Дисертації з теми "Diagramme Causaux"

Répondre à une question de recherche causale dans un contexte d’étude observationnelle nécessite desélectionner des variables de confusion. Leur intégration dans un modèle multivarié en tant que co-variablespermet de diminuer le biais dans l’estimation de l'effet causal de l'exposition sur le critère de jugement. Leuridentification est réalisée grâce à des diagrammes causaux (DCs) ou des graphes orientés acycliques. Cesreprésentations, composées de noeuds et d'arcs orientés, permettent d’éviter la sélection de variables quiaugmenteraient le biais, comme les variables de médiation et de collision. Les méthodes existantes deconstruction de DCs manquent cependant de systématisme et leur représentation de formalisme, d’expressivité etde complétude. Afin de proposer un cadre de construction formel et complet capable de représenter toutes lesinformations nécessaires à la sélection des variables sur un DC enrichi, d’analyser ce DC et surtout d’expliquerles résultats de cette analyse, nous avons proposé d'utiliser un modèle ontologique enrichi de règles d'inférences.Un modèle ontologique permet notamment de représenter les connaissances sous la forme de graphe expressif etformel composé de classes et de relations similaires aux noeuds et arcs des DCs. Nous avons développél’ontologie OntoBioStat (OBS) à partir d’une liste de questions de compétence liée à la sélection des variables etde l'analyse de la littérature scientifique relative aux DCs et aux ontologies. Le cadre de construction d’OBS estplus riche que celui d’un DC, intégrant des éléments implicites tels que les causes nécessaires, contextuels d’uneétude, sur l’incertitude de la connaissance et sur la qualité du jeu de données correspondant. Afin d’évaluerl’apport d’OBS, nous l’avons utilisée pour représenter les variables d’une étude observationnelle publiée etavons confronté ses conclusions à celle d’un DC. OBS a permis d'identifier de nouvelles variables de confusiongrâce au cadre de construction différent des DCs et aux axiomes et règles d'inférence. OBS a également étéutilisée pour représenter une étude rétrospective en cours d’analyse : le modèle a permis d’expliquer dans unpremier temps les corrélations statistiques retrouvées entre les variables de l’étude puis de mettre en évidence lespotentielles variables de confusion et leurs éventuels substituts ("proxys"). Les informations sur la qualité desdonnées et l’incertitude des relations causales ont quant à elles facilité la proposition des analyses de sensibilité,augmentant la robustesse de la conclusion de l’étude. Enfin, les inférences ont été expliquées grâce aux capacitésde raisonnement offertes par le formalisme de représentation d'OBS. À terme OBS sera intégrée dans des outilsd’analyse statistique afin de bénéficier des bibliothèques existantes pour la sélection des variables et de permettreson utilisation par les épidémiologistes et les biostatisticiens
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

Conselho Nacional de Desenvolvimento Científico e Tecnológico
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.

This thesis deals with modelling of project teams and their behavior using the principles of system dynamics. Main goal of this thesis is to create a model using system dynamics, which will allow to simulate how projects are finished. Results from the model are going to be used to define the best possible strategy to finish a project in required time. Theoretical part of this work is composed of presentation of project management and further the thesis extensively describes system dynamics, principles of system dynamics, used diagrams and possible ways of application of system dynamics in the real world. Furthermore are described the principles and advantages of using models and specifically system dynamics models. In the practical part of this thesis is presented the created model, which allows for simulating of project team behavior based on the input from the user of the model. Model serves the purpose of finding the best possible strategy to finish the product successfully.

El presente trabajo se enfoca en la mejora de la calidad concerniente a los elementos estructurales de un centro comercial, a efectos de reducir y minimizar las No Conformidades más relevantes que se presentaron en obra. El proyecto se basó en la construcción y ampliación de locatarios de un centro comercial que tendrá como fin su alquiler. Mediante la aplicación del Análisis Causa Raíz y con las herramientas de diagrama de Ishikawa y diagrama de Pareto, se pudo encontrar las posibles causas del incumplimiento de la calidad en los elementos estructurales, las que subsecuente se validaron a fin de determinar acciones correctivas. En el primer capítulo se señala el planteamiento del problema, problemas principales, secundarios, justificación del estudio, limitación y los objetivos generales y específicos. En el Segundo Capitulo se señala el marco teórico, donde menciona la calidad en el Perú, la gestión de la calidad total, los costos de la calidad en la construcción, ingeniería de la calidad y definiciones. En el tercer capítulo se indica la utilización del Análisis Causa Raíz, las herramientas Diagrama Causa Efecto y Diagrama de Pareto. En el cuarto capítulo, se presenta el desarrollo del análisis de causa raíz mediante una secuencia de pasos. En el quinto capítulo, La Evaluación Económica, Presupuesto de obra, Costo de Reparación y Análisis del Gasto Incurrido. Finalmente, en el capítulo seis, se presentará las conclusiones y recomendaciones del presente trabajo.
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

Environmental pressures from consumer products and mechanisms of predetermination were examined in this thesis using causal loop diagram (CLD) and life cycle assessment (LCA) footprinting to respectively illustrate and provide some indicators about these mechanisms. Theoretical arguments and their practical implications were subjected to qualitative and quantitative analysis, using secondary and primary data. A study integrating theories from various research fields indicated that combining product-service system offerings and environmental policy instruments can be a salient aspect of the system change required for decoupling economic growth from consumption and environmental impacts. In a related study, modes of system behaviour identified were related to some pervasive sustainability challenges to the design of electronic products. This showed that because of consumption and investment dynamics, directing consumers to buy more expensive products in order to restrict their availability of money and avoid increased consumption will not necessarily decrease the total negative burden of consumption. In a study examining product systems, those of washing machines and passenger cars were modelled to identify variables causing environmental impacts through feedback loops, but left outside the scope of LCA studies. These variables can be considered in LCAs through scenario and sensitivity analysis. The carbon, water and energy footprint of leather processing technologies was measured in a study on 12 tanneries in seven countries, for which collection of primary data (even with narrow systems boundaries) proved to be very challenging. Moreover, there were wide variations in the primary data from different tanneries, demonstrating that secondary data should be used with caution in LCA of leather products. A study examining pre-consumer waste developed a footprint metric capable of improving knowledge and awareness among producers and consumers about the total waste generated in the course of producing products. The metric was tested on 10 generic consumer goods and showed that quantities, types and sources of waste generation can differ quite radically between product groups. This revealed a need for standardised ways to convey the environmental and scale of significance of waste types and for an international standard procedure for quantification and communication of product waste footprint. Finally, a planning framework was developed to facilitate inclusion of unintended environmental consequences when devising improvement actions. The results as a whole illustrate the quality and relevance of CLD; the problems with using secondary data in LCA studies; difficulties in acquiring primary data; a need for improved waste declaration in LCA and a standardised procedure for calculation and communication of the waste footprint of products; and systems change opportunities for product engineers, designers and policy makers.

