Blockchain Papers

Supustra Sensai, Jiruth Sriratanaban

Introduction: The decentralization of Subdistrict Health Promoting Hospitals (SHPHs) to Provincial Administrative Organizations (PAOs) in Thailand represents a significant structural reform with direct implications for nurses working in primary healthcare settings. This study aimed to develop a competency model for nurses employed in SHPHs under PAO jurisdiction, ensuring alignment with decentralization policies and local health system needs. Methods: A mixed-methods design was used in 2 phases. Phase 1 employed qualitative methods to explore current nursing roles through in-depth interviews and thematic analysis. Phase 2 involved developing the competency model using quantitative data and the Delphi technique with expert consensus. Results: Findings from phase one indicated that nurses continue to play a vital role in community-based health promotion and care for vulnerable populations. Following decentralization, nurses have adapted to new responsibilities involving local workforce coordination, budgeting, and health information systems, necessitating expanded competencies. The competency model delineates stratified expectations by facility size: small SHPHs require generalist proficiency for autonomous service delivery; medium SHPHs necessitate specialized and collaborative competencies for programmatic functions; and large SHPHs demand advanced skills in systems management, strategic planning, and specialized care to align with institutional complexity. Conclusion: Although nurses’ core responsibilities in primary care remain central, decentralization has introduced new demands requiring advanced clinical, technological, data management, and interprofessional collaboration competencies. These expanded roles have strengthened nurses’ contributions to local health governance under the PAO system.

Götz G. Wehberg

The high importance attributed to the complexity management of supply chains raises the question of an adequate design. This problem has not yet been fully addressed by scientific efforts. H. J. Warnecke uses his concept of the “fractal factory” to design a system for production logistics. The fractal structure offers a hierarchizing of the manufacturing organization and enables sufficient complexity in this area via decentralized control loops. H. Wildemann offers the “modular factory” in response to the growing complexity of manufacturing. His concept implies complexity-increasing approaches, in particular in connection with the creation of structured networking and self-regulating, partially autonomous subsystems. There is a strong need for a frame of reference of digital supply chain management that supports decisions and resilience in particular. From an IT angle, such a framework has been drafted in terms of Reference Architecture Model Industry 4.0.

Barbara Isensee, Reiner Hanewinkel

No abstract is available for this record.