A construção modular é um método construtivo que estrutura os elementos de uma infraestrutura em componentes pré-fabricados, produzidos num ambiente controlado e posteriormente transportados para o estaleiro de obra, onde são assemblados. Apesar de proporcionar maior controlo na execução dos produtos, a abordagem modular apresenta várias complexidades, como a gestão e a otimização dos processos em fábrica, a logística de transporte dos produtos e a variabilidade das peças a produzir. A transição digital das empresas de construção modular e a implementação da metodologia Building Information Modelling (BIM) requerem, por isso, especial cuidado e uma adaptação específica a uma forma diferente de projetar e construir. O presente artigo apresenta a jornada de implementação do BIM numa empresa especializada na produção de soluções de construção modular em madeira. São identificados os principais desafios do processo construtivo industrial e os pontos críticos para a aplicação da metodologia BIM. Salientam-se como principais desafios: a baixa utilização de objetos estandardizados na indústria; os desafios de interoperabilidade entre projetos externos e os produtos; e, ainda, as dificuldades na normalização de processos de fabrico digital. De forma a alcançar alguns destes objetivos, o artigo delineia ainda o processo de elaboração de um Guia Técnico BIM e as respetivas ferramentas de apoio, que estrutura normas e diretrizes de boas práticas BIM, adaptadas ao contexto da construção modular industrial em madeira.

Reverse Logistics (RL) plays a fundamental role in supply by addressing returns, undelivered or damaged products, exchanges, and environmental concerns, directly contributing to more sustainable supply chain practices. Although firms recognize the importance and benefits of this concept, their supply chain remains focused on direct logistics, often overlooking RL’s potential to enhance sustainability performance. The aim of this article is to analyse the interaction between the barriers that challenge or prevent the implementation of RL in Small and Medium-sized Enterprises (SMEs). First, a literature review identified 22 barriers to developing RL in SMEs. Then, through experts’ opinions gathered in a Focus Group (FG), an Interpretive Structural Modeling (ISM) model was used to understand the hierarchy relations between barriers, and a Matrix Cross Impact Matrix Multiplication (MICMAC) analysis was carried out to aggregate the barriers in four categories according to their influencing power and dependence. Applying the methodology to the Portuguese case resulted in an ISM model with seven hierarchical levels and a MICMAC diagram without dependent barriers. Moreover, six key barriers emerged, namely, Lack of adequate organizational structure and support for RL practices, Lack of corporate social responsibility, Complexity of the operation, Lack of shared understanding of best practices, Difficulty with members of the supply chain, and Lack of support from supply chain players, which proved to be the most critical as they are positioned at the highest hierarchical levels of the ISM model and fall within the independent variable quadrant of the MICMAC analysis, thus revealing a strong driving power over the other barriers. The findings highlight that overcoming these barriers is crucial for SMEs to unlock the full sustainability potential of RL and transition towards supply chain models that are greener through a reduced carbon footprint, improved resource efficiency, and the adoption of circular economy practices. Academically, this research advances the literature by applying the ISM–MICMAC approach to SMEs, offering novel insights into the structural role of barriers in reverse logistics implementation.

Organizations strive to implement sustainable supply chain management (SSCM) practices and technologies to improve their economic, social, and environmental impacts. However, implementing SSCM is challenging. Therefore, it becomes crucial to understand how organizations may overcome these challenges and enable successful implementation and adoption of SSCM. This study reviewed literature to identify the barriers hindering SSCM implementation and their subsequent overcoming strategies. Overall, 80 barriers, divided into nine categories, were encountered. These comprise technological, economic and financial, supplier-related, information-related, market and networking, human resources, social and cultural, regulatory and institutional, and organizational barriers. Moreover, 40 strategies that can help overcome these barriers were reported and resumed in this study.

