The impact of digital transformation on green total factor productivity of heavily polluting enterprises.

Introduction: Digital transformation has become an important engine for economic high-quality development and environment high-level protection. However, green total factor productivity (GTFP), as an indicator that comprehensively reflects economic and environmental benefits, there is a lack of studies that analyze the effect of digital transformation on heavily polluting enterprises' GTFP from a micro perspective, and its impact mechanism is still unclear. Therefore, we aim to study the impact of digital transformation on heavily polluting enterprises' GTFP and its mechanism, and explore the heterogeneity of its impact. Methods: We use Chinese A-share listed enterprises in the heavily polluting industry data from 2007 to 2019, measure enterprise digital transformation indicator using text analysis, and measure enterprise GTFP indicator using the GML index based on SBM directional distance function, to investigate the impact of digital transformation on heavily polluting enterprises' GTFP. Results: Digital transformation can significantly enhance heavily polluting enterprises' GTFP, and this finding still holds after considering the endogenous problem and conducting robustness tests. Digital transformation can enhance heavily polluting enterprises' GTFP by promoting green innovation, improving management efficiency, and reducing external transaction costs. The improvement role of digital transformation on heavily polluting enterprises' GTFP is more obvious in the samples of non-state-owned enterprises, non-high-tech industries, and the eastern region. Compared with blockchain technology, artificial intelligence technology, cloud computing technology, big data technology, and digital technology application can significantly improve heavily polluting enterprises' GTFP. Discussion: Our paper breaks through the limitations of existing research, which not only theoretically enriches the literature related to digital transformation and GTFP, but also practically provides policy implications for continuously promoting heavily polluting enterprises' digital transformation and facilitating their high-quality development.

Decision support tools for invasive alien species management should better consider principles of robust decision making.

Invasive alien species (IAS) pose global threat to economies and biodiversity. With rising number of species and limited resources, IAS management must be prioritised; yet agreed tools to assist decision-making and their application are currently inadequate. There is need for simple decision support tools (DST) that guide stakeholders to optimise investment based on objective and quantifiable criteria. This paper reviews DSTs for IAS management to assess their availability and application of principles of robust decision-making. The aim is to provide guidance towards adopting the principles of robust decision-making to improve applicability and practical use of DST. A literature search conducted to identify relevant studies that report on DST in biological invasion. Results indicate an increase in availability of DST; however, available studies are largely biased in geographical, habitat and taxonomic focus. The results also show challenges in practical use of existing tools as most of them do not apply principles of robust decision-making. Application of these principles has the potential to overcome weakness of the current decision-making process and as such, enable decision-makers to efficiently allocate resources towards IAS management. A call is made for more consideration and adoption of principles of robust decision-making when developing DST for IAS invasions.

[Research on Management Efficiency of Hospital Low-value Consumables in Nursing Unit under Lean Management Mode].

Aiming at the management efficiency problems in the traditional medical low-value consumables management mode of the nursing unit, based on the perspective of supply chain management, this study uses lean management method to construct the lean management mode of low-value consumables with a whole cycle and whole process information monitoring, and analyzes the application effect of this mode. The results show that after the application of lean management mode, the low-value consumables of the nursing unit can achieve "consumables in use=priced consumables + un-priced consumables", the settlement cost is significantly reduced and its stability is high, and the efficiency of "supply-inventor-distribution" link is significantly enhanced. This model effectively improves the management efficiency of low-value consumables in the hospital, and also provides a reference for other hospitals to improve the management level of low-value consumables.

Governance of China's Potatso National Park Influenced by Local Community Participation.

Conservationists recognize that protected areas (PAs) have limited prospects without the involvement and support of local people. As a governance strategy, community participation is to implement the coordinated development of communities and PAs. However, the effects of community participation on national park governance have rarely been tested. Therefore, the present study used a mixed-method approach that is derived from the International Union for Conservation of Nature (IUCN) green list of protected and conserved areas (PCA) conservation outcomes framework, calibrated to the indigenous peoples and local communities' (IPLCs) self-assessments about the outcomes of community participation on national park governance to explore the community participation effects. Our results show that management efficiency controls governance outcomes. Potatso National Park's transformation from the tourism development model to national park is still ongoing, and there exists quite a few problems. We conclude that a successful national park governance as envisaged by the "ecological civilization" paradigm requires a balance of government regulation, participation of various stakeholders in decision-making and discussion, compensation, as well as sustainable access to environmental resources by the affected populations.

