problemas constatados, foi utilizada a ferramenta 5W3H. A metodologia adotada envolveu a pesquisa bibliogr?fica e a documental, para posterior coleta de dados atrav?s de entrevistas semiestruturadas. Depois dessa discuss?o, apresenta-se uma proposta de interven??o para o Campus estudado, visando tra?ar poss?veis solu??es para os problemas encontrados, sugerir novos procedimentos e apresentar novos fluxogramas.
The present paper proposes to analyze the Warehouse sector of the IFPB - Picu? through Quality Management tools in order to raise the problems encountered in all the steps of the sector. With this, we seek to identify the possible causes again through the 5W3H tool, seek to propose solutions in order to remedy such problems and make the sector more efficient and consequently with less waste of public money. The Warehouse has the role of planning common acquisitions, tracking the order, receiving it, conferencing, and keeping up the distribution to the end user. Thus, the present work constructs the flow chart of each stage of work in the Warehouse, analyzed according to the current norms and the Warehouse Manual of the institution. After this, the problems of each step are identified and one is selected as a priority to find its causes from tools like Cause and Effect Diagram or Ishikawa Diagram and 5W3H. To propose solutions, the 5W3H tool was used. The methodology adopted was through bibliographical and documentary research, for later data collection through semistructured interviews. After this discussion is presented a proposal of intervention to the studied Campus with the intention of tracing possible solutions to the problems found suggesting new procedures and presenting new flowcharts.
Šubrt, Radek. "Aplikace systémových přístupů na zavedení data warehouse nástroje." Master's thesis, Vysoká škola ekonomická v Praze, 2011. http://www.nusl.cz/ntk/nusl-114396.
Čapek, Michal. "Dynacorp Prototyp deskové manažerské hry pro podporu systémového myšlení." Master's thesis, Vysoká škola ekonomická v Praze, 2014. http://www.nusl.cz/ntk/nusl-198446.
Ferreira, Dayane Maximiano Carvalho. "Framework para avaliação de projetos de melhoria contínua sob a visão da complexidade : um estudo na área da saúde." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2018. http://hdl.handle.net/10183/178717.
Healthcare systems have been increasingly demanded to be more efficient, which has encouraged the use of process improvement initiatives. From these, lean production has emerged as a widely used approach. Some disappointing results of lean production can be partially due to the lack of consideration of the complexity of healthcare. Health systems are classified as Complex socio-technical systems (CSTS) due to the uncertainty, diversity, and non-linear interactions. According to the literature, the implementation of Lean in healthcare usually involves Kaizen, which tends to produce significant gains in efficiency and safety through relatively small and localized changes. However, local improvements may imply unwanted overall results, since interactions between elements of complex systems may not be linear. For this, this work develops and applies a framework that aims to evaluate improvement projects in CSTC. The study was performed in an in-patient surgical ward of a teaching hospital. The interactions between the projects were modelled through the development of a causal-loop diagram, which accounted for variables related to all five projects, and a FRAM model. The projects were also evaluated as to their impact on the system and their adherence to good Kaizen practices identified in the literature. The framework proved to be effective in highlighting the variables so that they can positively influence the projects results and support recommendations for conducting new improvement projects through a systemic view.
Nguyen, Quan Van, and Nam Cao Nguyen. "Systems thinking methodology in researching the impacts of climate change on livestock industry." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-126825.
Ảnh hưởng của biến đổi khí hậu đến ngành chăn nuôi là một trong những vấn đề phức tạp, bởi mối quan hệ chặt chẽ có hệ thống của chúng với các lĩnh vực khác như môi trường, xã hội, kinh tế và chính trị. Những tác động phức tạp đa chiều này không thể giải quyết đơn thuần bằng các giải pháp mang tính đơn lẻ. Phương pháp tư duy hệ thống được giới thiệu trong bài này cho phép hiểu đầy đủ, có hệ thống các tác động của biến đổi khí hậu đến ngành chăn nuôi, đồng thời xác định được những giải pháp chiến lược phù hợp để giải quyết vấn đề mang tính hệ thống này. Tư duy hệ thống là cách tư duy và tiếp cận với sự vật, hiện tượng khách quan, và các mối quan hệ của chúng, phương pháp này đã được nghiên cứu và phát triển từ xa xưa. Ngày nay, tư duy hệ thống đang được ứng dụng phổ biến và rộng rãi hơn trong các nghiên cứu phát triển bền vững vì phương pháp này cung cấp một “tư duy mới” để hiểu và quản lý được các vấn đề phức tạp, dù chúng ở qui mô địa phương hay trên phạm vi toàn cầu. Trong đó, bốn cấp bậc của tư duy là công cụ cơ bản để nhận biết các vấn đề phức tạp, và sơ đồ các vòng tròn tác động (CLD) là công cụ trực quan được xây dựng bằng phần mềm máy tính để chỉ ra bức tranh toàn cảnh các tác động của biến đổi khí hậu. Các vòng tròn tác động này phản ánh các diễn biến thực tế và các thông tin giúp cho việc xác định các giải pháp chiến lược
Černá, Jana. "Metody a nástroje znalostního managementu." Master's thesis, Vysoká škola ekonomická v Praze, 2012. http://www.nusl.cz/ntk/nusl-194191.
