A framework for rapid problem assessment in healthcare delivery systems

This thesis was submitted for the degree of Doctor of Philosophy and was awarded by Brunel UniversityProblems in healthcare are difficult to comprehend due to complexity, involvement of multiple stakeholders in decision making and fragmented structure of delivery systems. Major Problem Structuring Methods (PSMs) have been used to aid problem understanding which, in principle, can provide greater clarity to strategic problems and engage diverse decision makers using transparent representation that capture differing perceptions of problems. In reality, PSMs can be difficult in accurately representing problems, limited in highlighting improvement opportunities due to non-intuitive visual representations and requirements for facilitators and stakeholders to be experts in tools used. This research aims to address this gap by developing a framework, taking into account characteristics of healthcare delivery systems, advantages and limitations of PSMs with an aim of providing accurate and holistic representation of delivery workflow, so as to promote problem understanding in a rapid manner. The framework, termed CARE, first establishes nature of problem and a commonly agreed problem statement along with an understanding of stakeholder involvement and operating regulations. It then sets specific guidelines for data collection, representation, verification and validation from stakeholders and provides methodology for data analysis which allows facilitator insight into possible flaws in workflow. A case study approach is used to test effectiveness of CARE across two different healthcare settings, each involving a different nature of problem. Implementation of CARE leads to improved participation and ownership amongst stakeholders, ease of facilitation during individual or multidisciplinary meetings, intuitive and informative representation of workflow, minimized time and effort for implementation and minimized dependencies on learning new tools and terminologies. A post mortem indicates the positive impact of CARE on services rendered to the patients, leading to an increase in patient satisfaction and workflow efficiencies. The research concludes by noting the contributions and lessons learnt from this research for healthcare practitioners and possible future work

Soft systems methodology: a context within a 50-year retrospective of OR/MS

Soft systems methodology (SSM) has been used in the practice of operations research and management science OR/MS) since the early 1970s. In the 1990s, it emerged as a viable academic discipline. Unfortunately, its proponents consider SSM and traditional systems thinking to be mutually exclusive. Despite the differences claimed by SSM proponents between the two, they have been complementary. An extensive sampling of the OR/MS literature over its entire lifetime demonstrates the richness with which the non-SSM literature has been addressing the very same issues as does SSM

System Governance Analysis of Complex Systems

The purpose of this research was to develop and deploy a systems-based framework for analysis of complex governance systems using a multimethodology research design. Two research gaps motivated this research: (1) lack of an integrated conceptualization of a system governance construct, (2) an absence of studies that consider both the governed and governing systems as well as the emergent interactions that arise from within complex governance systems. The research focused on three primary questions: (1) What are the distinctive characteristics of governance?; (2) What system-based framework can be developed for analysis of governance in complex systems?, and (3) What results from deployment of the framework in a field setting? The multimethodology research design that guided the effort included three primary phases. First, the literature was synthesized to derive a set of governance elements. This synthesis was accomplished across an extensive and multidisciplinary literature set by a novel method of content document clustering analysis to reveal important elements of governance. Second, a conceptual framework for analysis of system governance was constructed from the confluence of extant governance literature and systems theory. This governance system analysis framework was informed by Bunge\u27s (2003) system perspective to advance the understanding of governance that will be meaningful in a given practice. Finally, a case based application of the analysis framework was conducted to examine implications of the framework from a field perspective. The original research provided contributions to theory, methodology, and practice. From a theoretical perspective, the research contributed to the body of knowledge by providing: (1) a literature derived set of generalizable elements of governance, and (2) the development of a systems-based framework to be used to analyze complex governance systems. From a methodological stand-point, the research advanced an integrated multimethodology research design that featured: (1) a novel content analysis approach for synthesis of diverse literature; (2) the development of an integrated systems analysis method; and (3) a rigorous single-case study application within the engineering management discipline. Lastly, from a practical perspective, the systems framework provided a foundation for derivative approaches to enhance practices related to system governance

A communicative model for stakeholder consultation: towards a framework for action inquiry in tourism I.T.