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

Predicting human behavior from a small amount of training examples is a challenging machine learning problem. In this thesis, we introduce the principle of maximum causal entropy, a general technique for applying information theory to decision-theoretic, game-theoretic, and control settings where relevant information is sequentially revealed over time. This approach guarantees decision-theoretic performance by matching purposeful measures of behavior (Abbeel & Ng, 2004), and/or enforces game-theoretic rationality constraints (Aumann, 1974), while otherwise being as uncertain as possible, which minimizes worst-case predictive log-loss (Gr¨unwald & Dawid, 2003). We derive probabilistic models for decision, control, and multi-player game settings using this approach. We then develop corresponding algorithms for efficient inference that include relaxations of the Bellman equation (Bellman, 1957), and simple learning algorithms based on convex optimization. We apply the models and algorithms to a number of behavior prediction tasks. Specifically, we present empirical evaluations of the approach in the domains of vehicle route preference modeling using over 100,000 miles of collected taxi driving data, pedestrian motion modeling from weeks of indoor movement data, and robust prediction of game play in stochastic multi-player games.

The aim of this research is to find out what environmental impact a wave power park has on the Swedish west coast by creating a consultation paper (”Samrådsunderlag”) for the Lysekilproject at Uppsala University. To highlight the complexity of the problem a system analytic approach was used and illustrated by a Causal Loop Diagram. The overall assessment of the Lysekilprojects wave power park at the Swedish west coast is that it will have a low impact on the environment. This is due to the relative small size of the wave power park and some technical solutions made with the environmental aspect in mind. Artificial reefs and a sanctuary for marine species are effects created by the wave power park and in the longer term the impact will give access to an untapped source of renewable energy, wave energy. Thus reducing the need of fossil fuels and making it possible to reach the Swedish national environmental goals.
Lysekilsprojektet

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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

Muestra cómo el diagrama causa efecto puede resultar eficiente al momento de identificar los riesgos críticos de un proceso durante la etapa de planeamiento de una auditoría de Procesos, para que así el programa de auditoría se pueda focalizar en aquellos riesgos que se considerarían los más críticos. Tenemos que existen muchos marcos de referencia, normas, modelos y metodologías para el análisis e identificación de riesgos, así como también existen diversas herramientas que nos facilitan tales tareas. El uso de tales herramientas para la identificación de riesgos depende de la realidad de cada organización, utilizando muchas veces más de una herramienta. Los temas presentados en la tesina se alinean a los nuevos enfoques de procesos y riesgos, que hoy en día están tomando muchas organizaciones, como consecuencia de la globalización, que exige que las empresas sean más eficientes.
Trabajo de suficiencia profesional

Healthy, functioning aquatic ecosystems are fundamental to the survival and development of any nation, particularly so for water-stressed countries like South Africa. Aquatic ecosystem services (AESs) are becoming increasingly recognised for their importance to society with regards to the ecological goods and services they provide in terms of health, social, cultural and economic benefits. The development of markets for AESs begins with a clear understanding of the nature and extent of the goods and services provided by aquatic ecosystems. However, an inclusive understanding of AESs and their associated values is currently lacking in South Africa. Although flows of ecosystem services provide a nearly limitless set of valuable properties, a large proportion of their services remain unpriced or inaccurately priced through traditional neo-classical markets. This often results in market failure, as these markets do not reflect the full social costs and/or benefits of ecosystem services. This provides incentive to identify and develop a tool to bridge the gap between ecosystem service valuation and practical, sustainable management recommendations for improving the provision of ecosystem services and their associated markets. This study explores the suitability of causal loop diagrams (CLDs) to assess the value chains of AESs in South Africa within the context of a case study. AESs do not usually have finite market values nor are they traded in formal markets, thus, a traditional approach to value chain analysis is unsuitable. A professional workshop environment was utilised to facilitate a transdisciplinary approach towards identifying relevant AESs and their complex inputs, interactions and trade-offs. Numerous CLDs were developed in an effort to map the complex relationships between these AESs and their associated inputs, which formed the basis to attempt subsequent scenario analyses and 'alternative' value chain analyses. The findings of this study show that CLDs have the potential to qualitatively identify challenges and opportunities within the value chains of AESs. Thus, the use of such 'alternative' value chain analyses can directly contribute towards the development of recommendations for improving sustainable management of aquatic ecosystems.

The paper describes our usage of and experience with the method of participatory systems mapping. The method, developed for the purpose of facilitating knowledge brokerage, builds on participatory modelling approaches and applications and was used in several events involving both researchers and policy makers. The paper presents and discusses examples of how different types of participatory interaction with causal loop diagrams ("system maps") produced different insights on issues related to sustainable consumption and enabled participatory reflection and sharing of knowledge. Together, these insights support a systemic understanding of the issues and thus the method provides instruments for coping with complexity when formulating policies for sustainable consumption. Furthermore the paper discusses the ability of the method - and its limits - to connect mental models of participants through structured discussion and thus bridge boundaries between different communities.

This thesis was a step forward in examining the underlying behaviour of the Australian retirement village industry and the effect of social sustainability on its behaviour. Three system dynamic models were developed to simulate future growth of the Australian retirement village industry when no social sustainability, base social sustainability and maximum social sustainability were taken into consideration. These models reveal the growth pattern of the industry and quantify the significant impact of social sustainability on its future growth until the end of this century.