LENAKAKI, Angeliki. "Why do Traditional Performance Management Systems in Healthcare not always lead to Improved Performance? Outlining the Unintended Consequences of the Greek Healthcare Reform in a Public Hospital through a Dynamic Performance Management Approach." Doctoral thesis, Università degli Studi di Palermo, 2021. http://hdl.handle.net/10447/514805.
Researchers all around the globe have not yet come to an end as regards the supposed positive impact of traditional performance management systems in healthcare, and some research has shown that, paradoxically, performance management policies do not always lead to improved hospital performance. Despite the extensive research identifying the “pitfalls” of the NPM reforms around Europe and the unintended consequences for hospital staff and patients, little is known about the mechanisms that caused those negative effects, which essentially creates a research gap worth investigating. This PhD study tries to address this gap and show why do traditional PM Systems in healthcare not always lead to improved performance, by outlining the unintended consequences of the Greek healthcare reform in a public hospital. By conducting empirical research using a case-study, and by adopting a systemic perspective, this research addresses this gap and sheds light on how hospital performance is perceived by stakeholders of a Greek public hospital and what mechanisms drive its dynamic behaviour. Following a systemic approach, the selected case study - which is a real hospital in the Greek Healthcare system - allowed us to investigate the causing mechanisms of the negative consequences of the Greek healthcare reform on the performance of the case hospital. In doing so, we framed our analysis using the Dynamic Performance Management methodology. Recently, researchers have started to see those negative outcomes as “system pitfalls”, occurring from the non-linear interconnection and the dynamic interaction of the different elements and factors that comprise the health system and the healthcare institutions, i.e., their structure, the policies implemented, the behaviour and the decisions of healthcare workers and patients inside this system. The implementation of a systemic performance assessment methodology in Healthcare is sponsored by many recent scholarly contributions in the field (Arnaboldi et al., 2015; Costanza et al., 2014; Bivona, 2010, 2015; Bivona & Cosenz, 2017a, 2017b; Bivona & Noto, 2020; Davahli et al., 2020; Franco-Santos & Otley, 2018; Fryer et al., 2009; Helal, 2016; Renmans et al., 2017; Mwita, 2000; Noto et al., 2020; Vainieri, Ferrè, et al., 2019; Vainieri, Noto, et al., 2020; Wang et al., 2020). Adopting a systemic perspective means taking as a unit of analysis the organisation as a whole, and not one unit or department; acknowledging its internal and external environment and culture in which health care is performed; and considering the concurrent existence of the pitfalls documented as inherent to the structure of the system and the policies implemented. Studies using such a methodology would be necessary in order to address the gap in existing knowledge, as well as to support policy-makers in designing better, more quality-oriented healthcare policies, interventions and reforms in the future. The purpose of this study was to empirically conceptualise a qualitative model of hospital performance as perceived by stakeholders of a Greek public hospital and use the DPM analysis in order to help policymakers in Greece re-design performance management policies and foster hospital performance. We adopted a systemic, participatory, inductive and dynamic approach by combining the Group Model Building and System Dynamics methodologies into the Dynamic Performance Management approach (Bianchi, 2016). Other research traditions identified in our study are the Stakeholders Theory and Participation. All those approaches stand in the constructivist side of the continuum as research approaches, because they all consider realities as subjective, complex and multi-layered, actively shaped by perceptions and opinions of stakeholders (De Gooyert, 2019; Lane & Schwaninger, 2008). Mixed methods were used to facilitate our approach, combining primary qualitative data from two Group Model Building sessions; four open, unstructured preliminary interviews; and seven semi-structured, disconfirmatory interviews; with secondary, qualitative and quantitative data from a scoping literature review and from a critical literature review; as well as from official, open-access, online text-documents and closed-access, internal text-documents of the hospital’s interdepartmental communication. An open call for participation in the research was sent by email to around 70 different hospitals in the cities of Athens and Thessaloniki in Greece, and the gatekeeper was identified. Starting from the gatekeeper, snowball sampling was used to select 10 participants in the case hospital for the Group Model Building (GMB) sessions, including at least one person from each main key-stakeholder category that our extensive stakeholder analysis identified (i.e., managers, doctors, nurses, paramedics and patients), with the purpose of “eliciting” their mental models and “capturing” them in a qualitative system dynamics model (causal loop diagram). Four of the participants were also interviewed before the GMB sessions (face-to-face, one-to-one preliminary interviews). Convenient sampling was