External Contractor Research Articles

Organizational and patient factors associated with positive primary care experiences for veterans with current or recent homelessness.

To identify organizational service features associated with positive patient ratings of primary care within primary care clinics tailored to accommodate persons with ongoing and recent experiences of homelessness (PEH). PEH receiving primary care in 29 United States Veterans Health Administration homeless-tailored clinics were surveyed about their primary care experience using the validated Primary Care Quality-Homeless (PCQ-H) survey. Characteristics of the clinics were assessed through surveys of clinic staff using a new organizational survey developed through literature review, site visits, statistical analysis, and consensus deliberation. Cross-sectional examination of patients' ratings of care based on surveys of patients, and of clinic characteristics, analyzed with Classification and Regression Tree (CART) analysis, a form of machine learning. Patient surveys (n = 3394) were obtained from a random sample of enrolled patients by both mail and telephone by an external survey contractor. Staff (n = 52 from 29 clinics) were interviewed by telephone. This analysis identified service features that impact patient experience favorably, including aspects of patient-centeredness, team identity, strong external leadership support, and service that reach beyond traditional primary care clinic confines. Results varied according to the patient experience scale analyzed. Individual characteristics of PEH, such as degree of social support, general health, and unsheltered status, were also correlated with how they rate care. Organizational characteristics correlate with ratings of primary care from patients with recent and ongoing homelessness. Primary care programs serving homeless individuals can assure better care based on who they hire, how they foster team identity, what services they provide, and the strength of leadership support to protect a homeless-focused mission.

Pharmacists working in residential aged care: a survey of pharmacist interest and perceived preparedness

BackgroundPharmacists involvement in residential aged care facilities has traditionally been limited to that of an external contractor providing medication reviews, or medication supply.AimTo explore Australian pharmacists’ interest and perceived preparedness to work as on-site pharmacists in residential aged care.MethodNational cross-sectional anonymous online survey open for two weeks (September 17th to October 1st 2022) consisting of Likert-type, multiple choice and multiple selection questions. Australian pharmacists were recruited using a broad advertising strategy which included social and traditional media platforms, and snowball sampling. Data were collected on pharmacist self-reported interest and perceived preparedness to work as on-site aged care pharmacists in residential aged care. Data were analysed using descriptive statistics.ResultsResponses were received from 720 participants, 643 were eligible. Most participants were female (n = 466, 73%) and mean (SD) age was 43.5 (SD 12.5) years. Over half the participants were interested or extremely interested in working as an on-site aged care pharmacist (56%, n = 360), and agreed or strongly agreed (n = 475, 76%) that they felt prepared to work as an on-site aged care pharmacist. Most pharmacists felt prepared to engage in a variety of roles within the facilities (> 73% for each role), including resident and system level roles, and the majority agreed they felt prepared to engage with stakeholders, including general practitioners (93%) and medical specialists (86%).ConclusionPharmacists reported they are interested and feel prepared to work as on-site aged care pharmacists. These findings will inform the roll-out of this new model of care to enhance multidisciplinary collaboration in residential aged care.Graphical

With Name, Image, and Likeness, College Sports Enters the Gig Economy

With the arrival of name, image, and likeness (NIL), the college sports labor market has distinctly taken on similar characteristics to the gig economy, with athletes able to earn extra compensation through external NIL-based independent contractor “gigs.” But with this comparison comes comparable issues, and scholarship and litigation examining and challenging gig economy structures have identified several legal and ethical concerns both individual to each worker and more broadly affecting labor markets. Building off this literature, we conceptualize the NIL phenomenon within the gig economy space, exploring the legal and ethical concerns that have plagued companies like Uber and applying those same concerns to the brave new world of NIL-fueled college sports. We not only find similar issues in college sports but also find even deeper concerns based on new and existing challenges unique to the novel space of college sports, particularly given the increased proliferation of NIL collectives.

Outsourcing of the business processes of an industrial enterprise based on a comparison of actual costs