Os municípios de Áurea, Machadinho, entre outros, tem a sua economia fundamentada na atividade da erva-mate. Porém sabe-se que a produtividade média anual dos ervais na região de estudo está em torno de 4.500 kilos de erva-mate verde por hectare. Sabe-se que agricultores que detém o benchmarking regional conseguem uma produtividade anual acima de 14.000 kilos por hectare, em ambiente agronômico semelhante. Neste aspecto, este trabalho tem como objetivo, através da utilização do Diagrama de Causa e Efeito, diagnostificar quais as causas que geram uma produtividade anual média tão baixa e apontar as possíveis causas da baixa produtividade. A pesquisa teve como base, a entrevista estruturada com um grupo de pesquisadores e extensionistas, para mensurar as tecnologias utilizadas por produtores da região, a pesquisa também usa as entrevistas semi-estruturadas com os produtores rurais, em uma amostra de 30 produtores de erva-mate situados na região norte do Rio Grande do Sul. Logo, a tabulação destes dados e a procedência de uma análise estatística dos dados através de um plano fatorial completo como variável dependente a produtividade e as variáveis independentes os quatro processos existentes na cultura da erva-mate (Procedência de mudas, implantação do erval, manejo e condução do erval, e colheita), e a influência da variável “Idade do Erval”, e através da regressão linear, possibilitar fazer conclusões sobre os processos mais importantes na cultura da erva-mate, e neste sentido, sugerir as medidas a serem tomadas pelo produtor rural, em nível de propriedade rural. A analise estatística demonstrou que os processos mais importantes no sistema de produção de erva-mate são o manejo e condução, colheita, implantação e procedência de mudas, ou seja, é importante o agricultor centralizar os investimentos nos processos “Manejo e condução” e “Colheita”, ficando em segundo plano a “Implantação do erval” e “Procedência de mudas”, porem a “Implantação do Erval” combinada com a variável “Idade do Erval” geram um bom resultado.

A flexibilidade dos sistemas de produção tornou-se indispensável para a sobrevivência das empresas de manufatura no mercado global, que impulsionada pelo crescente avanço das tecnologias utilizadas nos processos, nem sempre encontra ressonância nos sistemas de PPCP (planejamento, programação e controle da produção) existentes. Neste sentido, esta dissertação apresenta o estudo de caso realizado em uma empresa eletroeletrônica que mesmo dispondo de alta tecnologia em seu processo de fabricação, se deparava com a necessidade de implementação de técnicas que pudessem proporcionar melhorias na captação e atendimento de pedidos com curto prazo de entregas ou de alterações de pedidos já colocados. Seria necessário melhorar a flexibilização do processo de produção através de novas ações do PPCP que adotando uma posição mais analítica com o emprego de novas ferramentas de trabalho teria meios de agir decisivamente para a obtenção de melhores resultados. Não dispondo de muitos recursos, a empresa pesquisada deveria adotar soluções de baixo custo e complexidade que pudessem viabilizar sua rápida implantação. A modalidade de pesquisa realizada foi o estudo de caso, favorecido pela participação do autor ao longo do processo em estudo. Para gerar subsídios para essa dissertação foram feitas pesquisas em livros, dissertações, monografias, teses, artigos, sites da internet, e vários relatórios e documentos da empresa pesquisada. A metodologia aplicada para a análise e solução do problema foi elaborada através do ciclo PDCA e diagrama de causa-efeito. O detalhamento do trabalho, o emprego das técnicas, seu processo de implantação e os resultados obtidos serão descritos nesta dissertação.
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.

In the past decade, there has been an exponential increase on the PV adoption in Australia. However, concerns have been raised over the potential environmental and human health impacts from the photovoltaic (PV) panel waste generated once the technologies reach their end-of-life (EoL). Creating a circular economy system for this product is imperative to avoid these negative impacts and to unlock economic opportunities from recovering valuable materials inside the PV panels. However, with current recycling technologies and waste volume, it is not possible to achieve an economy of scale. Designing a product stewardship scheme coupled with landfill regulations are one way to mitigate this problem by incentivising producers to financially contribute to the collection and recovery activities. Promoting an effective waste management policy requires a holistic and systemic consideration due to the multi-faceted nature of stakeholder interests and goals in this system. Thus, the overarching aim of this research is to develop a systems model and a serious game that can explore different transition pathways toward managing EoL PV panels in Australia through a careful consideration into the causal relationships, feedback mechanisms, and time delays that are present in the system. This research selected the residential-scale PV panel sector as its case study because this sector makes up the largest number of PV adoption. This research started with identifying the knowledge gaps and synthesising the drivers, barriers, and enablers from the academic literature. These factors were then validated through an expert review process to adapt them to the Australian context. A stakeholder surveys was conducted to rank and compare these factors among different types of stakeholders to understand the problems that need to be addressed and the potential strategies to overcome them. Subsequently, a causal loop diagram (CLD) was developed to visualise the system structure and complexity where the model boundary was determined based on the previous information. The CLD was converted into a system dynamics (SD) model to perform a scenario analysis of different transition pathways (i.e. market-driven growth, conservative development, shared responsibility, and disruptive change). Finally, the SD model was converted into a serious game to communicate the model to stakeholders to improve their understanding and decision-making ability. The findings of this research suggested the importance of enabling a system of shared responsibility in managing EoL rooftop PV panels in Australia to require producers with substantial market share to participate in the product stewardship scheme. It is unlikely that under a voluntary arrangement, significant collection and recovery outcomes can be achieved since there is no incentive to participate in the product stewardship scheme. Mandating all producers to contribute to the scheme will also negatively impact the waste management cost that is internalised into the product price. The serious game is intended to convey and communicate these messages to decision-makers and industries to support their scheme design and assessment. Overall, this thesis has made significant theoretical contributions to the current body of knowledge as it shifts from a linear thinking to a systems thinking to solve a waste management problem in a holistic and systemic manner. The integration between a systems approach and a serious game also provided a new way of dealing with complex environmental problems, but also an innovative and engaging way to communicate the model and research findings to stakeholders to improve their decision-making process. It also has direct practical implications due to its close industry collaboration by supporting the on-going PV product stewardship scheme assessment.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Eng & Built Env
Science, Environment, Engineering and Technology
Full Text

The dependence of small-scale subsistence farmers on natural resources highlighted the need of a transition towards a more sustainable management of resources. An extensive literature is available on the structural factors affecting small-scale agricultural production in developing countries, while few studies are available on the role of social dynamics on the capacity of the system to react to adverse conditions. What are then the social, economic and environmental factors affecting small-scale subsistence agriculture? and, what is the effect of social behaviours on the adoption of agricultural innovation? This study is based on the specific case of eSwatini (southern Africa). A causal loop diagram was adopted to show the cause–effect relationship between variables. The role played by social behaviors in the diffusion of innovation is explored with the use of agent-based modelling (ABM). The model is based on agents, environment, links and five processes: crop production, social learning, individual learning, decision making, and resource recovery. In the simulation three farming behaviours can be adopted: no cropping, traditional practices or conservation agriculture (CA). The ABM was implemented in the Netlogo 6.2.0 platform. The case study is supported by scientific literature and interviews with local stakeholders. The results highlight the role of gender equality in the diffusion of knowledge. The model was run with and without gender equality for 10, 25 and 50 cycles representing farming seasons. The results show an increase in the spread of CA in the scenarios with no gender discrimination for which the rate of innovation adoption is faster. Moreover, the study casts light on the role of social learning and its dependence on training and education centres for the diffusion of new behaviours. Also, results show how an increase in the number of learning centres leads to a higher rate of knowledge diffusion.