used in order to identify seven more public hospital stakeholders from other public hospitals in Greece for the disconfirmatory interviews. The data analysis included a Scoping Review of the International Literature of Performance Management in the Health Sector; a Critical Review of the Literature on the Greek Healthcare Reform; a Stakeholder Analysis; a Narrative Analysis of Preliminary Interviews and Documents; a Qualitative System Dynamics Analysis (Causal Loop Diagram) of the Simplified version of the Conceptual Model of Hospital Performance created during the GMB sessions; and, finally, the Dynamic Performance Management (DPM) analysis. The GMB sessions helped hospital stakeholders gain a better understanding of what hospital performance is in a more systematic way; define it; show its trend (dynamic behaviour) in the hospital during the last decade in a diagram; and conceptualise it as a system, depicted as a qualitative system dynamics model of hospital performance (CLD - Causal Loop Diagram). The two final versions of this CLD Model (i.e., the Conceptual and the Policy Models of Hospital Performance, available in Appendixes 21 and 22 respectively and thoroughly described in terms of the variables and links they contain in Appendix 24) are the main outputs of the GMB sessions, and formed the basis of our analysis and research findings. The Conceptual Model of Hospital Performance is a CLD model that depicts the actual structure of hospital performance and can be used to explain its currently low levels, whereas the Policy Model of Hospital Performance is extended to incorporate the policy structure, i.e., the changes in the system structure which are necessary, according to our participant stakeholders, in order to improve hospital performance. Hospital performance was defined by the participant stakeholders as the provision of patient-centred care to the patient, with safety (for the patients and the staff); responsibility (adherence to protocols, proportions and procedures) and dignity (nice and clean facilities, reduced waiting times and no informal payments). The historical trend of the Hospital performance in the case hospital was also depicted in a diagram over time called Reference Mode (available in Appendix 19). The Reference Mode created and agreed upon by the participants showed that, despite the counterintuitive negative outcomes documented, the level of the overall performance in the case hospital has been slightly increasing after the healthcare reform and is now stabilizing. Our research showed that the Performance Management policies introduced during the Greek healthcare reform had a negative impact on many aspects of hospital performance in general, and in our case hospital in particular. The new policies undeniably contributed to the reduction of hospital spending, but they simultaneously contributed to the deterioration of hospital service quality. Goal-setting, the main PM strategy followed by Greek public hospitals according to Law N4369/16, is until today not properly implemented in the case hospital and managers seem to treat performance objectives as completely separated from performance and quality, and to consider them totally outside of their everyday tasks. Those findings of the preliminary interviews and documents analysis were validated from the findings of the pretests, conducted before the GMB sessions. Four of the goals that were set by the division managers of the case hospital came up during the GMB sessions and were integrated in the CLD model that the participants built: Standardization of the nursing forms of the nursing departments and units; Standardization of clinical procedures; Use of an Information System in the Interdepartmental Communication; and Application of digital signature and electronic document management. We combined our findings from the documents’ analysis with the descriptions of those goals, as set by the division managers, and we informed them with the findings from our DPM instrumental and objective analysis, which allowed us identify the activities and the resources that are needed for the achievement of each of those four goals. In that respect, we found that apart from the “tangible” strategic resources identified by the managers of the case hospital (e.g., financial and human resources) as essential in the achievement of each of those four goals, Management Capacity - which is an intermediate, administrative product of the hospital, built by the public workers - was equally necessary. Out of all the unintended negative outcomes of the Greek healthcare reform documented in the literature, we found the following seven negative outcomes to be present at the case hospital: (1) Low Quality and Safety of Services perceived by health workers and patients; (2) Low Patient Satisfaction; (3) Informal Payments; (4) High Mortality Rates; (5) Numerous Medical Errors; (6) High Nosocomial & Multidrug-Resistant Bacteria Infections Rates; (7) Low adherence to Clinical Guidelines and Treatment Protocols. Regarding those seven negative outcomes, the analysis of the simplified version of the Conceptual Model of Hospital Quality which the participant stakeholders created during the GMB sessions at the case hospital, showed that: (1) Low Quality and Safety are mostly associated with the variables Survival Rate / Patients' Health Status & Quality of Life and Complications of our model, and can be explained by the dominance of the balancing