On the estimation of the fill rate for the continuous (s, S) inventory system for the lost sales context.

In the continuous review reorder point, base-stock (s, S) policy, the replenishment order is launched when the inventory position reaches the reorder point, s. It is commonly assumed that the inventory position is exactly equal to the reorder point at the moment the order is launched, when actually it could be lower at that moment. This implies neglecting the possible undershoots at the reorder point, which has a direct impact on the calculation of the expected shortages per replenishment cycle. This article presents a method for an exact calculation of the fill rate (fraction of demand that is immediately satisfied from shelf) which takes explicit account of the existence of undershoots and is applicable to any discrete demand distribution function in a context of lost sales. This method is based on the determination of the stock probability vector at the moment the replenishment order is launched. Furthermore, neglecting the undershoots is shown to lead to an overestimation of the fill rate, particularly when we move farther away from the unitary demand assumption. From a practical point of view, this behaviour involves underestimating the base-stock level, S, when a target fill rate is set for its determination. The method proposed in this paper overcomes these shortcomings.

Processo de trabalho e gestão da produção de máscaras e aventais na pandemia do SARS-CoV-2 / Work process and production management of masks and aprons in the SARS-COV-2 pandemic

Objetivo: Relatar a experiência de discentes de enfermagem em uma unidade de produção de equipamentos de proteção individual durante a pandemia do SARS-CoV-2. Metodologia: Relato de experiência de um estágio curricular obrigatório desenvolvido em uma cidade do Centro-Oeste do Brasil, no ano de 2020. Resultados: Tal trabalho baseou-se nos aspectos vivenciados pelos discentes, durante um período de cinco meses. Os resultados foram organizados em três perspectivas, sendo essas a contextualização do Projeto EPI-UFG, a análise da gestão em conjunto com o processo de trabalho e de recurso e as ações interprofissionais no desenvolvimento de máscaras de proteção descartáveis e aventais. Conclusão: Notou-se a indissociabilidade da gestão frente aos processos de trabalho e recursos, concomitantemente com a importância da enfermagem atuante nas diversas frentes de ocupação, além de demonstrar as habilidades desenvolvidas pelos discentes no projeto em questão.

Objective: To report the nursing students experience in a production unit of personal protective equipment during the SARS-CoV-2 pandemic. Methodology: Experience report of a mandatory curricular internship developed in a city in the Midwest of Brazil, in the year 2020. Results: This work was based on the aspects experienced by students, during five months. The results were organized in three perspectives, about the contextualization of the EPI-UFG Project, the management analysis together with the work process and resources and the interprofessional actions in the development of disposable protective masks and aprons. Conclusion: It was noted the inseparability of management of the work processes and resources, concomitantly with the importance of nursing acting in the various fronts of occupation, in addition to demonstrating the skills developed by students in the project in question.

A methodology for the modular structure planning of product-service systems.

Product-service system (PSS) is an important way of the transformation and upgrading of modern manufacturing industry, it is also one of core development trends of intelligent manufacturing. A PSS can be configured quickly and cheaply to meet the customer's personalized product and service requirements via a PPS design platform, and a modular master structure is the core of PSS design platform. When a PSS instance is configured, it needs to determine the module types and make decisions on the types of PSS firstly, so as to build a master structure for PSS. Therefore, the decision-making on module types and customization degree is a key step to establish the PSS modular master structure. This article proposes a five-step planning method for the modular structure planning of PSS. Firstly, the PSS module types are classified based on the Kano model. Then, bi-level decision-making on modules and its properties are finished by using conjoint analysis method, includes the customer's decision-making on modules and their properties, and the manufacturer's modules and their properties, which provides support for PSS modular optimization configuration design. Finally, the proposed methodology is validated through the case of power transformer. The proposed module planning method for the PSS modular structure helps to determine the module types for PSS services solution layer and generic part layer.

[Structure of Relationships Formed by Occupational Health Nurses for Co-operating with Managers to Support Workers with Mental Health Concerns].