Adopting building information modeling (BIM) within the architecture, engineering, and construction (AEC) industry presents an opportunity to tackle persistent challenges, such as chronic productivity deficits and emerging imperatives like sustainability. However, BIM implementation (BIMI) across European Union (EU) countries diverges due to different contexts and the complexity of BIM. This study aims to identify the main barriers to BIMI and recommend effective mitigation measures in Portugal, a late-adopting EU country. Initially, 28 BIMI barriers were identified through a literature review. Experts in a Delphi survey then selected 15 critical barriers. An interpretive structural modeling (ISM) model was developed with input from a focus group to clarify the hierarchical relationships among barriers, and an impact matrix cross-reference multiplication applied to a classification (MICMAC) analysis was performed to evaluate the barriers’ driving and dependence powers. The resulting main barriers to BIMI include a lack of evaluation mechanisms, ignorance of BIM benefits, a shortage of skilled professionals, limited experience and cooperation, resistance to change, and inadequate top management support. Finally, experts in a second focus group developed mitigation measures to address the main barriers while ensuring the measures affect the entire barrier system. These findings will assist researchers, policymakers, and practitioners in late-adopter EU countries in addressing these barriers effectively.

Lean Six Sigma (LSS) is recognized as a powerful process improvement methodology for enhancing operational efficiency and long-term sustainability. This study examined the barriers hindering LSS implementation in the chemical process industry within an emerging economy, Brazil. It developed a structured methodology for designing mitigation measures to overcome those barriers. First, 26 barriers from the literature were ranked by LSS experts through a Delphi survey to select the top 15. Then, a combined interpretive structural modeling (ISM) approach and impact matrix cross-reference multiplication applied to a classification (MICMAC) analysis approach was used, supported by a focus group, to determine the hierarchical relationships among the barriers and their driving power and dependence. Finally, a second focus group defined adequate mitigation measures. The top four main barriers are the lack of time, insufficient systemic understanding of lean principles, misalignment between LSS and corporate strategies, and inadequate top management commitment. Additionally, 10 mitigation measures are proposed. This study contributes to LSS implementation in the chemical process industry in Brazil, thus enhancing industry sustainability by improving operational efficiency, curbing waste, reducing transportation-related emissions through a decreasing reliance on imported chemical products, and contributing to economic growth and job creation within the industry.

Construction delays are recurrent worldwide, regardless of the type of work, and can result in severe impacts, such as time and cost overruns and conflicts. This work aims to present a methodology to develop mitigation measures for the causes of Delays in Construction Projects (DCPs). Prior works have explored strategies to develop these measures but systematically failed to consider that the interrelationships among causes affect the significance of the impact of each cause. The methodology proposed combines the Interpretative Structural Modelling (ISM) and Matrix Cross Impact Matrix Multiplication (MICMAC) analyses approaches and is grounded on the opinions of construction experts collected during Focus Group Interviews (FGI). First, the critical causes of DCPs are identified. Second, the ISM model is built, representing the interrelationships between the causes and their hierarchy. Third, the MICMAC analysis is performed, revealing the strengths of the relationships among the influencing causes. Fourth, mitigation measures are developed to address the root causes identified in the previous steps, but they are designed to target and mitigate other causes, given their hierarchical relationships, driving power, and levels of dependence. Applying this methodology to the Portuguese context revealed 16 critical causes, which were then hierarchized into six levels of influence. Inadequate bidding and contract award processes and deficient communication between parties were deemed root causes, and 23 measures were put forward to mitigate DCPs. Therefore, this study contributes to the body of knowledge by designing an innovative and practitioner-wise methodology to develop mitigation measures in relation to DCPs and revealing some measures for the Portuguese context.

Sustainable supply chain management (SSCM) integrates economic, social, and environmental goals within the supply chain to enhance long-term performance. It assists organizations in monitoring their performance concerning social, environmental, and economic factors to bolster sustainability. Yet, implementing SSCM poses significant challenges for most organizations, particularly small and medium-sized enterprises (SMEs). This study aims to identify key barriers and strategies for overcoming them in SMEs. A thorough literature review revealed 80 barriers across nine categories: technological, economic and financial, supplier, information, market and networking, human resources, social and cultural, regulatory and institutional, and organizational barriers. Eight experts from SMEs in focus group discussions considered 55 relevant barriers and prioritized them using the best–worst method. Then, based on the top 15 barriers they deemed key, they adapted and improved 24 strategies based on the literature that, in their opinion, could support the implementation of and improve the SSCM in SMEs. The findings from this study highlight economic and financial barriers as the foremost challenges to the implementation of SSCM, mainly due to the lack of funding and capital to make changes in activities to include sustainability. The findings are valuable for SMEs seeking to implement SSCM, offering insights into potential barriers and strategies for surmounting them. Moreover, this study provides a structured approach that can be replicated to identify the most pressing barriers to overcoming and improving long-term sustainability.

