Lean Project Management as a facilitator of Organisational Learning

The utility and impact of lean principles remains a point of contention (Staats et al, 2011) and few research studies have attempted to link lean project management (LPM) thinking with overall learning and knowledge success from a behavioural perspective (Hines et al, 2004). Those who have done so, have used lean project management principles to highlight singular process-related, task-driven systems and identify barriers in improving operational procedures (Spear, 2005; Poksinska, 2010; Staats et al, 2011) rather than investigating the potential link between desired outcomes and behaviours (Nidumolu & Subramani, 2003). Such studies have limited the progress of LPM as a viable change initiative in solution-focused environments. In this paper, we explore the utility of lean project management against a background of complexity and uncertainty and consider if, and how, LPM can facilitate learning within organisations to establish and sustain improvements for economic success

Thiopurine withdrawal during sustained clinical remission in inflammatory bowel disease:relapse and recapture rates, with predictive factors in 237 patients

Background: Thiopurines (azathioprine and mercaptopurine) remain integral to most medical strategies for maintaining remission in Crohn's disease (CD) and ulcerative colitis (UC). Indefinite use of these drugs is tempered by long-term risks. While clinical relapse is noted frequently following drug withdrawal, there are few published data on predictive factors. Aim: To investigate the success of planned thiopurine withdrawal in patients in sustained clinical remission to identify rates and predictors of relapse. Methods This was a multicentre retrospective cohort study from 11 centres across the UK. Patients included had a definitive diagnosis of IBD, continuous thiopurine use ≥3 years and withdrawal when in sustained clinical remission. All patients had a minimum of 12 months follow-up post drug withdrawal. Primary and secondary end points were relapse at 12 and 24 months respectively. Results: 237 patients were included in the study (129 CD; 108 UC). Median duration of thiopurine use prior to withdrawal was 6.0 years (interquartile range 4.4–8.4). At follow-up, moderate/severe relapse was observed in 23% CD and 12% UC patients at 12 months, 39% CD and 26% UC at 24 months. Relapse rate at 12 months was significantly higher in CD than UC (P = 0.035). Elevated CRP at withdrawal was associated with higher relapse rates at 12 months for CD (P = 0.005), while an elevated white cell count was predictive at 12 months for UC (P = 0.007). Conclusion Thiopurine withdrawal in the context of sustained remission is associated with a 1-year moderate-to-severe relapse rate of 23% in Crohn's disease and 12% in ulcerative colitis

An exploration of the barriers, benefits and enablers for the effective implementation of lean project management

This paper explores the factors which contribute to the effective implementation of lean project management (LPM) as perceived by a group of practitioners working in lean project management. In contrast to traditional forms of project management, the lean approach has been considered beneficial, although difficult to execute due to a lack of understanding of the barriers and enablers that are relevant to the contemporary practice environment. Between 2018 and 2019, 58 semi-structured interviews were conducted with project management professionals in Germany, the UK and Switzerland, from a variety of disciplines. Barriers, benefits and enablers were identified but more importantly, factors which specifically address barriers and enable effective implementation were also identified. Findings highlight the importance of awareness of underpinning elements of knowledge, experience, skills, social and behavioural factors, as well as the project environment context to facilitate long-term sustainability of the lean implementation journey in projects

Safe feeding practices for infants and young children

Objective: To review local and overseas experience of food asphyxia in children and to examine aspects of safe childhood eating practices. Methodology: Inpatient separation information data for childhood hospital admissions in South Australia were searched for episodes of food-induced airway obstruction and case records of the Department of Histopathology at the Women's and Children's Hospital were searched for cases of fatal food asphxia. Results: While other forms of injury to young children appear to be declining in numbers, episodes caused by choking on food have remained relatively constant. The increase in average length of hospital stay (from 2.8 days in 1989-90 to 5.2 days in 1993-94) also suggests that the episodes have been more severe. Two fatal cases were also found. Conclusions: Choking due to food inhalation is a problem with potentially fatal consequences. Young children are particularly at risk as they have immature dentition and control of swallowing, and lack experience of food. Although young children should avoid potentially dangerous foods such as raw carrot sticks and raw apples, certain currently available information packages for parents recommend these foods