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THE BUCHAREST UNIVERSITY OF ECONOMIC STUDIES Council for Doctoral Studies Management Doctoral School PHD THESIS - summary POSSIBILITIES TO INCREASE THE COMPETITIVENESS OF HEALTH ORGANIZATIONS BY MODERNIZING THE MANAGEMENT TOOLS Supervisor: Professor Ion POPA, PhD PhD Candidate: Simona Cătălina M. ȘTEFAN Bucharest, 2017

ABSTRACT The present PhD thesis, entitled "Possibilities of increasing the competitiveness of health organizations by modernizing the managerial tools", is a theoretical and practical incursion into the complex field of health services management, aiming to critically analyzing the use in the management practice of the Romanian health organizations the systems, methods and techniques provided by management science, corroborated with national and international theoretical approach, highlighting the relationships between them and organizations level of competitiveness. Starting from the research aim and objectives and considering the theoretical approach presented in the first part of the paper, twelve research hypotheses were developed. For their validation, a clear and well-structured methodology was designed, together with the selection of the most appropriate statistical and econometric methods for data analysis, able to guide the entire research process in the right direction. Through the research results, we consider that personal contributions can be highlighted by: (1) theoretical development of the topics addressed, (2) providing empirical evidences to support existing theoretical approaches, and (3) providing information able to support managers of health organization in selection, operationalization and judicious melding of managerial tools, so that, by maximizing their potential, contribute to enhancing the performance and competitiveness of their organizations. Key words: competitiveness; competitive advantage; Factor Analysis; health organization; health system; hypothesis; management method; managerial tools; management technique; management system; performance; survey

Table of contents SUMMARY ACKNOWLEDGEMENTS CONTENTS LIST OF TABLES LIST OF FIGURES LIST OF ANNEXES LIST OF ABBREVIATIONS AND ACRONYMS INTRODUCTION Purpose and objectives The novelty and relevance of the chosen theme Expected results Structure of the thesis Keywords PART I LITERATURE REVIEW CHAPTER 1. THE HEALTH SYSTEM 1.1 Addressing health services in line with EU 2020 Strategy 1.2 The Romanian health system in European context 1.3 The health organization's environment 1.4 Conclusions CHAPTER 2. COMPETITIVENESS AND COMPETITIVE ADVANTAGE IN THE HEALTH SECTOR 2.1 Introduction 2.2 Competitiveness 2.2.1 Defining the concept of competitiveness 2.2.2 Levels of approach to the concept of competitiveness 2.2.3 Efficiency - Efficiency - Performance - Competitiveness 2.2.4 Addressing competitiveness from a temporal perspective and sustainable competitiveness 2.2.5 Acceptances of the concept of competitiveness health organization 2.3 The competitive advantage and its peculiarities in the health system 2.4 Competitiveness analysis 2.4.1 Competitiveness analysis approaches 2.4.2 Competitiveness analysis models 2.4.3 Models of health organization's competitiveness analysis 2.5 Conclusions

CHAPTER 3 FEATURES OF USE OF INSTRUMENT MANAGEMENT IN ORGANIZATIONS IN ROMANIA 3.1 Introduction 3.2 Managerial tools - conceptual delimitations 3.3 The role of managerial tools in the modern organization 3.3.1 Managerial tools in the context of knowledge-based management and organization 3.3.2 Managerial tools: efficiency, effectiveness 3.3.3 The role of managerial tools to increase organization s competitiveness 3.4 Previous research on managerial tools 3.5 Conclusions PART II RESEARCH ON THE POSSIBILITIES OF INCREASING THE COMPETITIVENESS OF HEALTH ORGANIZATIONS BY MODERNIZING THE MANAGEMENT TOOLS CHAPTER 4. RESEARCH METHODOLOGY 4.1 Research objectives and hypotheses 4.1.1 Outlining objectives 4.1.2 Developing research hypotheses 4.2 General framework of research methodology 4.3 Research Methods 4.3.1 Bibliographic documentation 4.3.2 "Face-to-face" survey 4.3.3 Online survey 4.4 Research tool - questionnaire 4.4.1 Structure of the questionnaire 4.4.2 Items 4.5 Data analysis methods 4.5.1 Factor Analysis (FA) 4.5.2 Principal Component Analysis (PCA) 4.5.3 Structural Equations Modeling (SEM) 4.5.4 Two-Step Cluster Analysis 4.5.5 Multiple linear regression 4.6 Software used for data analysis CHAPTER 5. PILOT STUDY 5.1 Methodological considerations 5.1.1 Organize the pilot study 5.1.2 Population and sample 5.1.3 Research method and tool 5.2 Towards a Model of Competitiveness of Health Organizations

5.2.1 Exploratory Factor Analysis 5.2.2 Interpretation of results 5.2.3 Discussions and implications 5.3 Conclusions and contributions of the pilot study CHAPTER 6. Analysis of the peculiarities management tools employed within Romanian organizations 6.1 Methodological considerations 6.2 Validation of research hypotheses 6.2.1 Validation of hypothesis 1 6.2.2 Validation of hypothesis 2 6.2.3 Validation of hypothesis 3 6.2.4 Validation of hypothesis 4 6.2.5 Validation of hypothesis 5 6.3 Conclusions and implications CHAPTER 7. MODEL OF COMPETITIVENESS HEALTH ORGANIZATIONS 7.1 Methodological considerations 7.1.1 Development of the 6th research hypothesis 7.1.2 Research method and tool 7.1.3 Population and sample 7.1.3.1 Define the population 7.1.3.2 Sampling method 7.1.3.3 Determining the sample size 7.1.3.4 Data collection 7.1.3.5 Sample validation 7.1.3.6 Respondent demographics 7.2 Preliminary data screen 7.2.1 Common method bias 7.2.2 Non-response bias 7.2.3 Missing data 7.2.4 Outliers 7.2.5 Normality 7.3 Exploratory Factor Analysis 7.3.1 Adequacy dataset for Factors Analysis 7.3.1.1 Sample size 7.3.1.2 Variables correlation, multicollinearity, singularity 7.3.2 Extraction and rotation of factors 7.3.3 Choosing the number of factors 7.3.4 Identifying and naming the Factors. Results interpretation 7.4 Confirmatory Factor Analysis 7.4.1 Methodological considerations 7.4.2 Construction and validation of the first order factorial model

7.4.3 Construction and validation of the multidimensional model of competitiveness of health organizations - validation of the hypothesis 6 7.5 Conclusions and implications CHAPTER 8. OPPORTUNITIES increase competitiveness by modernizing health unit management tools 8.1 Particularities of the management tools employed within health organizations 8.1.1 Methodological considerations 8.1.2 Principal Component Analysis (PCA) 8.1.3 Two-Step Cluster Analysis 8.1.4 Validation of hypothesis 7 8.1.5 Validation of hypothesis 8 8.2 Analysis of the influence of the use of management tools on the competitiveness of health organizations 8.2.1 Methodological considerations 8.2.2 Validation of hypothesis 9 8.2.3 Validation of hypothesis 10 8.2.4 Discussions 8.3 Improving the training of managers of health organizations in the use of modern management tools 8.3.1 Validation of hypothesis 11 8.3.2 Validation of hypothesis 12 8.3.3 Discussions 8.4 Conclusions and implications CHAPTER 9. FINAL CONSIDERATIONS 9.1 Final conclusions 9.2 Personal contributions 9.3 Constraints and limits of research 9.4 Directions for future research 9.5 Valorization and dissemination of research results BIBLIOGRAPHY ANNEXES