Transport-on-demand services, such as demand-responsive transport (DRT), involve a flexible transportation service that offers convenient and personalised mobility choices for public transport users. Integrating DRT with mobile data and data analytics enhances understanding of travel patterns and allows the development of improved algorithms to support design-optimised services. This study introduces a replicable framework for DRT that employs an on-demand transport simulator and routing algorithm. This framework is supported by a mobile data set, enabling a more accurate service design grounded on actual demand data. Decision-makers can use this framework to understand traffic patterns better and test a DRT solution before implementing it in the actual world. A case study was conducted in Porto, Portugal, to demonstrate its practicality and proof of concept. Results show that the DRT solution required 135% fewer stops and travelled 81% fewer kilometres than the existing fixed-line service. Findings highlight the potential of this data-driven framework for urban public transportation systems to improve key performance metrics in required buses, energy consumption, travelled distance, and stop frequency, all while maintaining the number of served passengers. Under specific circumstances, embracing this approach can offer a more efficient, user-centric, and environmentally sustainable urban transportation service.

Ever-growing mobility and traffic congestion within urban areas make the need for a sustainable form of transport inevitable. Traffic congestion has a significant effect on the amount of energy consumption of a vehicle and, as a result, on its associated environmental impacts. Any decision-making regarding structuring a fleet without taking into account the traffic congestion level (TCL) will lead to a less sustainable fleet with higher environmental and economic costs. To address this issue, this study examines the effects of the traffic congestion intensity level on the fleet structure of an urban car-sharing company over a certain planning period. We present a new optimization framework for finding an optimal vehicle composition of the fleet of an urban car-sharing company considering the energy consumption of vehicles at different traffic congestion levels. The results show that electric vehicles (EVs) are more competitive than diesel vehicles (DVs) in high-peak traffic congestion from the outset of the planning period. In addition, we perform a sensitivity analysis to take into account the effects of specific uncertain parameters such as the energy and purchasing costs of EVs on the total cost of ownership. As expected, the purchasing price of EVs, energy prices of DVs, and increase in diesel prices have the highest impact on the total cost.

The Lean methodology allows for the streamlining of management and production systems to reduce costs. In the case of the construction sector, the goal is to optimize processes, reduce waste, increase product quality, and increase client satisfaction. These have been areas where construction, as a sector, is struggling to deliver substantial results. Despite the potential benefits associated with Lean approaches, there has been significant resistance from the construction industry. The main objective of this research is to identify the barriers to applying Lean methodology in the Portuguese construction sector. This will contribute to understanding why Lean is not gaining traction among construction stakeholders and help to identify improvement areas replicable in similar markets. Initially, the barriers were identified based on a comprehensive literature review, and those barriers were evaluated based on their importance using a survey responded to by construction sector professionals. Based on the survey's results, 15 barriers were considered critical. Additionally, a combined ISM model and MICMAC analysis was developed to study the relations between these barriers and the driving and dependence power of each one of the critical barriers. The results obtained show that the main barriers are the lack of support and commitment from top management, a lack of organizational communication, a lack of communication and transparency between stakeholders, unsuitable organizational structures, a lack of adequate Lean awareness and understanding, management resistance to change, and employees' aversion to change and fear of new procedures.

Since the 1990s, studies and pilot tests have been conducted to reduce traffic, accidents, and pollution due to urban freight transport (UFT). These ended up in several policies, regulations, and restrictions for UFT, such as low emission zones, delivery time windows, and vehicle size and weight restrictions. However, issues in UFT under regulatory measures still persist. This study introduces an optimization framework for deriving an optimal combination of various types of vehicles with different capacities for vehicle replacement with UFT. This framework allows an understanding of how an urban freight company with a limited budget efficiently satisfies its freight demand within an urban area in the presence of regulatory measures by urban administrators. The introduced formulation, which is mixed-integer linear programming, will assist the operator in choosing the best investment strategy for introducing new vehicles of certain types and sizes, for operation in different zones, into its fleet while gaining economic benefits and having a positive impact on the liveability of the urban area. Furthermore, an elasticity analysis is performed to consider the effects of specific uncertain parameters on the total cost. The numerical results show that the share of electric vehicles in the fleet increases, and they are more competitive than diesel vehicles.