Performance measurement for green supplier selection based on data envelopment analysis.

With increasing global awareness of sustainable development and environmental protection, the importance of green supplier selection has become widely recognized. Recently, more and more literature focus on the green supplier selection issue and measurement of supplier performance; the measurement indicators mainly defined two sets of criteria, including management criteria and green criteria. A novel methodology based on data envelopment analysis (DEA) has been developed, which is effective for solving multi-criteria decision problems in supplier selection and evaluating the performance of a set of homogeneous decision-making units (DMUs). To solve the green supplier selection problem, previous studies apply the DEA method by dividing management criteria as inputs and green criteria as outputs. This paper aims to propose a DEA-type green supplier selection methodology by considering the management criteria and green criteria. Unlike the previous method, we define a reasonable and effective division of measurement indicators, where management criteria consist of input variables, desirable and undesirable output variables, while green criteria consist of desirable and undesirable output variables. We also provide an improved model with multi-criteria and multi-objective programming by considering DEA efficiency decomposition, which evaluates management, green, and overall efficiency of candidate suppliers simultaneously. The multi-criteria decision model will help companies to select the best green supplier. To demonstrate the applicability and effectiveness of our proposed model, we present a numerical example at last.

The heterogeneous dynamic effect of financial development and environmental regulation on Chinese urban green technology management efficiency.

China is facing the large-scale urbanization and great pressure of energy consumption and environmental protection in the past few decades. In this process, urban green technology management efficiency (GMEC) is of great importance for the future work of greener transformation. Using China's 286 city-level panel data from 2006 to 2018, this paper proposes a global Malmquist index, PVAR, and panel quantile regression model to explore the heterogeneous dynamic effect of financial development (FIN) and environmental regulation (ER) on GMEC. The results indicate that during 2006-2018, (1) the growth rate of GMEC fluctuated violently, with a change of more than 28%. In addition, there is "one tight and one loose" phenomenon of GMEC. This indicates that there is much room for the improvement of GMEC; (2) in northeast cities, FIN is not conductive to GMEC, but in other regional cities, FIN has dynamic beneficial effect on GMEC. In addition, FIN represents a changing trend of dropping at first to rising afterwards in all regional cities; (3) furthermore, from time angle, ER has the heterogenous dynamic effect on GMEC among regional cities. Specifically, in northeast, eastern, central, and western cities, GMEC has an "M," "N," "U," and "U"-shaped relationship with the level of ER, respectively. From space angle, there is distinct heterogeneous effect of ER on GMEC at different quantiles within regional cities. Therefore, the local government are supposed to establish and implement policies based on regional cities' characteristics.

MEDICAL AND SOCIAL JUSTIFICATION OF THE FINANCIAL AND ECONOMIC CONDITION OF THE «HORODENKA NON-COMMERCIAL CENTER OF PRIMARY MEDICAL CARE¼ BEFORE AND AFTER THE INTRODUCTION OF THE HOSPITAL DISTRICT.

OBJECTIVE: The aim of the work is to identify the peculiarities of medical and social justification of the financial and economic condition of «Horodenka non-commercial center of primary medical care¼ before and after introduction of a hospital district. To achieve the goal, the following are defined task: to conduct an analysis of the main indicators of «Horodenka non-commercial center of primary medical care¼; to determine the problems of inefficient work of the «Horodenka non-commercial center of primary medical care¼. PATIENTS AND METHODS: Materials and methods: When conducting research, they were used general scientific and special methods of research, in particular the system approach and system analysis - to carry out a comprehensive study of the identified objects and systems in their external and internal relationships, as well as determination of approaches to identifying and analyzing problems and developing ways to solve them solution; process approach - for the study of various types of activities in the existing management system of the health care facility before and after implementation of the hospital district; medical and statistical - for statistical processing of received data; analytical methods. RESULTS: Results: The efficiency of health care facilities and the quality of the provided medical services are considered as the main target functions of the health care system. In many countries, programs for ensuring the quality of medical care have been implemented and are operating. The activities of Ukrainian medical institutions and the health care system as a whole are often harshly criticized by patients and the public for the low quality of providing medical services. The quality of medical services, medical care and medical infrastructure definitely depends on the principles of building the Ukrainian medical system and the development of the national economy. Because without a financial basis, it is very difficult to build an effective health care system and ensure proper medical care and the work of all medical institutions. CONCLUSION: Conclusions: Thus, after the introduction of the hospital district in the «Horodenka non-commercial center of primary medical care¼, it is proposed to carry out a number of measures to increase the effectiveness of the implementation of financial management. In order to increase the efficiency of management, including financial resources, it is important to improve personnel management. The main emphasis in the management is the formation of the personnel potential of the «Horodenka non-commercial center of primary medical care¼ the involvement of qualified specialists in the field of medicine, the motivation of various directions for the support and improvement of the qualifications of management personnel. It is also important to use the system of financial planning of a budget institution, to ensure expenses for its life activities. In particular, the main direction of cost control is targeted use of funds, strict control over this use, formation of an effective internal audit system of a medical institution.