The goal of the research is to support the development of an effective communication strategy within public health through social media. Drawing upon the Social Amplification of Risk Framework (SARF), developed by Kasperson et al. (1988) as the theoretical basis, this research explores and compares the use of Twitter by health organisations during health risk events. The research focuses on Twitter as an information channel and its role in the amplification and attenuation of risk events. The empirical research employs a two case comparative case study approach in which data was collected from participants in health organisations in Nova Scotia and Scotland. The data collection method was semi-structured interviews. The interview data was analysed through a thematic analysis to identify the main themes emerging from the data. Lastly, a causal loop diagram was developed to model the interdependencies among factors during a risk event. The research found that health organisations were using Twitter as a means of strengthening risk communication strategies. The use of Twitter had an increasingly important role within communication showing that it had a role in increasing credibility and trust in the organisation; a way of pushing and pulling information and a means of direct communication. However, the participatory, interactive nature of Twitter provided challenges for these organisations. Theoretical contributions are made to the extant body of research relating to SARF, extending the application of the framework to Twitter. Also, more widely, to the field of risk communication identifying that Twitter is a medium through which information can both be pushed and pulled by organisations. Methodological contributions are made by applying causal loop diagramming to SARF. The use of causal loop diagrams enhances the SARF tool-kit providing a tool that models relationships between factors during a risk event. This methodology could be used by others and applied in other areas related to SARF.

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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.

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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.

This diploma thesis is focused on the application of a system approach, which was configured by the author. Configured approach was used to analyze project of implementation of data warehouse tool. Dynamics of the project delivery system was shown by causal loop diagram and then by system dynamics model. Thesis defined and used terms like system, system complexity, system approach, system approach configuration, causal loop diagram, system dynamics model, system archetype of shifting the burden, data warehouse and its definition against a database definition, project, project organizational structures, methods and their necessity in implementation of information systems projects, feasibility of the information system projects and problems with measurement of project performance. Time-proportional simulation of system dynamics model quantified effects of factors and also quantified different results of project implementation approaches. Based on the analyzed project was provided a brief general recommendations for information systems projects.

The thesis is focused on promoting the training of systems thinking using board game. The primary goal is to create a board game, useful for training of the information managers. The secondary objective is to describe process of the design and creation of board game. The theoretical basis of the thesis is to define the profile information manager and demands for his skills further description of the principles of systems thinking and game theory. External work output is a prototype board game. The theoretical part of the paper discusses in particular the principles of board game , systems thinking and psychological effect on the player so that it can pass through the game players more experience. From the perspective of the theory of systems thinking are discussed and applied basic principles of feedback, causal thinking and system archetypes. Theory of board games then processes the options and mechanisms to transmit the necessary knowledge and experience. In the practical part thesis focuses on the description of the mechanisms used in the game Dynacorp and their justification in terms of teaching systems thinking. Conclusion The paper evaluates the fulfillment of the set objectives, the potential of game and describes future goals.

Sistemas de saúde têm sido cada vez mais exigidos a serem mais eficientes, o que encorajou o uso de iniciativas de melhoria de processos. A partir de então, a Produção Enxuta (PE) surgiu como uma abordagem amplamente utilizada. Alguns resultados insatisfatórios da PE podem ser, parcialmente, explicados pela falta de considerar a complexidade dos serviços de saúde. Os sistemas de saúde são classificados como sistemas sócio-técnicos complexos (SSTC) devido à incerteza, diversidade e interações não-lineares. De acordo com a literatura, as implementações de Lean em serviços de saúde geralmente envolvem Kaizen, que tende a produzir ganhos significativos de eficiência e segurança através de mudanças relativamente pequenas e localizadas. Contudo, as melhorias locais podem implicar resultados globais indesejados, uma vez que as interações entre os elementos de sistemas complexos podem não ser lineares. Para isso, este trabalho desenvolve e aplica uma framework que visa avaliar projetos de melhoria em SSTC. O estudo foi realizado em uma unidade de internação de um hospital escola. As interações entre os projetos foram modeladas através do desenvolvimento de um diagrama de loop causal, o qual representou variáveis relacionadas a cinco projetos de melhoria analisados e um modelo FRAM. Os projetos também foram avaliados quanto ao seu impacto no sistema e sua adesão a boas práticas em Kaizen, identificadas na literatura. A framework demonstrou-se eficaz em elencar as variáveis para que possam influenciar positivamente os resultados dos projetos e embasar recomendações para a condução de novos projetos de melhoria por meio de uma visão sistêmica.
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.

The impacts of climate change on livestock production are complex problems, existing in the rela-tionship among this sector and others sectors such as environmental, social, economic and political systems. The complexity and dynamic of these impacts cannot be solved simply in isolation with the linear approach. A system thinking methodology is introduced in this paper to understand the impacts of climate change on livestock production, and identify effective interventions strategies to address this systemic problem. System thinking is a way of thinking about the world and relationships which has been developed far along way in the past. Today, systems thinking has become increasingly popular because it provides a \'new way of thinking\' to understand and manage complex problems, whether they rest within a local or global context. While four levels of thinking is a fundamental tool to identify systemic problems, Causal Loop Diagram (CLD) is a visual tool created by a computer program to illustrate the whole picture of climate change impacts. CLD consist of feedbacks for system, which help strategists identify appropriate intervention strategies in solving the systemic problem
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

The Master's Thesis is focused on methods and tools in knowledge management. The paper introduce knowledge management its history and present. Meanwhile history is presented as a list of important events present view is supported by current trends in field of knowledge management, business analysis of selected companies and evaluation of available publications on the topic of knowledge management. The main aim the paper is to present suitable methodology for the initial phase of Mitroff's model - conceptualization. The selected approach is then applied to the model situation. It is the decision of the city government for the construction and expansion of local factory. The last part is about Business Model Canvas which aims to outline the possible application of the methodology in practice.

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.
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.

The Swedish capital Stockholm is at the forefront of biogas gas use, especially when it comesto biogas used for vehicle gas. This technology has the potential of being a fuel with veryhigh environmental performance, but in order to realize the full potential publicenvironmental management must be optimized. Environmental objectives are anenvironmental management is one tool that is used to strive for the desired development. Theaim of this study is to explain the dynamics within the biogas system in Stockholm, with aparticular emphasis on which factors that affects the amount of biogas available for vehiclegas upgrading on the market in Stockholm. The study has been conducted using modelingsessions with key stakeholders involved in the biogas system. The study concludes that theformulation of environmental objectives has a profound impact on how the variousstakeholders act, and thus how the system behaves. The trade off of how much fossil naturalgas that can be mixed into the renewable biogas based vehicle gas is at the very pinnacle ofcomplex matter. A conclusion that is of vital importance for the local planning process andwhen the experiences of Stockholm’s environmental planning are communicated out to therest of the world.