Aim. The presented study aims to improve existing methods of economic justification for outsourcing.Tasks. The authors analyze existing outsourcing models; identify their typical stages; investigate qualitative and quantitative methods of economic justification for outsourcing, determine their advantages and disadvantages; develop a model that will more accurately substantiate the practicability of outsourcing business processes.Methods. This study uses scientific, analytical, generalized, and comparative methods to analyze existing outsourcing models and identify their typical stages. Qualitative and quantitative methods of economic justification for the transfer of business processes to an external contractor are used, and their advantages and disadvantages are determined with a focus on the methodological problems of quantitative justification for outsourcing.Results. A model that makes it possible to more accurately calculate the cost of auxiliary business processes of an industrial enterprise is developed with allowance for cyclical economic relationships between them. In the first stage, the costs of auxiliary business processes are allocated to consumer processes in multiple cycles, and conditions for completing cyclical calculations are checked. In the second stage, the actual cost of business processes is calculated. Based on this model, an algorithm of economic justification for the outsourcing of business processes of an industrial enterprise is developed.Conclusions. First, a common disadvantage of the existing tools for the justification of outsourcing is the problem of assessing the impact of transferring one or more business processes to an external contractor on the system as a whole and economic performance. Second, an original model for calculating the actual cost of auxiliary business processes is developed to eliminate the shortcomings of the existing tools. Third, the original algorithm for the economic justification of outsourcing business processes of an industrial enterprise is based on comparing the actual costs of a business process when performed by the enterprise internally and by a thirdparty contractor.

Interobserver agreement on landmark and flexure identification in colon capsule endoscopy

PurposeWhen an optical colonoscopy is carried out, Scope Guide can assist the endoscopist in determining the localization. In colon capsule endoscopy (CCE), this support is not available. To our knowledge, the interobserver agreement on landmark identification has never been studied. This study aims to investigate the interobserver agreement on landmark identification in CCE.MethodsAn interobserver study was carried out comparing the landmark identification (the ileocecal valve, hepatic flexure, splenic flexure, and anus) in CCE investigations between an external private contractor and three in-house CCE readers with different levels of experience. All CCE investigations analyzed in this study were carried out as a part of the Danish screening program for colorectal cancer. Patients were between 50 and 74 years old with a positive fecal immunochemical test (FIT). A random sample of 20 CCE investigations was taken from the total sample of more than 800 videos.ResultsOverall interobserver agreement on all landmarks was 51%. Interobserver agreement on the first cecal image (ileocecal valve), hepatic flexure, splenic flexure, and last rectal image (anus) was 72%, 29%, 22%, and 83%, respectively. The overall interobserver agreement, including only examinations with adequate bowel preparation (n = 16), was 54%, and for individual landmarks, 73%, 32%, 24%, and 85%.ConclusionOverall interobserver agreement on all four landmarks from CCE was poor. Measures are needed to improve landmark identification in CCE investigations. Artificial intelligence could be a possible solution to this problem.

Impact pathways: managing relational risk in project operations

PurposeThe purpose of this paper is to assess how we implement new ways of managing relational risk at the operational level of outsourced projects and to provide guidance to project management (PM) policy makers and practitioners seeking to ensure project operations consistently deliver project relational risk management (PRRM) strategies.Design/methodology/approachThrough exploratory study data were obtained from a panel of six experts in PM and from a pilot survey of PM practitioners. The data reveal future directions and vectors for scholarship and research activity in terms of the impact of PRMM-related mechanisms and deliverables on project success and the implementation process to enhance PRRM as a key PM capability.FindingsDeliverables for PRRM need to part of a multidimensional framework that includes mechanisms besides the contract. Such a framework enables the codification of PM knowledge so that PRRM contributes to project success. With knowledge codified, PRRM strategies can be consistently delivered at the operational level. The framework is novel in that it integrates hereto disparate elements that are encompassed under the broad umbrella of relational governance mechanisms.Practical implicationsPM policy makers and practitioners recognise the importance of effective relationships to deliver projects successfully, yet they lack practical solutions to address the negative effects of dysfunctional relationships. The authors provide a list of PM deliverables for effective PRRM, including deliverables besides those related to the contract, which can be used in practice to bring the gap between PRRM strategy development and implementation. This will enable client organisations that outsource their projects to an external contractor to enhance their PRRM capability and increase the likelihood of project success.Originality/valueThe authors provide insights into how PRRM is practised at the project operations’ level where PM is outsourced. These insights lead to three pathways of impactful Operations Management (OM)/PM scholarship and research, namely, the following: 1) How PM deliverables act as a key success factor for effective PRRM? 2) How the duality of roles carried out by PM actors influences PRMM practices? 3) How companies innovate to enhance their PRMM capability? These pathways will enable PM research and scholarship to address disconnects between PRMM strategy and operations and hence go beyond answering “what” PRMM is to encompass “how” it is implemented.

Building a Harmonized Datamart by Integrating Cross-Institutional Systems of Clinical, Outcome, and Genomic Data: The Pediatric Patient Informatics Platform (PPIP).