Microporous Layer Containing CeO2-Doped 3D Graphene Foam for Proton Exchange Membrane Fuel Cells at Varying Operating Conditions.

To improve the interfacial mass-transfer efficiency, microporous layers (MPLs) containing CeO2 nanorods and the CeO2 nano-network were prepared for proton exchange membrane fuel cells (PEMFCs). In order to minimize the contact resistance, the three-dimensional (3D) graphene foam (3D-GF) was used as the carrier for the deposition of CeO2 nanorods and the nano-network. The CeO2-doped 3D-GF anchored at the interface between the catalyst layer and microporous layer manufactured several novel functional protrusions. To evaluate the electrochemical property, the normal MPL, the MPL containing raw 3D-GF, and MPLs containing different kinds of CeO2-doped 3D-GF were used to assemble the membrane electrode assemblies (MEAs). Measurements show that the CeO2-doped 3D-GF improved the reaction kinetics of the cathode effectively. In addition, the hydrophilic CeO2-doped 3D-GF worked as the water receiver to prevent the dehydration of MEAs at dry operating condition. Besides, at a high current density or humid operating condition, the CeO2-doped 3D-GF provided the pathway for water removal. Compared with the CeO2 nanorods, the CeO2 nano-network on 3D-GF revealed a higher adaptability at varying operating conditions. Hence, such composition and structure design of MPL is a promising strategy for the optimization of high-performance PEMFCs.

Does central environmental inspection improves enterprise total factor productivity? The mediating effect of management efficiency and technological innovation.

The strong demand from the public to find new ways to both improve economy and protect nature has been evoked by "pollute first and control later", which is the previous Chinese mode of development. With the new round of central environmental inspection approaching, should the Chinese government continue to intensify its supervision? The policy effect of the first round of central environmental inspection in 2015 can be a good reference. Based on the data from 1498 listed companies during the period between 2014 and 2018, the Levinsohn-Petrin (LP) method was used to measure enterprises' total factor productivity. Also, a propensity score matching-difference in difference (PSM-DID) method was established to explore the impact of central environmental inspection on enterprises' total factor productivity and its impact mechanism. The results indicate that first, central environmental inspection improved the total factor productivity of enterprises by promoting management efficiency and technological innovation. Second, the mediating effect of management efficiency accounts for approximately 16.6% of the total effect, while the mediating effect of technological innovation accounts for only 7.7% of the total effect.

Constraints of coal mining safety management efficiency.

BACKGROUND: Investigation of the safety management efficiency in a coal mine aims to improve its safety management level thus ensuring coal mining safety. However, the safety management efficiency is affected by many factors especially for those coal mines operated underground. Furthermore, the constraint factors that are difficult to be identified and eliminated may impede safety management efficiency. OBJECTIVE: This work aims to explore the constraints affecting safety management efficiency through a mathematical model accompanied by some effective measures guided by the theory of constraint (TOC). METHODS: An index system for coal mining safety management efficiency (CMSME) is first established. Then a mathematical model roughly identifying the constraint factors is constructed. The principle of the proposed model is a comparison with the changes of the ratio of integrated CMSME and the ratio of each impact factor over a certain period. Thus, a constraint factor may be one whose ratio changes at a slower rate than that of the integrated CMSME. Following this, some measures are adopted to identify one, or more, real constraints. Finally, the constraints may be broken by internal, or external, means. RESULTS: A case study from Quandian coal mine verified the proposed method: the constraints affecting CMSME could be identified and broken through during the production. This research currently is applied to coal mining activities in a few coal mines, and it will be widely used in the future. CONCLUSIONS: This paper provides a novel method investigating the constraints affecting CMSME and breaking through them. The case study shows that breaking through constraints during the production is beneficial to CMSME. Furthermore, a coal mine with a high CMSME index may still, at some time, have one, or more, bottleneck constraints.