OBJECTIVE: Occupational health staff and managers play important roles in supporting workers with mental health concerns and mutual co-operation among them is a necessary element. However, when co-operating with other professionals, several problems arise that often make such co-operation a challenge. Effective mutual actions are needed to promote such co-operation, and relationships must be formed for this purpose. Therefore, in this study, we aimed to clarify how occupational health nurses form relationships for facilitating co-operation with managers to provide support to workers with mental health concerns. METHODS: Data were collected using semi-structured interviews with 11 occupational health nurses who provide individualized mental health support and who have at least 5 years of experience as occupational health nurses. Analysis of the recorded interviews was performed using a qualitative statistical method (KJ method). RESULTS: Six elements that constitute the formation of relationships were identified. When occupational health nurses form relationships for facilitating co-operation with a manager to provide support to workers, they "form relationships through strategic communication" with them and when co-operation is required, they form a relationship by "acting in a manner that suits the manager," such as his/her character and the situation. To support this relationship, occupational health nurses "provide mental support to the manager" by listening to his/her anxiety or real intention about supporting the subordinate with mental health concerns and provide relief while understanding their burdens during the co-operation. Occupational health nurses even "provide support to the manager in their activities," which assessed the situation at the workplace as the specialist and advised the manager to understand how to concern to the subordinate specifically. In addition, they "indirectly support the manager" which included coordinating with the concerned persons so as to not excessively burden the manager. Such support promoted the "creation of systems for clear roles" of managers in supporting the subordinate with mental health concerns. DISCUSSIONS: Relationships that occupational health nurses form with their managers were the structure which formed emotional human relationships from the front or back necessity of co-operation causes and developing confidence in relationships with the foundation of emotional human relationships.

Strengthening implant provision and acceptance in South Africa with the 'Any woman, any place, any time' approach: An essential step towards reducing unintended pregnancies

Progress in reducing unintended pregnancies in South Africa is slow. The implant, introduced in 2014, expanded the range of available longacting reversible contraceptives (LARCs) and held much promise. Uptake, however, has declined precipitously, in spite of its 'unmatched effectiveness' and high levels of satisfaction for most users. We propose policy and provider interventions to raise implant use, underscored by a 'LARC-first' approach. Contraceptive counselling should focus on the particular benefits of LARCs and methods be presented in order of effectiveness. Moreover, implants hold particular advantages for certain groups, especially adolescents and young women, in whom it is considered first-line contraception. Provision of immediate postpartum and post-abortion implants is safe and highly acceptable, yet remains under-utilised. Implant services at HIV and tuberculosis clinics are a key priority, as is inclusion of LARC provision within school health services. Implants could also be delivered by existing mobile outreach services, for example in sex worker programmes. Services could be built around nurses dedicated solely to providing implants, with other health workers receiving brief refresher training. Women who experience side-effects, especially abnormal bleeding, require timely interventions, following a standardised protocol, including use of medications. Encouraging return for side-effects, follow-up phone calls and home visits would raise continuation rates. Removal services require doctor support or designated nurses at specific centres. Limited access to removal services, health workers' resistance or botched procedures will further undermine implant provision. Rapid implant demonstration projects in postpartum wards, schools, outreach services and by dedicated providers may rapidly advance the field. Together, the actions outlined here will ensure that the implant fulfils its potential and reinvigorates family planning services.

service line analytics in the new era.

To succeed under the value-based business model, hospitals and health systems require effective service line analytics that combine inpatient and outpatient data and that incorporate quality metrics for evaluating clinical operations. When developing a framework for collection, analysis, and dissemination of service line data, healthcare organizations should focus on five key aspects of effective service line analytics: Updated service line definitions. Ability to analyze and trend service line net patient revenues by payment source. Access to accurate service line cost information across multiple dimensions with drill-through capabilities. Ability to redesign key reports based on changing requirements. Clear assignment of accountability.

Hospital diversification strategy.

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

Sustainable competitive advantage for accountable care organizations.

In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.

How to survive climate change and still run a thriving business.

Climate change presents clear and pressing threats to business--materials and product shortages, price volatility, legal bans or consumer backlash, and damaged transportation infrastructure, to name just a few. But there are opportunities as well. Lowitt, a consultant in the sustainability field, has developed a series of detailed checklists that will help smart managers reduce operational, regulatory, and reputational risk while finding new ways to cut costs, improve performance, enhance customer relationships, and otherwise increase competitiveness. The checklist recommendations, tested and refined through Lowitt's research into and work with firms including Coca-Cola, GE, and Owens Corning, cover four broad areas in the product life cycle: sourcing, manufacturing, distribution, and consumption. Actions range from educating and incentivizing employees to use climate change-conscious behavior to measuring and reporting key metrics to determining when alternative materials, methods, sites, or contract partners may be called for. Like any such tool, the checklists don't provide a one-size-fits-all plan. Rather, they equip executives to customize their strategies according to factors such as their goods and services, risk tolerance, customer needs, and reliance on third parties throughout the value chain.

Simulation and modeling efforts to support decision making in healthcare supply chain management.

Recently, most healthcare organizations focus their attention on reducing the cost of their supply chain management (SCM) by improving the decision making pertaining processes' efficiencies. The availability of products through healthcare SCM is often a matter of life or death to the patient; therefore, trial and error approaches are not an option in this environment. Simulation and modeling (SM) has been presented as an alternative approach for supply chain managers in healthcare organizations to test solutions and to support decision making processes associated with various SCM problems. This paper presents and analyzes past SM efforts to support decision making in healthcare SCM and identifies the key challenges associated with healthcare SCM modeling. We also present and discuss emerging technologies to meet these challenges.