With growing environmental concerns, reverse logistics (RL) assumes a significant role in the sustainability of the construction industry to the extent that it can contribute to mitigating some of the negative environmental impacts related to its activity. However, despite the benefits that can be attributed to RL, its implementation level in the construction industry is still very low. This research determines the root barriers to adopting RL in construction (ARLC) using the case of the Portuguese construction market. The methodology involved focus groups and a combined Interpretive Structural Modelling (ISM) and Matrices d’Impacts cross-multiplication appliqúe a classmate (MICMAC) approach. The root barriers that have been identified by the application of the methodology to the ARLC are: lack of financial incentives to incorporate recycled materials, lack of knowledge about RL, lack of technical support, standard codes and regulations in favor of using recycled materials, lack of information sharing, cooperation and coordination among entities of the supply chain, current buildings have not been designed for deconstruction, and lack of construction and demolition waste (CDW) management and recycling infrastructures and markets for the materials resulting from CDW. The highest hierarchical level includes barrier B10 (lack of financial incentives to incorporate recycled materials into the construction); this barrier influences all the other barriers and, as such, it is considered the key barrier to the ARLC in Portugal. The research has also identified 17 different mitigation measures to tackle these barriers, with different natures: fiscal, regulatory, financial, etc.

In recent decades, the purchasing function has occupied an essential role in managing companies in all industries. In healthcare, purchasing medicines is critical due to the amount of resources involved, the quantity and wide variety of items purchased, and the impact on the quality of health service. This research aims to propose a more efficient and effective practitioner-wise model for medicine purchasing strategic management in the healthcare industry. For such, this study combined action research with a case study to develop a Purchasing Portfolio Model based on the Kraljic Purchasing Matrix in the context of a central hospital. Analytic Hierarchy Process techniques were used for criteria prioritization and direct measurement to score each criterion. MultiDimensional Scaling was used to position the items in the quadrants of the Kraljic Purchasing Matrix. The Purchasing Portfolio Models developed allows the classification of different classes of medicine in terms of strategic impact and supply risk, enabling the development of differentiated purchasing strategies. The results confirmed the model's value in defining medicine purchasing strategies in a central hospital and provided guidelines for applying the model.

Modular construction is the most advanced method of off-site construction available, generating fully-fitted modules with up to 80% of the work completed in a controlled environment prior to their transportation and installation on-site. The adoption of modular construction (AMC) has increased in several countries worldwide. However, in smaller construction markets, the adoption rates remain low, and the industry is still heavily reliant on traditional labor-intensive methods. The main research question for this study is: What are the main barriers (including the root barriers) to the adoption of modular construction in Portugal? The methodology used was a mixed methods research (MMR) approach, trying to understand if there are any specificities in the Portuguese (European Union) markets compared with the more well-documented North American and Asian markets. First, a literature review followed by a survey were used to prioritize a list of 15 critical barriers to the AMC. The results and interrelations between the barriers were analyzed through an interpretive structural modeling (ISM) approach and an impact matrix cross-reference multiplication applied to a classification (MICMAC) analysis. The combined analyses show that the main barriers are low levels of R&D, a lack of accredited organizations to certify the quality of the manufactured components and the industry’s unwillingness to innovate.

Delays are a common issue in construction projects worldwide, and they can frequently have an influence on time and cost overruns, among other problems. This study aims to add to the knowledge on construction project management theory and practice by identifying the leading causes of Delays in Construction Projects (DCP) in Portugal, modeling their interrelationships, and determining their main causes. The study presented herein adopted a two-phase methodology. First, based on the literature, the causes of DCP in Portugal are identified. Then the hierarchical structure of the causes of DCP is determined, using integrated Interpretive Structural Modelling (ISM), and an ISM-based Model is developed. The results show that the 16 causes of DCP taken into consideration are hierarchized in six different influence levels. The causes Bidding and contract award process and Lack of communication between parties are the most influential causes, and are thus considered to be the root causes of DCP in Portugal. Additionally, the results show that the causes of DCP can be divided into four different categories relating to Relationships and contract, Material, the Developer, and the Contractor. Finally, these results provide fundamental insights for practitioners and researchers to develop effective measures to mitigate the causes of DCP.