Gestão fiscal, eficiência da gestão pública e desenvolvimento socioeconômico dos municípios cearenses / Gestión fiscal, eficiencia de la gestión pública y desarrollo socioeconómico de los municipios del estado de Ceará / Fiscal management, public management efficiency and socioeconomic development of Ceará municipalities

Resumo A administração pública tem o papel na sociedade de gerenciar o patrimônio público de modo a proporcionar melhores níveis de bem-estar social, promovendo maior desenvolvimento socioeconômico. A utilização eficiente dos recursos públicos apresenta-se como um princípio básico para que a gestão pública alcance seus objetivos. Além disso, a transparência e o controle, proporcionados pela gestão fiscal, apresentam-se como fatores capazes de otimizar os resultados no setor público, uma vez que conduzem os gestores públicos a boas práticas gerenciais. Nesse contexto, este artigo analisa os efeitos da gestão fiscal e da eficiência da gestão pública no desenvolvimento socioeconômico municipal. Utilizou-se a análise envoltória de dados (data envelopment analysis - DEA) e regressão linear para analisar os 184 municípios cearenses, no período de 2007 a 2013. Os resultados indicam que a gestão fiscal e a eficiência da gestão pública influenciam positivamente o desenvolvimento socioeconômico municipal, sinalizando que os gestores públicos devem melhorar a eficiência de sua gestão e observar as regras de controle fiscal.

Resumen La administración pública tiene la función en la sociedad de gestionar el patrimonio público para proporcionar mejores niveles de bienestar social, promoviendo un mayor desarrollo socioeconómico. La utilización eficiente de los recursos públicos se presenta como un principio básico para que la gestión pública alcance sus objetivos. Además, la transparencia y el control, proporcionados por la gestión fiscal, se presentan como factores capaces de optimizar los resultados en el sector público, ya que conducen a los gestores públicos a buenas prácticas gerenciales. En ese contexto, este trabajo analiza los efectos de la gestión fiscal y de la eficiencia de la gestión pública en el desarrollo socioeconómico de los municipios. Se utilizó el análisis envolvente de datos -DEA- y la regresión lineal para analizar los 184 municipios de Ceará, de 2007 a 2013. Los resultados indican que la gestión fiscal y la eficiencia de la gestión pública influyen positivamente en el desarrollo socioeconómico municipal, lo que señala que los gestores deben mejorar la eficiencia de su gestión y observar las reglas de control fiscal.

Abstract The role of public administration in society is to manage public assets to provide better social welfare, promoting greater socioeconomic development. The efficient use of public resources is a basic principle for public management to fulfill this role. In addition, the transparency and control offered by fiscal management are factors that optimize results in the public sector, since they lead public managers to apply best managerial practices. In this context, this work analyzes the effects of fiscal management and public management efficiency on municipal socioeconomic development. Data from the 184 municipalities in the Brazilian state of Ceará, from 2007 to 2013, are analyzed using DEA and linear regression. The results indicate that fiscal management and public management efficiency positively influence municipal socioeconomic development, which indicates that public managers should seek better management efficiency and follow rules of fiscal control.

Influences of information management path coordination with dynamic monitoring on the quality of hospital drug management.