System dynamics modelling has been used for around 40 years to address complex, systemic, dynamic problems, those often described as wicked. But, system dynamics modelling is not an exact science and arguments about the most suitable techniques to use in which circumstances, continues. The nature of these wicked problems is investigated through a series of case studies where poor situational awareness among stakeholders was identified. This was found to be an underlying cause for management failure, suggesting need for better ways of recognising and managing wicked problem situations. Human cognition is considered both as a limitation and enabler to decision-making in wicked problem environments. Naturalistic and deliberate decision-making are reviewed. The thesis identifies the need for integration of qualitative and quantitative techniques. Case study results and a review of the literature led to identification of a set of principles of method to be applied in an integrated framework, the aim being to develop an improved way of addressing wicked problems. These principles were applied to a series of cases in an action research setting. However, organisational and political barriers were encountered. This limited the exploitation and investigation of cases to varying degrees. In response to a need identified in the literature review and the case studies, a tool is designed to facilitate analysis of multi-factorial, non-linear causality. This unique tool and its use to assist in problem conceptualisation, and as an aid to testing alternate strategies, are demonstrated. Further investigation is needed in relation to the veracity of combining causal influences using this tool and system dynamics, broadly. System dynamics modelling was found to have utility needed to support analysis of wicked problems. However, failure in a particular modelling project occurred when it was found necessary to rely on human judgement in estimating values to be input into the models. This was found to be problematic and unacceptably risky for sponsors of the modelling effort. Finally, this work has also identified that further study is required into: the use of human judgement in decision-making and the validity of system dynamics models that rely on the quantification of human judgement.

A Avaliação Integrada da Sustentabilidade (AIS) é um processo cíclico e interactivo. O conjunto de princípios subjacentes à AIS dizem respeito aos trade‐offs entre valores, horizontes longos e curtos, entre domínios sociais, económicos e ecológicos e entre diferentes níveis de escalas de análise. Um processo de AIS inclui um sistema de interesse que é caracterizado por um problema persistente, motivando o potencial de uma política de intervenção, culminando numa decisão ponderada que recomende ou rejeite uma dada proposta. A Avaliação Ambiental Estratégica (AAE) surge como uma avaliação de Planos, Programas ou Políticas, no sentido de enquadrar desde uma fase inicial de planeamento, as questões ambientais, a um nível estratégico. Muitos autores e diversas equipas de AAE encaram já estes processos de uma forma integrada. A literatura evidenciou algumas lacunas apontadas a este processo, bem como o espaço existente para novos métodos. A modelação participada consiste numa ferramenta baseada na metodologia de dinâmica de sistemas, apresentando‐se como uma plataforma promissora no envolvimento de partes interessadas nos processos de tomada de decisão em ambiente. Qualquer forma de participação num processo de modelação, pode ser aceite como modelação participada. Estes processos foram bastante bem sucedidos em alguns casos de planeamento com vista à sustentabilidade. Neste sentido, efectuou‐se uma análise comparativa de um conjunto de AAE’s, considerando uma escala de cinco parâmetros (factores de avaliação, indicadores, participação, alternativas e efeitos cumulativos). Esta análise teve o intuito de facilitar o entendimento sobre o comportamento das AAE relativamente a estes aspectos, de forma a identificar oportunidades de melhoria. Foram realizadas entrevistas a um conjunto de peritos na área de AAE, com o objectivo de recolher a opinião sobre este tema. Posteriormente, foi desenvolvido um modelo conceptual de aplicação da modelação participada a processos de AAE. Este modelo não tem o objectivo de se sobrepor às metodologias existentes mas tenta colmatar alguns aspectos menos conseguidos da AAE revelados pela análise comparativa entre as AAE’s e pelas entrevistas realizadas. Conclui‐se que esta metodologia, mais propriamente a modelação participada em dinâmica de sistemas, poderá contribuir positivamente para processos de AAE. As principais vantagens surgem numa fase de definição de âmbito, nomeadamente na estruturação do processo participativo, na identificação das inter‐relações entre os diferentes factores de avaliação e na identificação de alternativas e efeitos cumulativos. Pode também ser útil para a fase de avaliação de efeitos, através da construção de um modelo de simulação, sendo que esta fase demonstrou alguns pontos fracos relacionados com a informação disponível e a morosidade do processo.

Introdução: As bases de dados administrativas hospitalares construídos em torno de Grupos de Diagnóstico Homogéneos representam uma importante ferramenta para o financiamento hospitalar em diversos sistemas de saúde e também são uma importante fonte de dados para investigação clínica, epidemiológica e de serviços de saúde. Portanto, a qualidade dos dados de tais bases de dados é de extrema importância. Este artigo tem como objetivo apresentar uma revisão sistemática das causas dos problemas de qualidade de dados que afetam os dados hospitalares baseados em GDH, criando um catálogo de potenciais problemas para os analistas de dados explorarem. Métodos: As bases de dados MEDLINE e Scopus foram pesquisadas usando critérios de inclusão baseados em dois blocos de conceitos a seguir: (1) bases de dados de hospitalares administrativas e (2) qualidade dos dados. Três investigadores leram cada artigo e extraíram as causas. Posteriormente, estas foram classificadas de acordo com o modelo de Ishikawa com base em 6 categorias. Resultados: Identificámos e analisámos 77 de 2009 artigos relevantes, revistos por pares, publicados entre 1990 e 2019 e na língua inglesa. Cento e cinco causas foram extraídas. A maioria das causas estava associada ao conhecimento, preferências, educação e cultura das pessoas. Conclusões: Esta estrutura de Ishikawa facilita a análise e os esforços para resolver os problemas que afetam a qualidade dos dados em dados hospitalares administrativos baseados em GDH.
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.