Siloed electronic medical data limits utility and accessibility. At the Dana-Farber/Boston Children's Cancer and Blood Disorders Center, cross-institutional data were inconsistent and difficult to access. To unify data for clinical operations, administration, and research, we developed the Pediatric Patient Informatics Platform (PPIP), an integrated datamart harmonizing multiple source systems across two institutions into a common technology. Starting in 2009, user requirements were gathered and data sources were prioritized. Project teams, including biostatisticians, database developers, and an external contractor, were formed. Read-access to source systems was established. The 3-layer PPIP architecture was developed: STAGING, a near-exact copy of source data; INTEGRATION, where data were reorganized into domains; and, CONSUMPTION, where data were optimized for rapid retrieval. The diverse systems were integrated into a common IBM Netezza technology. Data filters were defined to accurately capture the Center's patients, and derived data items were created for harmonization across sources. An interactive online query tool, PPIP360, was developed using Microstrategy Analytics. Driven by scientific objectives, the PPIP datamart was created, including 33,674 patients, 2,983 protocols, and 3.6 million patient visits from 14 source databases, 164 source tables, and 2,622 source data items. The PPIP360 has 605 data items and 33 metrics across 11 reports and dashboards. Dana-Farber and Boston Children's established a legal data-sharing agreement. The PPIP has supported hundreds of faculty, staff, and projects, including planning clinical trials and informing strategic planning. The PPIP has successfully harmonized and integrated diagnostic, demographic, laboratory, treatment, clinical outcome, pathology, transplant, meta-protocol, and -omics data, for efficient, daily operational and research activities at Dana-Farber/Boston Children's Cancer and Blood Disorders Center, and future external sharing.

A multi-item batch fabrication problem featuring delayed product differentiation, outsourcing, and quality assurance

Variety, quality, and rapid response are becoming a trend in customer requirements in the contemporary competitive markets. Thus, an increasing number of manufacturers are frequently seeking alternatives such as redesigning their fabrication scheme and outsourcing strategy to meet the client’s expectations effectively with minimum operating costs and limited in-house capacity. Inspired by the potential benefits of delay differentiation, outsourcing, and quality assurance policies in the multi-item production planning, this study explores a single-machine two-stage multi-item batch fabrication problem considering the abovementioned features. Stage one is the fabrication of all the required common parts, and stage two is manufacturing the end products. A predetermined portion of common parts is supplied by an external contractor to reduce the uptime of stage one. Both stages have imperfect in-house production processes. The defective items produced are identified, and they are either reworked or removed to ensure the quality of the finished batch. We develop a model to depict the problem explicitly. Modeling, formulation, derivation, and optimization methods assist us in deriving a cost-minimized cycle time solution. Moreover, the proposed model can analyze and expose the diverse features of the problem to help managerial decision-making. An example of this is the individual/ collective influence of postponement, outsourcing, and quality reassurance policies on the optimal cycle time solution, utilization, uptime of each stage, total system cost, and individual cost contributors.

Life cycle assessment of refractory waste management in a Spanish steel works

A life cycle assessment (LCA) is conducted on the current refractory waste management practices in a steel works in Spain producing around 6,000 tonnes of refractory waste in 2018. Management practices included direct reuse of spent magnesia-carbon (MgO-C) bricks, recycling of MgO-C bricks and high-alumina refractories by an external contractor and landfilling of monolithics and isostatic refractories, for which there were yet no established valorization routes. This current situation was compared to a hypothetical scenario where all refractories were disposed in landfill. The LCA included waste management activities (collection, transport, treatment) as well as production of substituted primary materials (dead-burned magnesia, calcined bauxite and new MgO-C bricks) produced in China and Germany. Results are discussed for four indicators: greenhouse-gas emissions, Non-renewable energy demand, land use and water use. Overall, per tonne of produced waste, the current management leads to a reduction or saving of 0.54 tonnes CO2-eq, 3 GJ primary energy from non-renewable sources, the occupation of 10 m2 of land during one year and the abstraction of 5 m3 freshwater. The results also show that reuse, in the particular case of spent MgO-C bricks, leads to higher benefits than recycling by At least a factor four. The robustness of these results is confirmed through the application of a Monte Carlo uncertainty analysis, as well as a sensitivity analysis focusing on a shift from coal to natural gas in the Chinese refractory industry.