Background: Studies show that healthcare-associated infections (HAIs) represent a crucial issue in healthcare and can lead to substantial economic impacts in intensive care units (ICUs). Aim: To estimate direct costs associated with the most significant HAIs in 50 teaching hospitals in Brazil, affiliated to the unified health system (Sistema U acute accent nico de Saude: SUS). Methods: A Monte Carlo simulation model was designed to estimate the direct costs of HAIs; first, epidemiologic and economic parameters were established for each HAI based on a cohort of 949 critical patients (800 without HAI and 149 with); second, simulation based on three Brazilian prevalence scenarios of HAIs in ICU patients (29.1%, 51.2%, and 61.6%) was used; and third, the annual direct costs of HAIs in 50 university hospitals were simulated. Findings: Patients with HAIs had 16 additional days in the ICU, along with an extra direct cost of US$13.892, compared to those without HAIs. In one hypothetical scenario without HAI, the direct annual cost of hospital care for 26,649 inpatients in adult ICUs of 50 hospitals was US$112,924,421. There was an increase of approximately US$56 million in a scenario with 29.1%, and an increase of US$147 million in a scenario with 61.6%. The impact on the direct cost became significant starting at a 10% prevalence of HAIs, where US$2,824,817 is added for each 1% increase in prevalence. Conclusion: This analysis provides robust and updated estimates showing that HAI places a significant financial burden on the Brazilian healthcare system and contributes to a longer stay for inpatients. (c) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Over the years, the purchasing area has taken on an essential role in the management of companies in all activity sectors. In the health sector, purchasing medicines is highly important considering the amounts involved, the impact on the service quality, and the wide variety of purchased products. This research work combined action research with a case study and aims to apply to a Central Hospital a Purchasing Portfolio Model based on the Kraljic Purchasing Matrix (KPM). The KPM allows for the classification of different classes of medicines in accordance with their impact on profits and supply risk dimensions, making it possible to define differentiated purchasing strategies. This application used the Analytical Hierarchical Process (AHP) tool for criteria prioritization and used direct measurement for criterion rating. By applying the model to a Central Hospital, this study seeks to increase the areas of applicability of purchasing portfolio models. Moreover, the results confirmed the model's value in defining medicine purchasing strategy at the Central Hospital and also gave rise to guidelines for applying the model.

Background: Little is known about the economic burden of healthcare-associated infections (HAIs) in Brazil. Aim: To analyse the costs of hospitalization by reimbursement from the Brazilian government, via the Brazilian Unified Health System (SUS) affiliation, and direct costs in the adult Intensive Care Unit (ICU). Methods: The matched-pairs case-control study (83 patients with HAIs and 83 without HAIs) was performed at a referral tertiary-care teaching hospital in Brazil in January 2018. In order to calculate the HAI costs from the perspective of the payer, the total cost for each hospitalization was obtained through the Hospital's Billing Sector. Direct costs were calculated annually for 949 critical patients during 2018. Findings: The reimbursement cost per hospitalization of patients with HAIs was 75% (US$2721) higher than patients without HAIs (US$1553). When a patient has an HAI, in addition to a longer length of stay (15 days), there was an extra increase (US$996) in the reimbursement cost per hospitalization. An HAI in the ICU was associated with a total direct cost eight times higher compared with patients who did not develop infections in this unit, US$11,776 x US$1329, respectively. The direct cost of hospitalization in the ICU without HAI was 56.5% less than the reimbursement (US$1329 x US$3052, respectively), whereas for the patient with an HAI, the direct cost was 111.5% above the reimbursement (US$11,776 x US$5569, respectively). Conclusion: HAIs contribute to a longer stay and an eight-fold increase in direct costs. It is necessary to reinforce programmes that prevent HAIs in Brazilian hospitals. (C) 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.