• This study develops a framework that measures the quality effects into a separate component of the metafrontier global Malmquist index. • The proposed approach make use and derive benefit from the transitivity property of the developed index to overcome the possible data scarcity problems and provide consistent assessments with and without quality data. • We use the developed methodological framework, to better understanding the interrelationships between production and quality within the healthcare setting. • From a managerial perspective this study provides an empirical analysis of productivity drivers of Greek hospitals during the period of economic crisis to explore how the fiscal pressure affects hospital management. The main purpose of the study is to examine how the global economic crisis has affected the hospital productivity growth and quality performance of public hospitals in Greece. Through the nonparametric estimation of a quality-adjusted metafrontier Malmquist index, the study accounts the heterogeneity of hospitals according to the hierarchical levels of the healthcare system (primary, secondary and tertiary care) to examine the trends of efficiency change, innovation change, and leadership change during the period 2009-2013. The proposed approach relies on a novel methodological framework for measuring quality into a separate component of the metafrontier Malmquist. To understand the effect of the economic crisis in healthcare the study further explores the association between productivity and quality in the hospital sector. The results show that the implemented austerity measures have had a negative impact particularly on the quality of the tertiary hospitals that exhibited an overall productivity regress.

Resilience management aims to increase the ability of the system to respond to adverse events. In this study, we develop and apply a structured framework for assessing the resilience of the decision-making process related to reservoir (or lake) regulation with the resilience matrix approach. Our study area is Finland, where the initiatives for the regulation have typically been hydro power production or flood prevention, but nowadays recreational and environmental issues are also increasingly considered. The main objectives of this study are twofold. First, it aims to provide support for reservoir operators and supervisors of the water course regulation projects in their work for identifying the possible threats and actions to diminish their consequences. Second, it studies the applicability of the resilience matrix approach in a quite specifically defined operational process, as most of the earlier applications have focused on a more general context. Our resilience matrix was developed in close co-operation with reservoir operators and supervisors of regulation by means of two workshops and a survey. For the practical application of the matrix, we created an evaluation form for assessing the resilience of a single dam operation process and for evaluating the cost efficiency of the actions identified to improve the resilience. The approach was tested on a dam controlling the water level of a middle-sized lake, where it proved to be a competent way to systematically assess resilience.