loops B3 - Actual Time Available & Errors, and B4 - Actual Time Available and Adherence to Guidelines & Protocols, both of which cause those two variables to decrease as in the Limits to Success archetype, resulting at less Proper Communication & Attendance to Patients’ Needs, more Errors and Complications, longer Length of Stay, higher Nosocomial Infections Rate, and, finally, to lower Survival Rate and Patients’ Health Status & Quality of Life after treatment (Dynamic Hypothesis 1). (2) Low Patient Satisfaction can be explained by the dominance of the loops B1 – Word of Mouth & Waiting Times, B2 – Patient Satisfaction & Attendance to Patients’ Needs, B3 - Actual Time Available & Errors, and B4 - Actual Time Available and Adherence to Guidelines & Protocols, all of which lead to a gradual decrease and stabilisation of Patient Satisfaction and of Hospital Reputation in the long run as in the Limits to Success archetype, resulting at less Proper Communication & Attendance to Patients’ Needs, more Informal Payments for early Surgery/Admission longer Waiting List for Surgery or Admission, longer Waiting Time in ER & Outpatient Services and, finally, to lower Survival Rate and Patients’ Health Status & Quality of Life after treatment. (Dynamic Hypothesis 2). (3) The existence of Informal Payments can be explained by the Loop R2 – Informal Payments & Corruption, which leads to a perpetual increase of private spending and to the outspread of corruption between the case hospital doctors, given the good reputation of the case hospital and the long waiting lists that are already in place. This phenomenon is sustained by the current policies in place, which favour the creation of long waiting lists. However, this phenomenon is also sustained by factors external to the case hospital and to our model, such the relative tolerance of the Ministry of Health and of the authorities, and the widespread idea between patients in Greece that informal payments are necessary for a timely and proper treatment. (Dynamic Hypothesis 3). (4) High Mortality Rates can be explained by the Loops B3 - Actual Time Available & Errors, and B4 - Actual Time Available and Adherence to Guidelines & Protocols, both of which lead to a gradual decrease and stabilisation at a low level of the Actual Time Available per Patient and of the Adherence to Guidelines & Protocols in the long run as in the Limits to Success archetype, resulting at less Proper Communication & Attendance to Patients’ Needs, more Errors and Complications, longer Length of Stay, higher Nosocomial Infections Rate, and, finally, to higher Failure & Mortality Rates. (Dynamic Hypothesis 4). (5) Numerous Medical Errors can be explained by the Loop B3 - Actual Time Available & Errors, which leads to a gradual decrease and stabilisation at a low level of the Actual Time Available per Patient and of the Adherence to Guidelines & Protocols in the long run as in the Limits to Success archetype, resulting at higher Difficulty of Shift Schedule for nurses and doctors, less Proper Communication & Attendance to Patients’ Needs and, finally, to more medical, nursing and patients’ Errors (Dynamic Hypothesis 5). (6) High Nosocomial & Multidrug-resistant bacteria Infections Rates can be explained by the loops R5 – Multidrug Resistance in the General Population and B4 - Actual Time Available and Adherence to Guidelines & Protocols, both of which cause Nosocomial Infections to increase in the long run, resulting at more Complications and higher Multidrug Resistance in the General Population (Dynamic Hypothesis 6). (7) Low Adheremce to Clinical Guidelines and Treatment Protocols can be explained by the loop B4 - Actual Time Available and Adherence to Guidelines & Protocols, which leads to a gradual decrease and stabilisation at a low level of the Actual Time Available per Patient in the long run, as in the Limits to Success archetype, resulting at increased Difficulty of Shift Schedule for nurses and doctors, low Availability of Equipment, ICT, Standard Procedures & Digital Forms and, finally, to low Adherence to Guidelines & Protocols. In order to test those seven hypotheses, a quantified SD model (a stock-flow diagram) would be needed, as that would enable us to run simulations and test our hypothesis in different scenarios to analyse the loop dominance. Such a model is out of the scope and purposes of the present, qualitative study and is not included, but is recommended for future research. However, we used the Dynamic Performance Management analysis as an alternative method, in order to: (1) identify Strategic Resources, Performance Drivers and End Results of hospital performance and show their role in the hospital performance management and measurement; (2) show how the time factor influences the overall hospital performance; (3) understand the contribution of each one of the four hospital divisions (the Medical, the Nursing, the Administrative & Financial and the Technical division) on the End Results (i.e., the final hospital services produced); (4) allow the division managers to start concentrating on the core intermediate, administrative products that divisions are required to deliver on the process that leads to the final end-results; (5) map the ultimate and intermediate services value chain provided to both external and internal users of the case hospital; (6) make performance measures (i.e., the drivers and end-results associated with the delivery of products) explicit