BACKGROUND: To explore the impact of information management path coordination with dynamic monitoring on the quality of hospital drug management. METHODS: Based on the management mode of the information management path coupled with dynamic monitoring for hospital drug management, the overall structure of drug management was designed according to the drug management needs, and the management process was dynamically monitored by computer. The incidence of drug management errors was analyzed before and after implementation, including errors in drug placement, unreasonable actions, and vague labeling of high-risk drugs. The near-term and overdue statuses of various drugs were analyzed before and after implementation. Based on the "Hospital Pharmaceutical Management Regulations", a questionnaire about drug management quality was designed to address issues such as the pharmacy area, pharmacy management, drug management, pharmacy equipment management, and management efficiency; a drug management quality score was given before and after implementation. RESULTS: The incidence rates of drug placement errors, unreasonable actions, and vague labeling of high-risk drugs were 1.67%, 2.50%, and 1.67%, respectively, which were significantly lower than the pre-implementation rates of 8.33%, 10.00%, and 8.33% (P<0.05), respectively. The expiration rates of emergency medicines and general medicines after the implementation of information management path coordination with dynamic monitoring were 0.00% and 3.41%, respectively, which were significantly lower than the rates of 30.00% and 11.36% before implementation (P<0.05). The total score and the scores for the pharmacy area, pharmacy management, drug management, pharmacy equipment management, and management efficiency after the implementation of the information management path combined with dynamic monitoring were significantly higher than those before implementation (P<0.05). CONCLUSIONS: Using information management path coordination with dynamic monitoring can reduce the incidence of errors in the drug management process, improve the drug utilization rate in the near-term, and improve the management quality.

Evaluating the Efficiency of Municipal Solid Waste Management in China.

Poor public health is always associated with the mismanagement of municipal solid waste (MSW). Many cities are besieged by MSW in the world. It is essential to do a good job in MSW management (MSWM). In order to improve the efficiency of MSWM, the Chinese government has intensively implemented relevant policies. There are still few studies on MSWM efficiency in China. The research aims to comprehensively analyze MSWM efficiency, find high-efficiency MSWM policy implementation routes and the breakthrough on improving MSWM efficiency. To measure Chinese MSWM efficiency accurately, this paper introduced the three-stage data envelopment analysis (DEA) model into the research. According to the results of DEA, Fuzzy c-Means algorithm was used to the cluster analysis of 33 typical cities. After eliminating the interference of the external environment and random disturbance, the mean value of MSWM efficiency declined from 0.575 to 0.544. The mean of pure technical efficiency (PTE) was declined from 0.966 to 0.611, while the mean of scale efficiency (SE) increased from 0.600 to 0.907. The PTE of central and northeastern cities was relatively low. The SE of western cities was comparatively high and the efficiency distribution of the eastern region was relatively scattered. In general, MSWM efficiency is low and expected to be improved. Regional differences in MSWM efficiency have been shown. The management effectiveness of eight pilot cities (MSW classification) is affirmative but not that significant. To improve MSWM efficiency, differential management for four types of cities should be carried out.

Does Scale of Public Hospitals Affect Bargaining Power? Evidence From Japan.

BACKGROUND: Many of public hospitals in Japan have had a deficit for a long time. Japanese local governments have been encouraging public hospitals to use group purchasing of drugs to benefit from the economies of scale, and increase their bargaining power for obtaining discounts in drug purchasing, thus improving their financial situation. In this study, we empirically investigate whether or not the scale of public hospitals actually affects their bargaining power. METHODS: Using micro-level panel data on public hospitals, we examine the effect of the scale of public hospitals (in terms of the number of occupancy beds) on drug purchasing efficiency (DPE) (the average discount rate in purchasing drugs) as a proxy variable of the bargaining power. Additionally, we evaluate the effect of the presence or absence of management responsibility in public hospital for economic efficiency as the proxy variable of an economic incentive and its interaction with the hospital scales on the bargaining power. In the estimations, we use the fixed effects model to control the heterogeneity of each hospital in order to estimate reliable parameters. RESULTS: The scale of public hospitals does not positively correlate with bargaining power, whereas the management responsibility for economic efficiency does. Additionally, scale does not interact with management responsibility. CONCLUSION: Giving management responsibility for economic efficiency to public hospitals is a more reliable way of gaining bargaining power in drug purchasing, rather than promoting the increase in scale of these public hospitals.

Effects of asymmetric medical insurance subsidy on hospitals competition under non-price regulation.