Introdução: As bases de dados administrativas hospitalares construídos em torno de Grupos de Diagnóstico Homogéneos representam uma importante ferramenta para o financiamento hospitalar em diversos sistemas de saúde e também são uma importante fonte de dados para investigação clínica, epidemiológica e de serviços de saúde. Portanto, a qualidade dos dados de tais bases de dados é de extrema importância. Este artigo tem como objetivo apresentar uma revisão sistemática das causas dos problemas de qualidade de dados que afetam os dados hospitalares baseados em GDH, criando um catálogo de potenciais problemas para os analistas de dados explorarem. Métodos: As bases de dados MEDLINE e Scopus foram pesquisadas usando critérios de inclusão baseados em dois blocos de conceitos a seguir: (1) bases de dados de hospitalares administrativas e (2) qualidade dos dados. Três investigadores leram cada artigo e extraíram as causas. Posteriormente, estas foram classificadas de acordo com o modelo de Ishikawa com base em 6 categorias. Resultados: Identificámos e analisámos 77 de 2009 artigos relevantes, revistos por pares, publicados entre 1990 e 2019 e na língua inglesa. Cento e cinco causas foram extraídas. A maioria das causas estava associada ao conhecimento, preferências, educação e cultura das pessoas. Conclusões: Esta estrutura de Ishikawa facilita a análise e os esforços para resolver os problemas que afetam a qualidade dos dados em dados hospitalares administrativos baseados em GDH.
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.

This work is focused on visualisation of Schwarzschild, Reissner- Nordström and Kerr black hole. The two-dimensional conformal diagram was constructed. In the case of Kerr black hole, the causal structure was visualized by intersection of chronological future of given point in spacetime with hyper- surfaces of constant value of Boyer-Lindquist coordinate t. Conformal diagram for Kerr black hole was constructed only in the neighbourhood of outer event horizon. Then the causal diagram, which is analogous to conformal diagram for Reissner-Nordström black hole was constructed. In all cases two-dimensional spa- celike hypersurfaces were chosen that were embedded into Euclidean space. The interpretation of time evolution of black hole universe was given to a sequence of such embedded hypersurfaces. In the case of Kerr black hole the embedding of outer ergosphere and outer event horizon were also constructed. 1

This diploma thesis focuses on the application of system thinking and its methods to the issues of decision making within destination management and its organizations. The main aim of the thesis was to create a model to support decision making of destination management organization and to plan sustainable and responsible tourism development in the destination. A partial aim was to create a simplified model in which a simulation of the given system was performed. This aim has been applied to the destination of Cesky Krumlov. The contribution of the work is to find optimal decisions, policies and individual processes in order to assess the subsequent impacts and manage the development of tourism destination towards sustainability.

Food security, which affects mainly developing countries, is a worldwide problem that has called the attention of the economic, political and scientific community. Achieving food security is a very complex process that involves not only the ability of farming but also a constant adaptation to natural phenomena, as for example, rainfall patterns. Limited knowledge and access to information and technologies, restrict the capacity of local farming communities to achieve food security. Furthermore, there is a lack of suitable methods and tools for involving stakeholders, such as farmers, in the development and assessment of food policies and their long-term system-wide effects. The main goal of this research is to investigate how the use of mixed-methods – scenarios and participatory System Dynamics (SD) modelling – are capable of improving understanding and an integrative view of food systems, serving as a lever for supporting food security decision-making processes. Additionally, this research aims to answer the following two questions: i) How can scenarios and participatory SD be used together to study plausible futures of food security involving smallholder farmers in developing countries?; ii) What are the possible policy pathways to avoid undesirable situations and to stimulate desirable ones, in a context of subsidence farming in Sub-Saharan African countries?. For this specific purpose, a group of smallholder farmers in Zambia was analyzed as a case study. First, a workshop was implemented in which a scenario of poor rainfall and no government help was developed. In order to achieve food security, participants had to find policy proposals and pathways to avoid or to overcome this undesired scenario. Subsequently, from the scenario workshop data, causal loop diagrams (CLD) were built using a systematic coding process. The next steps were to analyse policy proposals through a cross-impact analysis and develop an outline of pathways to study the complementarity and compatibility of such proposals. The 11 policy proposals were Charcoal Business; Livestock Business; Groundnuts Business; Gardening; Loan; Piecework; Land (productive land); Rental Business; Partnership; Legislation for Deforestation/Afforestation; and, Retention Basins/Drilling Boreholes. Finally, it was possible to design an innovative Action Plan that shows the pathways and the pace at which each proposal may achieve food security. It was concluded that scenario workshop and participatory SD may tightly coupled since these methods complement each other, stimulating system thinking and co-creation of knowledge. Scenario workshops are a disruptive and exploratory method, as it allows to elicit creative and plausible images from participants. Participatory SD supports decision-making processes by analysing policy proposals and its pathways, leading to the elaboration of joint action plans. In the Zambian case, from the 11 plausible policy proposals, it was found that Piecework enables a swifter path to achieve food security, while Rental Business would be the slowest. Additionally, it was found that some of the policy proposals could be reinforced if implemented together, while others, such as Charcoal Business and Legislation for Deforestation/Afforestation, did not show such potential. A follow-up survey with workshop participants showed that they were following the Action Plan, confirming the preference for the short-term policy proposal pathways.

This thesis investigates the use of a combined set of quantitative and qualitative tools to help address known barriers associated with adopting and sustaining pollution prevention (P2) in an industrial manufacturing setting. The research was conducted at an Ontario dairy processing facility in the form of a case study. P2 is an alternative approach to traditional pollution control or abatement techniques. P2 is a preferred method for pollution management, both environmentally and economically, as it focuses on the efficient use of resources to prevent pollution at the source. The tools used in this research included: wastewater treatability testing, hierarchical process mapping, employee interviews, and causal loop diagrams (CLDs). The application of these tools assisted the participating facility in better characterizing its existing environmental problems, uncovering concrete resource saving opportunities within its processes, and providing more adaptive visual approaches of documenting and conveying P2 concepts.
OMAFRA Agri-Food and Rural Link KTT Funding Program