Channel Coordination under Predictive and Corrective Maintenance Outsourcing

With respect to Industry 4.0, predictive maintenance plays an important role in production systems. A better predictive maintenance strategy is absolutely essential to an efficient, reliable and safe production process. This study considers a supply chain that consists of a manufacturer and an external contractor wherein the manufacturer is willing to outsource the predictive maintenance activities provided by the contractor. In order to achieve channel coordination, we introduce three incentive contracts: 1) maintenance cost subsidisation contract; 2) uptime target and bonus contract; 3) uptime reward contract, which enhance the cooperation willingness of the contractor and increases profit for both parties, thereby leading to a win-win situation. We also discuss the feasibility of the contracts given improvements in the failure rate and maintenance capability. Theoretical results show that the uptime target and bonus and uptime reward contracts can achieve channel coordination under specific conditions given increases in the failures rate and maintenance capacity. Numerical results are further presented to reveal the managerial insights.

The effective outsourcing of building retrofitting: key decisions and motivators

Purpose Despite their energy conservation potential, still existing buildings are slow in embracing building energy efficiency retrofits (BEER), mainly because of the absence of a clearly defined process to deliver the BEER projects, and the lack of proactive guidance for project teams. Further, the identification of factors that can facilitate BEER projects is also important to ensure the project success. This is particularly true in energy service company (ESCO)-led projects. Hence, this study aims at investigating the decision-making process, including the motivators for the successful execution of each stage in implementing BEER when projects are outsourced to a third party. Design/methodology/approach An in-depth case study was carried out to investigate the decision-making process and motivators in implementing BEER in a selected hotel building. Seven semi-structured interviews were conducted to collect the required data within the case. Findings Study disclosed the 13 key decisions made and 37 key activities performed in each stage of the project. A total of 19 motivators for the successful execution of the respective stages were also elicited. Ultimately, the research findings are mapped against the five key stages of BEER decision-making process. Originality/value The outcome of this study will provide the industry practitioners a basis for the effective adoption and implementation of BEER in existing hotel buildings when an external contractor is involved.

Plant factories

Plant factories

Outsourcing energy retrofitting of hotel buildings: the decision-making process

Poor energy performance of existing buildings worldwide has led to a crucial need to retrofit existing buildings to minimise energy consumption. Among the existing buildings, hotels use as much as 50% of their total expenses on energy and offer significant opportunities for energy efficiency improvement. Yet, comparatively the level of implementation of energy retrofits found to be low, which has attributed to, inter alia, the absence of a clearly defined process for ensuring the delivery of energy retrofit projects and lack of proactive guidance for project teams to ensure that they make the right decisions at the right time to achieve the desired outcomes. Since many energy retrofit projects in existing hotels are carried out with the involvement of an external contractor, or an Energy Service Company (ESCO), this study focuses on investigating the decision-making process in implementing energy retrofits when the project is outsourced to an external party. An in-depth case study is used to obtain insights into the critical decisions to be taken and key activities to be performed throughout the decision-making process. The findings are used to propose a step-by-step decision-making process comprising of three key phases: i.e., pre-retrofit, retrofit implementation and post-retrofit. It is hoped that the decision-making process developed in this study will serve as a roadmap for the effective adoption and implementation of energy retrofits in existing hotel buildings when an external contractor is involved.

Sustaining system coordination in outsourcing the maintenance function of a process having a linear failure rate

ABSTRACTAn increasing trend in manufacturing is the outsourcing of maintenance and repair activities to an external contractor. An outsourced maintenance contract is presented that details the costs, timing, and possible bonuses for maintaining uptime thresholds and covers both minimal corrective repairs and regularly scheduled preventive replacements. By negotiating an incentive-based maintenance contract, the manufacturer and contractor can achieve system coordination, a mutually beneficial relationship that maximizes system profit. We study the sensitivity of system coordination to the expected cost of minimal corrective process repairs. For a manufacturing process with a linear failure rate, we develop a complete characterization of the intervals for the expected cost of repair and the corresponding contract parameters wherein system coordination is guaranteed for any expected cost of repair that occurs within the interval.

A mainstream social housing response to dementia

Purpose The purpose of this paper is to explore how social housing providers could respond to residents living with dementia in non-specialist housing. Design/methodology/approach A research framework was developed from published material and used to assess how dementia friendly a national housing provider was, and what could be different. Electronic surveys were completed by 209 members of staff; semi-structured interviews with 18 senior managers and an external contractor; a customer focus group with five residents. A literature review and telephone interviews with housing providers identified current areas of innovation and good practice which informed the research recommendations. Findings There are ways a non-specialist social housing provider can develop dementia friendly services through developing a customer focused approach, staff awareness raising and training, and through working collaboratively with specialist statutory and non-statutory services across health and social care. These have the potential to impact positively on the quality of life of residents with dementia or caring for people with dementia. Practical implications Social housing providers should be considering their older residents, and how they can design and develop services to respond to specific needs. Originality/value There is limited understanding of how mainstream housing providers could and should develop an offer for their residents living with dementia. This research provides an assessment approach and has developed ideas about what this offer could look like.