A thesis submitted for the degree of Doctor of Philosophy of the University of BedfordshireThis thesis focuses on an under-researched area of tourism -the multi stakeholder, inter organisational business to business Tourism IT domain which exhibits a marked rate of failure. A critical review of B2B case studies reveals that this failure is in large part due to the primacy afforded to technical problem solving approaches over human centred ones. The main purpose of the research is therefore stated as: "how do we ensure that, as technological solutions are implemented within this domain, due consideration is given to human-centred issues?" In order to tackle this research problem an interdisciplinary approach is taken and a communicative model for stakeholder consultation is developed. At the centre of the model lies an innovative method for deconstructing and reconstructing stakeholder discourse. A Co-operative Inquiry research methodology was used and a significant number of stakeholders were engaged in an Open Space event sponsored by two major Tourism IT companies who wanted to investigate the issues and opportunities connected with travel distribution and technology. This was followed up with face to face interviews and live discussions over the internet. In addition stakeholder discourse was captured via the Travelmole tourism discussion site. The discourse between stakeholders was reconstructed and the normative and objective claims analysed in depth. The presentation of these reconstructions in textual, tabular and diagrammatic formats captures the complexity of stakeholder interactions, revealing that although IT is an important tool, what really lies at the core of multi stakeholder projects are the normative positions to which participants subscribe. The model provided a practical means for critiquing stakeholder discourse, helping to identify stakeholders both involved and affected by the issue; juxtaposing the 'is' against the 'ought'; and enabling critical reflection on the coercive use of power. The review of the tourism literature revealed that these issues are as important in general B2B tourism partnerships as in Tourism IT and in this respect the model provides a practical tool for critique and for enabling the formation of a shared normative infrastructure on which multi stakeholder projects can proceed. In addition, while borrowing from Management Science, this thesis also makes a contribution to it, specifically in the area of boundary critique, through the way in which Habermas' ideal speech criteria arc practically implemented

Information Systems Development through an Integrated Framework

Information systems are essential entities for several organizations who strive to successfully run their business operations. One of the major problems faced by the organizations is that many of these information systems fail, and thus the organizations do not achieve their required targets in time. Many of the reasons for the information system failures documented in the literature are related to development methodologies or frameworks that are unable to handle both ‘hard’ and ‘soft’ system aspects. In general, the hard issues of the system are considered more significant than the soft issues, however, all the methodologies must be able to deal with all the system and business aspects. This thesis investigates the possibility of developing and evaluating a multimethodology framework that can be used for information systems development in an academic and business environment. The research explores the applicability of such a framework that comprehends both ‘soft’ and ‘hard’ system aspects in order to eliminate information system failures. Different software development approaches are investigated, including the dominant ‘domain-driven design’ (DDD) approach. A new multimethodological framework entitled ‘Systemic Soft Domain Driven Design’ (SSDDDF) has been developed by combining ‘soft system methodology’ as a guiding methodology, ‘unified modelling language’ as a business domain modelling approach, and a domain-driven design implementation pattern. This framework is intended as an improvement of the DDD approach. Soft and hard techniques are integrated through mapping from the ‘consensus primary task model’ of the soft approach to the ‘use cases’ of the hard approach. In addition, ‘soft language’ is introduced as a complement to DDD’s ‘ubiquitous language’, for facilitating the communication between the different stakeholders of a project. The implementation pattern (e.g., Naked Objects) is included for generating code from domain models. The framework has been evaluated as an information systems development approach through different undergraduate and postgraduate projects. Feedback from the developers has been positive and encouraging for further improvements in the future. The SSDDD framework has also been compared to different ISD methodologies and frameworks among of these DDD as an approach to ISD. The results of this comparison show that SSDDDF has advantages over DDD and significant improvements to DDD have been achieved. Finally, the research suggests an agenda for further improvements of the framework, while suggesting the development of different pattern languages