Industry 4.0 represents both a vision and a concept that paves the way to the next industrial revolution. The rise of new IT-technologies such as artificial intelligence, machine learning and cyber-physical systems build the technological foundation of what is considered a paradigm shift in how goods and services are developed, produced and delivered. While the term was often criticised in the beginning as an empty promise that solely serves marketing purposes, Industry 4.0 gained recognition fast with governments, research institutes and corporations around the globe starting to invest into the idea. However, despite all the efforts and resources spent to make the vision a reality, studies have shown that the implementation of Industry 4.0 is far from being a smooth process, as companies need to rethink their entire business strategies. In fact, the transformational process has been investigated from various angles to provide companies with a compass that guides them through this challenging transition. However, a systematic understanding of the forces and their magnetic features that steer the needle into the future is still lacking. As a consequence, companies either hesitate to embark on the transition or struggle to implement Industry 4.0 on a broader scale. In order to address this shortcoming, this thesis seeks to synthesise the strongly fragmented knowledge about the factors that have an impact on the implementation of Industry 4.0 and to evaluate their importance for companies. The main objective of the thesis is addressed through three distinct publications. A systematic literature review has been conducted in Publication 1 to identify the factors that need to be considered when companies implement Industry 4.0. Based on this approach, the study identifies 14 factors, discusses their theoretical meaning, and proposes three categories to distinguish between them. Based upon these findings, Publication 2 assesses the importance of the previously determined implementation factors through the application of a convergent parallel mixed-study design which is based on surveys with 140 Industry 4.0 practitioners and in-depth interviews with 16 Industry 4.0 experts. In that context, results show that the factors are not equally important and that five key factors play an elementary role when it comes to the transitional process. What is more, the findings show that the importance of certain factors varies throughout the life cycle of the transition and that the practitioners’ perception has an impact on the perceived importance of the factors. Publication 3 complements the finding of the previous two studied by illustrating and visualising the relationship between the previously identified and assessed factors through the combination of network theory and systems thinking. This approach offers a new perspective on the importance of the implementation factors by showing that the importance of the examined factors is not static and that it changes depending on the relationship to other implementation factors. Consequently, the findings lay the foundations for the development of quantitative models that can be used to simulate specific implementation scenario.
Thesis (Ph.D.) -- University of Adelaide, Business School, 2021

Urbanization coupled with the lack of space has led to soil sealing and encroachment upon stream corridors in many cities the world over. This has caused not just the degradation of the riparian ecosystem, but has also increased the frequency and intensity of flash flooding. India is one of the countries worst affected by urban floods. To manage flood risk, especially in the case of rain-fed urban streams, not just the government but also the public needs to be engaged in the management of the stream corridor. In this context of flood risk management, the resilience concept is increasingly being applied. It revisits some fundamental notions conventionally associated with viewing and managing floods, beginning by acknowledging that floods are natural and unavoidable, and resilience, not stability is the desirable quality. This research aims to study how governance attributes like public participation can enhance flood resilience. To this end, relevant literature on resilience and governance has been studied followed by a study of the events surrounding the flooding of the Ramnadi stream corridor in Pune city through policy analysis, data derived from documents and maps, and through semi-structured interviews with stakeholders like locals, experts, activists and civic authorities. Categorization and meaning interpretation of relevant data has enabled an analysis of the governance structure for the Ramnadi corridor using a causal loop diagram. The nodes, linkages and feedback loops in this diagram have been studied to understand how public participation affects resilience characteristics. Findings of this investigation along with draft recommendations for specific actors were presented to stakeholders in a validation workshop. Implications of the results on the theories of flood resilience, governance and public participation have been examined which has enabled their analytic generalization. General policy recommendations have been based on this. Subsequently, recommendations which promote systems approach based public participation and systems thinking in the governance of social-ecological systems have been made.:Table of Contents i List of figures iv List of tables vi Abbreviations vi Definitions vii 1 Introduction: Urban Floods, Urban Causes 1 1.1 Urban flood risk in India 3 1.2 Flooding in urban stream corridors 5 1.3 Rationale and aims of the research 8 1.4 Structure of the document 9 2 Theoretical and Conceptual Framework 13 2.1 Flood risk management 15 2.1.1 Towards a systems approach 16 2.2 Social-ecological systems 17 2.2.1 The stream corridor as a social-ecological system 17 2.3 Resilience 22 2.3.1 From ecological resilience to social-ecological resilience 23 2.3.2 Characteristics of resilience 24 2.4 Resilience in the light of other prevalent concepts for flood risk management 29 2.5 Flood Resilience 30 2.5.1 Flood resistance vs flood resilience 31 2.6 Governance 32 2.6.1 Resilience building attributes of governance 33 2.6.2 The Resilience characteristics vs. Governance attributes matrix 36 2.6.3 Special focus: Public participation 37 2.7 Research Questions 44 2.8 Conclusions from the theoretical and conceptual study 45 3 Research design and methods 47 3.1 Overall research design 48 3.1.1 The case study approach 51 3.1.2 Sampling of the case study 54 3.1.3 Boundaries of the case study 56 3.2 Data collection methods 57 3.2.1 Why interviews? 57 3.2.2 Interviewing techniques 58 3.3 Data analysis 61 3.3.1 Coding and Categorization 63 3.3.2 Meaning interpretation: 64 3.3.3 Causal loop diagram 65 3.3.4 Validation of the results and recommendations 66 3.4 Concluding remarks on the adopted research design and methods 67 4 The Ramnadi corridor: A Social-Ecological System 69 4.1 Ramnadi in context 70 4.2 A journey along the Ramnadi 75 4.2.1 Section 1: Ramnadi at the source 77 4.2.2 Section 2: Ramnadi in Bhukum 79 4.2.3 Section 3: Ramnadi between Bhukum and Pune Municipal Corporation limits 84 4.2.4 Section 4: Ramnadi in Bavdhan 87 4.2.5 Section 5: Ramnadi between the Pashan Lake and its confluence with the Mula River 91 4.3 Conclusion after the Ramnadi corridor reconnaissance 93 5 Changes in flood governance and observations from the case study 95 5.1 The history of local governance in India 96 5.2 Institutional framework for urban flood management in India 97 5.3 Flood governance and participation in the stream corridors of PunePune 98 5.3.1 The Ramnadi 98 5.3.2 The Devnadi 103 5.4 Remarks on the changes in flood governance seen in the case study 105 6 Understanding the causal links between governance attributes and flood resilience 107 6.1 The need for a Causal Loop Diagram 108 6.2 Causal Loop Diagram 109 6.2.1 Use of Causal Loop Diagram in this Thesis 109 6.2.2 The importance of identifying archetypes 111 6.2.3 Explanation of the causal loop diagram of governance of the Ramnadi corridor 113 6.2.4 Understanding the implications of change in the governance structure between 2010 and 2016 on flood resilience 141 6.3 The importance of public participation for flood resilience 142 6.3.1 Public participation promotes self-organization 142 6.3.2 Public participation increases the adaptive capacity through promotion of learning 142 6.3.3 Public participation increases robustness 143 6.3.4 Public participation increases redundancy 143 6.3.5 Public participation can increase resilience by boosting other governance attributes 143 6.3.6 Some emerging ideas on complex systems and their implications for public participation 145 6.4 Benefits of systems thinking and of the causal loop diagram for public participation 147 6.5 Conclusions from the causal loop diagram based study 149 7 Towards flood resilience through public participation 151 7.1 Continuous public participation and event-based public participation 153 7.1.1 The need for continuous public participation 154 7.1.2 Disadvantages of continuous public participation 158 7.2 Institutional recommendations for continuous public participation 158 7.2.1 Municipal Corporations and other urban local development bodies 158 7.2.2 Schools: 164 7.2.3 NGOs: 166 7.2.4 Ward Councils: 167 7.3 Conclusion 169 8 Epilogue: Discussion and Avenues for Further Research 171 8.1 Answering the research questions in the course of this research 172 8.2 Key lessons 173 8.3 Theoretical contribution to governance, public participation and resilience 174 8.3.1 Interplay between governance attributes 174 8.3.2 A new paradigm for classification of public participation 175 8.3.3 Systems approach for social-ecological resilience 175 8.4 Achieving the Sustainable Development Goals of the UN 176 8.5 Limitations of the research 176 8.6 Avenues for further research 177 9 References 179 10 Appendices 193