BACKGROUND: Poor medical care and high fees are two major problems in the world health care system. As a result, health care insurance system reform is a major issue in developing countries, such as China. Governments should take the effect of health care insurance system reform on the competition of hospitals into account when they practice a reform. This article aims to capture the influences of asymmetric medical insurance subsidy and the importance of medical quality to patients on hospitals competition under non-price regulation. METHODS: We establish a three-stage duopoly model with quantity and quality competition. In the model, qualitative difference and asymmetric medical insurance subsidy among hospitals are considered. The government decides subsidy (or reimbursement) ratios in the first stage. Hospitals choose the quality in the second stage and then support the quantity in the third stage. We obtain our conclusions by mathematical model analyses and all the results are achieved by backward induction. RESULTS: The importance of medical quality to patients has stronger influence on the small hospital, while subsidy has greater effect on the large hospital. Meanwhile, the importance of medical quality to patients strengthens competition, but subsidy effect weakens it. Besides, subsidy ratios difference affects the relationship between subsidy and hospital competition. Furthermore, we capture the optimal reimbursement ratio based on social welfare maximization. More importantly, this paper finds that the higher management efficiency of the medical insurance investment funds is, the higher the best subsidy ratio is. CONCLUSIONS: This paper states that subsidy is a two-edged sword. On one hand, subsidy stimulates medical demand. On the other hand, subsidy raises price and inhibits hospital competition. Therefore, government must set an appropriate subsidy ratio difference between large and small hospitals to maximize the total social welfare. For a developing country with limited medical resources and great difference in hospitals such as China, adjusting the reimbursement ratios between different level hospitals and increasing medical quality are two reasonable methods for the sustainable development of its health system.

Conceptual basis for an integrated system for the management of a protected area. Examples from its application in a mediterranean area.

Improving the efficiency of management in protected areas is imperative in a generalized context of limited conservation budgets. However, this is overlooked due to flaws in problem definition, general disregard for cost information, and a lack of suitable tools for measuring costs and management quality. This study describes an innovative methodological framework, implemented in the web application SIGEIN, focused on maximizing the quality of management against its costs, establishing an explicit justification for any decision. The tool integrates, with this aim, a procedure for prioritizing management objects according to a conservation value, modified by a functional criterion; a project management module; and a module for management of continuous assessment. This appraisal associates the relevance of the conservation targets, the efficacy of the methods employed, both resource and personnel investments, and the resulting costs. Preliminary results of a prototypical SIGEIN application on the Site of Community Importance Chafarinas Islands are included.

Justificación del ingreso en el Servicio de Medicina Interna del Hospital “Joaquín Albarrán” / Justification of admission in the Internal Medicine service of “Joaquin Albarrán” Hospital

Se realizó un estudio descriptivo de pacientes ingresados para determinar la justificación de los ingresos en el servicio de medicina interna como elemento para elaborar intervenciones que eleven la calidad y eficiencia de los servicios de salud. Se aplicó a 454 pacientes el Protocolo de Evaluación de la Adecuación (AEP). Se utilizó la técnica estadística de análisis de distribución de frecuencia, comparación de medias y pruebas de independencia para demostrar diferencias entre los grupos según la adecuación del ingreso. Se halló que el 18,7 % de los ingresos fueron considerados no adecuados (INA), los que tuvieron edades (53,5 + 18,2 años) inferiores que aquellos con ingresos adecuados(62,1 + 18,9 años) y estadías ligeramente superiores (9,8 vs. 8,5 d). Los pacientes con INA utilizaron el 20 % del total de días/pacientes del período (833 días/pacientes), fueron ingresados básicamente los lunes, martes, miércoles y viernes, y provenían, en general, de áreas de salud no asignadas al hospital. Se concluyó que el frecuente ingreso de pacientes de forma inadecuada requiere de la revisión de aspectos organizativos del servicio y la institución, que conduzcan a una mejor eficiencia de la gestión hospitalaria.

A descriptive study of patients admitted was conducted to determine the justification of admissions in the Internal Medicine service as an element to make interventions that increase the quality and efficiency of the health services. The Adapting Evaluation Protocol was applied to 454 patients. The statistical technique of frequency distribution analysis, mean comparison and independence tests was used to show the differences between the groups according to the admission adapting .It was found that 18.7% of the admissions were considered inadequate (INA). The individuals that were inadequately admitted were younger (53.5 ± 18.2 years old) than those with adequate admissions (62.1 ± 18.9 years old), and their lengths of stay were slightly higher (9.8 vs 8.5 days). Patients with inadequate admissions used 20 % of the total of days/patients of the period (833 days/patients), they were admitted basically on Monday, Tuesday, Wednesday and Friday, and they generally came from health areas that were not assigned to the hospital. It was concluded that the frequent inadequate admission of patients requires a review of organizational aspects of the service and institution leading to a better efficiency of hospital management.