Routing centralization across domains via SDN: A model and emulation framework for BGP evolution

The Border Gateway Protocol (BGP) was designed almost three decades ago and has many limitations relating to its fully distributed nature, policy enforcement capabilities, scalability, security and complexity. For example, the control plane can take several minutes to converge after a routing change; this may be unacceptable for real-time network services. Despite many research proposals for incremental improvements and clean-slate redesigns of how inter-domain routing should work, BGP is likely one of the most ossified protocols of the Internet architecture and it has not retrofitted the proposed ideas. In this work, we propose a radical, incrementally deployable Internet routing paradigm in which the control plane of multiple networks is logically centralized. This follows the Software Defined Networking (SDN) paradigm, although at the inter-domain level involving multiple Autonomous Systems (AS). Multi-domain SDN centralization can be realized by outsourcing routing functions to an external contractor, which provides inter-domain routing services facilitated through a multi-AS network controller. The proposed model promises to become a vehicle for evolving BGP and uses the bird’s eye view over several networks to benefit aspects of inter-domain routing, such as convergence properties, policy conflict resolution, inter-domain troubleshooting, and collaborative security. In addition to the proposed paradigm, we introduce a publicly available emulation platform built on top of Mininet and the Quagga routing software, for experimenting on hybrid BGP–SDN AS-level networks. As a proof of concept, we focus specifically on exploiting multi-domain centralization to improve BGP’s slow convergence. We build and make publicly available a first multi-AS controller tailored to this use case and demonstrate experimentally that SDN centralization helps to linearly reduce BGP convergence times and churn rates with expanding SDN deployments.

China's Eagerness to Export Its High-speed Rail Expertise to ASEAN Members

The Chinese government is adopting a 'going-out' strategy to promote China's high-end rail technology overseas and strengthen its global competitiveness. This article examines China's high-speed rail diplomacy towards the Association of Southeast Asian Nations (ASEAN) and uncovers the link between China's ambitious foreign policies towards the ASEAN and both national pride and commercial stakes in promoting high-speed rail in the region. It analyses the rationale behind China's high-speed rail development proposals for the ASEAN in the context of the rise of China and rivalry between China and Japan. China is especially eager to participate in the construction of high-speed railroads with ASEAN members. The high-speed rail link can forge regional economic integration within the ASEAN. For ASEAN member states, China is a key external investor and contractor for their infrastructure development. Nevertheless, China is facing serious challenges to the realization of its proposals.

Maintenance outsourcing coordination with risk-averse contractors

Under a maintenance outsourcing contract, an external contractor receives a fixed payment from a manufacturer for periodically performing preventive maintenance and for performing minimal repairs whenever process failures occur. If the contractor’s maintenance policy results in a process uptime above a target level specified in the contract, the contractor receives a bonus payment based on the difference between the uptime and the target levels. We study the optimal designs of maintenance outsourcing contracts for achieving channel coordination when the contractor is risk averse towards uncertain repair costs caused by process failures. We find cases in which channel coordination cannot be achieved because of the contractor’s risk preference. Furthermore, the contractor’s risk preference may make channel coordination more difficult or easier, depending on the parameters considered in the model.

Global sourcing of complex production processes

We develop a theory of a firm in an incomplete contracts environment which decides on the complexity, the organization, and the global scale of its production process. Specifically, the firm decides i) how many intermediate inputs are simultaneously combined to a final product, ii) if the supplier of each input is an external contractor or an integrated affiliate, and iii) if that input is offshored to a foreign country. Our model leads to a rich set of predictions on the internal structure of multinational firms. In particular, it provides an explanation why many firms choose hybrid sourcing and have both outsourced and integrated suppliers.

Maintenance-outsourcing contracts for a system with backup machines

In this paper, we consider a system with multiple components, each prone to failure, during which production is halted. Minimal repair is performed by an external contractor whenever a component breaks down. The contractor also conducts a general preventive maintenance (PM) for the whole system at pre-determined times. The contractor’s goal is to minimise maintenance-related costs; however, the system (made up of the contractor and the manufacturer, who gains revenue whenever the system is up) profit would be maximised if the revenue is also considered. Since these goals usually require different PM schedules, we propose a cost subsidisation scheme which coordinates the system. We then extend this basic model by considering the existence of a backup machine which will allow the system to continue running (albeit, generating a lower revenue) whenever a component fails. We show that the existence of such a machine reduces the profit difference between uncoordinated and coordinated systems.