Indigenous (Métis, First Nation, and Inuit) peoples and communities in Canada, especially in the prairies, continue to experience disproportionate levels of tuberculosis (TB) compared to the rest of the Canadian born population. This inequitable distribution of TB disease burden demands effective policy, program, and practice responses. These have so far failed to materialize, perhaps in part because of limitations in the approaches we have taken to understanding the issue. As well, these responses have largely been grounded in western scientific paradigms. Science is the search and the re-search for knowledge and this varies according to the perspectives and paradigms of the researcher(s) and stakeholders. In this project, the student researcher collaborated with the Métis Nation-Saskatchewan (MN-S) and two volunteer health researchers to adapt and ground a western paradigm and methodology (System Dynamics and Group Model Building) to a Métis research paradigm to understand experiences of tuberculosis (TB) among Métis people. Data collection took place in a 2-day Métis-adapted group model building (GMB) workshop. The outcome is a causal loop diagram with associated stories co-created by the team and the workshop participants. The workshop was evaluated using a storytelling and story listening method that explored the appropriateness of adapting GMB within a Métis research context. The approach was determined to be successful methodologically, and substantively new knowledge was created in our Métis community about the determinants of TB. This research was a journey of diversity, working at the intersection of knowledge systems to produce a new understanding of a health issue as complex as TB.

A fundamental change in societal values and economic structures is required to address increasing pressures on ecosystems and natural resources. Transition research has developed in the last decades to analyze the co-dynamics of technological, institutional, social and economic elements in the provision of key functions such as energy, water and food supply. This doctoral dissertation provides conceptual and methodological contributions to the pro-active governance of sustainability transitions. Three research gaps are identified that are addressed in this dissertation. First, a comprehensive conceptualization of learning in sustainability transitions is currently missing that comprises learning at multiple societal levels (ranging from individuals to policy-actors). Learning concepts are often not explicitly discussed in transition research even though learning is considered as fundamental for innovation processes, niche formation and development as well as breakthrough and diffusion of innovations. Second, methods for the analysis and design of transition governance processes are lacking that specify case-specific intervention points and roles of actors in the implementation of innovations. Third, participatory modeling approaches are only applied to a limited extent in transition research despite a high potential for supporting communication and learning. The conceptualization of multi-level learning developed in this doctoral research conceptualizes learning at different societal levels as specific learning contexts ranging from individual and group contexts to organizational and policy contexts. The conceptual framework further differentiates between learning processes, intensity, objects, outcomes, subjects and factors, allowing for a more detailed analysis of learning within and across learning contexts. Thus, learning contexts can be linked by processes that involve actors from different learning contexts (e.g., community groups and policy-makers), as well as exchanges of physical aspects, institutions and knowledge (in the form of ‘learning factors’). This research has also provided a classification of model uses in transition research that supports a purposeful discussion of the opportunities of modeling and promising future research directions. The methodology developed in this doctoral research aims at the analysis and design of transition governance processes by specifying the various opportunities to contribute to sustainability transitions through purposeful action at different societal levels, as well as related roles of stakeholders in implementing such processes of change. The methodology combines different streams of previous research: 1) a participatory modeling approach to identify problem perceptions, case-specific sustainability innovations as well as related implementation barriers, drivers and responsibilities; 2) a systematic review to identify supportive and impeding learning factors from the general literature that can complement case-specific factors; and 3) a method for the analysis and design of case-specific transition governance processes. Three case studies in Canada (topic: sustainable food systems), Cyprus (water-energy-food nexus) and Germany (sustainable heating supply) have been selected to test and iteratively develop the methodology described above. The results for each case study reveal that there are learning objects (i.e., learning requirements) in all learning contexts, which underscores the importance of multi-level learning in sustainability transitions, ranging from the individual to the group, organizational and policy levels. Actors have various opportunities to actively facilitate societal transformations towards sustainable development either directly through actions at their particular societal levels (i.e., context-internal learning) or indirectly through actions that influence learning at other societal levels. In fact, most of the learning factors require cooperation across learning contexts during the implementation process. The comparing of learning factors across case studies underline the importance of several factor categories, such as ‘physical a ‘disturbance or crisis’, ‘information and knowledge’. Of the 206 factors identified by stakeholders, 40 factors are case-specific and not contained in the general, review-based factor list. This underscores the value of participatory research, as general, top-down analyses might have overlooked these case-specific factors. The methodology presented in this dissertation allows for the identification and analysis of case-specific intervention points for sustainability transitions at multiple societal levels. The methodology furthermore permits the analysis of interplay between individual, group, organizational and policy actions, which is a first step towards their coordination. The focus on sustainability innovations links the broad topic of sustainability transitions to a set of opportunities for practical interventions and overcoming their implementation barriers. The methodology presented allows for the analysis and design of these interlinkages between learning contexts. While the methodology cannot provide any ‘silver bullets’ for inducing sustainability transitions, it is flexible enough to identify an appropriate abstraction level for analyzing and designing transition governance processes. The methodology developed in this doctoral research also provides several contributions for the development of participatory modeling methods in transition research. Thus, the participatory method supports an integrated analysis of barriers and drivers of sustainability innovations, and allows application in practice and education. The concepts and methods developed in this research project allow for reflection on transition governance processes from a systemic viewpoint. Experiences in the case studies underline the applicability of the concepts and methods developed for the analysis of case-specific transition governance processes. Despite substantial differences in the geographic location, culture and topics addressed, all case studies include promising sustainability innovations and the engagement of multiple actors in their implementation. The diversity and multitude of initiatives in the case study regions provides an optimistic outlook on future opportunities for large-scale sustainability transitions.