and then link them to the goals and objectives of the division managers of the case hospital; (7) discuss the insights that the DPM analysis offers us for a sustainable Performance Management in Greek public hospitals in general, and in the case hospital in particular. The identification of Strategic Resources, Performance Drivers and intermediate End Results, as well as the different views that our DPM analysis offered (i.e., instrumental, dynamic, subjective, objective) provided the hospital decision-makers with signs of potential future shift in End Results, and can help public hospital managers in Greece interpret and calculate the consequences of an incident or the implications of a policy; show possible discrepancies on performance; and try to mitigate it. The performance measures we identified could be helpful to foresee possible changes in the financial and clinical results of public hospitals in Greece. When framed in a wider sense than budgetary control, transaction cost drivers can provide hospital managers and policy makers in Greece with valuable information for strategic planning, such as the opportunity to identify trade-offs in space and in time (e.g., higher costs for investments and for managerial capacity building in the short-run, versus investments in equipment, ICT, and facilities that would increase performance in the long run). Thus, the performance management policies adopted at the case hospital during the healthcare reform ( i.e., structure and process reforms undertaken) and their overall impact for Greek public hospitals’ outputs and outcomes, can now be examined through a different “lenses” by the hospital managers; lenses that will allow them overcome the seven counterintuitive, negative outcomes documented, and align the hospital’s and the different division’s and departments’ goals and actions to achieve improved efficiency and effectiveness, along with better hospital service quality for patients.
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Introduction: Administrative hospital databases built around Diagnosis Related Group (DRG) represent an important tool for hospital financing in several health systems and are also an important data source for clinical, epidemiological and health services research. Therefore, the data quality of such databases is of utmost importance. This paper aims to present a systematic review of root causes of data quality problems affecting DRG-based hospital data, creating a catalogue of potential issues for data analysts to explore. Methods: The MEDLINE and Scopus databases were searched using inclusion criteria based on two following concept blocks: (1) administrative hospital databases and (2) data quality. Three researchers read each article and extracted root causes. These were subsequently classified according to the Ishikawa model based on 6 categories. Results: We identified and analyzed 77 of 2009 relevant peer-reviewed papers published between 1990 and 2019 in English language. One hundred and five root causes were extracted. Most of the root causes were associated with people's knowledge, preferences, education and culture. Conclusions: This Ishikawa framework facilitates the analysis and the efforts to solve these problems that affect data quality in DRG-based administrative hospital data.
Carvalho, Roberto da Silva. "Análise de causas de problemas que afetam a qualidade de dados hospitalares baseados em Grupos de Diagnósticos Homogéneos: revisão sistemática e diagrama Ishikawa." Dissertação, 2021. https://hdl.handle.net/10216/134525.
Introduction: Administrative hospital databases built around Diagnosis Related Group (DRG) represent an important tool for hospital financing in several health systems and are also an important data source for clinical, epidemiological and health services research. Therefore, the data quality of such databases is of utmost importance. This paper aims to present a systematic review of root causes of data quality problems affecting DRG-based hospital data, creating a catalogue of potential issues for data analysts to explore. Methods: The MEDLINE and Scopus databases were searched using inclusion criteria based on two following concept blocks: (1) administrative hospital databases and (2) data quality. Three researchers read each article and extracted root causes. These were subsequently classified according to the Ishikawa model based on 6 categories. Results: We identified and analyzed 77 of 2009 relevant peer-reviewed papers published between 1990 and 2019 in English language. One hundred and five root causes were extracted. Most of the root causes were associated with people's knowledge, preferences, education and culture. Conclusions: This Ishikawa framework facilitates the analysis and the efforts to solve these problems that affect data quality in DRG-based administrative hospital data.
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Ferreira, Maria Eduarda Bruel de Salles. "Combining Scenario Workshops and Participatory System Dynamics Modelling to Study Food Security. A case study with farmers in Zambia." Master's thesis, 2017. http://hdl.handle.net/10362/29986.
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OMAFRA Agri-Food and Rural Link KTT Funding Program
Hoyer, Christian. "Exploring the Factors that have an Impact on the Implementation of Industry 4.0." Thesis, 2021. https://hdl.handle.net/2440/134261.
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