Including Generative Mechanisms in Project scheduling using Hybrid Simulation

Scheduling is central to the practice of project management and a topic of significant interest for the operations research and management science academic communities. However, a rigour-relevance gap has developed between the research and practice of scheduling that mirrors similar concerns current in management science. Closing this gap requires a more accommodative philosophy that can integrate both hard and soft factors in the construction of project schedules. This paper outlines one interpretation of how this can be achieved through the combination of discrete event simulation for schedule construction and system dynamics for variable resource productivity. An implementation was built in a readily available modelling environment and its scheduling capabilities tested. They compare well with published results for commercial project scheduling packages. The use of system dynamics in schedule construction allows for the inclusion of generative mechanisms, models that describe the process by which some observed phenomenon is produced. They are powerful tools for answering questions about why things happen the way they do, a type of question very relevant to practic

A critical argument in favour of theoretical pluralism: project failure and the many and varied limitations of project management

In project management, failure is often assumed to be evidence of deficient management: a problem that can be overcome by better management. Drawing on qualitative research within UK construction projects we examine how four different theoretical approaches (positivism, structural Marxism, interpretivism and actor–network theory) all challenge this managerial assumption. Each theoretical perspective enables a specific analysis of empirical data that critiques the notion that project failures are easily, simply, or largely, associated with the failure of project management. In so doing, our pluralist analysis reveals the social and political contextualization of performance in project management. We thus conclude by proposing that practitioner and scholarly concerns with project failure (and success), can actively contribute to attempts to reflect upon various matters of political concern as developed within the Making Projects Critical community, and by extension Critical Management Studies. Thus, we propose greater interaction between critical and mainstream project research communities

Information management within the Nursing Department at Hamad Medical Corporation (HMC), Qatar

Hamad Medical Corporation, the main healthcare provider in the state of Qatar, sponsored this study to investigate the use of electronic records management as the basis for a novel information management system in its Nursing Department. To assess the viability of an electronic records management system a questionnaire survey of a representative sample of the staff and interviews with key post holders were under taken. Results obtained indicated a wide spread dissatisfaction with the existing manual system. However, introduction of any computer-based technology requires great care. To assist with identifying any issues with this technological change, Soft System Methodology (SSM) was employed to discern what changes could be made to improve the current problematic situation found in the Nursing Department. In fact the change archetypes uncovered (procedural, attitudinal, structural and cultural) formed an innovative input into obtaining a roadmap for development of the electronic staff records system. This roadmap was facilitated by the use of Nominal Group Technique (NGT) and Interpretive Structural Modelling (ISM): In fact the roadmap was an ISM intent structure. The roadmap suggested that change could be affected by having written policy documents and the top goal to be achieved reflected an improvement in manpower placing and budgetary forecasts. The use of a multi-methods approach meant that as well as this study's main objectives being reached, the process encompassed some methodological innovations. This study is the first to use the output of SSM to facilitate the NGT and ISM interactions. Equally, it is the first study of its sort to be applied to the Nursing Department at HMC, Qatar, which is an example of a cross-cultural eastern philosophical tradition. The methods used here revealed some significant findings, and have helped in the development of an electronic records management system for use at HMC, Qatar

Low carbon building performance in the construction industry: A multi-method approach of system dynamics and building performance modelling

The construction industry contributes significantly to energy consumption and carbon emissions. Moreover, people spend more time inside buildings, so their health is increasingly influenced by indoor environmental conditions. When considered through these lenses, the concept of total building performance can span energy consumption, the associated CO2 emissions, and indoor environmental quality (IEQ). At the individual project level, building underperformance with respect to energy and IEQ is frequent, and the ex post performance gap is partially attributed to the construction project management and operations phase of the building lifecycle. This underperformance motivates the research of this paper into the construction process outcomes in terms of energy performance and IEQ, and ways to reduce the performance gap. The paper develops a multi-methodology framework to analyse the effect of building development project process on energy performance and IEQ from an operations management perspective. The framework couples system dynamics modelling of construction project management to building performance modelling. The paper details the way they are coupled, the application steps and data requirements, so that they can be applied on a case by case basis. The aim is to combine operations management to building performance disciplines and deliver insights for industry practitioners and policy makers