Leadership Requirements for Successful Implementation of Lean Management in Health Care: A Systematic Review of the Literature

Lean is a management philosophy aimed at increasing value for end users by controlling waste. As such, it is a promising approach for health-care organizations to improve quality and control costs. Yet the transition to Lean management often fails in health-care organizations, commonly due to a lack of specific Lean leadership skills. This research addresses a gap in the knowledge about leadership requirements for successful Lean implementation in health-care organizations. A systematic literature search was performed using the MEDLINE, EMBASE and Emerald databases, resulting in the selection of 23 articles. Analysis of these articles confirmed the five Lean leadership principles identified in the manufacturing literature—improvement culture, self-development, employee training, going to the gemba, and hoshin kanri—and identified specific leadership behaviors, skills, characteristics, and attitudes for each principle. A sixth leadership principle, that of customer value, was also identified. This research contributes to existing Lean literature by providing new insights into leadership requirements for Lean transitions in health care. A new leadership framework is suggested for Lean leadership requirements during Lean implementation. In practice, this research provides health-care leaders with a practical framework and guidance with which to successfully implement Lean in a health-care institution

Lean leadership:Towards continuous improvement capability in healthcare

This research focuses on the role of leadership styles during Lean Management (LM) initiatives in healthcare environments. Specifically, this study examined the role of leadership styles in the development of Continuous Improvement (CI) capability of teams. The empirical evidence was collected by applying a multiple-case design, and consisted of interviews, observations, and documentation. These data sources were used to develop case studies, and to identify leadership behaviours supportive of LM. Through qualitative case analysis, the influence of leadership styles on CI capability was determined. The results show that a hybrid leadership style is associated with higher levels of CI capability, and that the duration of a LM program in itself does not dictate maturity. A mix of both transactional and transformational leadership styles seems a necessary condition for teams to reach higher levels of CI capability. Based on these findings, this paper provides a framework to structure thinking on LM and leadership styles, and concludes with supporting propositions. The current outcomes imply that leaders should be sensitive towards their adopted leadership style, and should adopt a leadership style that combines both transformational as well as transactional elements, when leading LM teams

Cuaderno de trabajo de motricidad para el contexto achuar : propuesta metodológica para primer año de Educación General Básica

This work is for the development of the graph-motricity, because it is very fundamental for the boys and the girls, and their son has difficulties to enter the school, this is the material that allows the development of fine motor skills, it is the tuning to work and how to use the handling of the materials. In this material drawings are designed to the reality of children, there are also activities where they can be developed alone. This work has three parts divided as first work, cut the images to paste in the notebook, paste, second job is to paint the images and as a third job to join the points to form image. In order for this work to be done, the children of the KATIRA educational center, of the San Francisco school of the Wasakentsa Salesian community, were first visited to visualize the level of development of the achuar children, according to the diagnosis. with the boys and girls, also to know the level of how it can be done and how to write the children at the time of writing. Why? Because the pages that came with the children, girls and boys had learning problems, how to paint and write the letters correctly. But now, seeing the reality that happens with writing problems correctly with boys, girls and boys, girls and boys, boys and girls.Este trabajo es para el desarrollo del grafo-motricidad, pues es muy fundamental para los niños y niñas achuar preescolares, porque tienen dificultades al ingresar a la escuela, por estas razones realizo este material que permitirá el desarrollo de la motricidad fina, es la afinación de trabajar y cómo utilizar y manejar los materiales. Cuaderno de trabajo grafo motricidad está desarrollada para los niños prescolares, para que ya desde la edad temprana tengan la idea o la capacidad de mover correctamente sus manos, que por sí solos sepan de rayar, pintar los gráficos, recortar las figuras y unificar los puntos, todo este trabajo ayudará a los niños. El trabajo realizado cuaderno de trabajo de motricidad para el contexto achuar. Propuesta metodológica para primer año de educación general básica, es un material desarrollada es importante porque nuestros niños cuentan todavía con las dificultades al manejo de la motricidad dina al manejo de motricidad gruesa En este material los dibujos están diseñados con la realidad de los niños, también hay actividades en la que ellos puedan desarrollar independencia al trabajar solos. Este trabajo tiene tres partes la primera es recortar las imágenes para pegar en el cuaderno, luego pintar las imágenes y finalmente unir los puntos para formar la imagen. Para realizar este trabajo primero se visitó a los niños de la escuela del centro educativo Katira, del barrio San Francisco de la comunidad salesiana Wasakentsa, para visualizar el nivel de desarrollo de los niños y niñas achuar, de acuerdo a eso se desarrolló el diagnóstico con los niños y niñas, también para saber el nivel de cómo se desarrollan y escriben. Porque sin este documento los docentes que vinieron trabajando con los niños, niñas achuar han tenido problema para enseñar cómo pintar, escribir correctamente las letras y leer. Pero ahora, viendo la realidad que sucede el problema de escribir correctamente con los niños, niñas achuar y para que este documento en el futuro sea útil para los docentes para aplicar en los centros educativos así, para mejorar su trabajo con los niños, niñas de nuestra comunidad

Glycyrrhizin Attenuates Toll Like Receptor-2, -4 and Experimental Vasospasm in a Rat Model

Upregulated TLRs are observed in the serum of animals following experimental subarachnoid hemorrhage. This study was to examine glycyrrhizin's effect on proinflammatory cytokines and TLRs in SAH rats. Administration with glycyrrhizin was initiated 24 hr before and 1 hr later using osmotic minipump. Basilar arteries were harvested to examine TLRs mRNA and protein (rt-PCR and western blot) and CSF cytokines (rt-PCR). Morphologically, deformed endothelium, tortuous elastic lamina, and smooth muscle necrosis were observed in the SAH rats, but were absent in the glycyrrhizin pretreatment group. The TLR-3 protein level was not increased in SAH animals, compared with the controls, while that of TLR-2 and -4 in the SAH only and SAH plus vehicle groups was significantly elevated ( < 0.01). Pretreatment and treatment with glycyrrhizin reduced TLR-2 and -4 by 28 ± 8% and 33.4±9.2%, respectively. Likewise, glycyrrhizin was able to reduce the IL-1 and MCP-1 mRNA levels. This study shows glycyrrhizin exerts anti-inflammatory effects on SAH induced vasospasm and attenuates the ultrashort time expression of TLRs, like TLR-2 and -4. It corresponds to SAH induced early brain injury. These findings offer credit to the antivasospastic effect of glycyrrhizin and its effect on SAH induced early brain injury

Bayesian optimization for materials design

We introduce Bayesian optimization, a technique developed for optimizing time-consuming engineering simulations and for fitting machine learning models on large datasets. Bayesian optimization guides the choice of experiments during materials design and discovery to find good material designs in as few experiments as possible. We focus on the case when materials designs are parameterized by a low-dimensional vector. Bayesian optimization is built on a statistical technique called Gaussian process regression, which allows predicting the performance of a new design based on previously tested designs. After providing a detailed introduction to Gaussian process regression, we introduce two Bayesian optimization methods: expected improvement, for design problems with noise-free evaluations; and the knowledge-gradient method, which generalizes expected improvement and may be used in design problems with noisy evaluations. Both methods are derived using a value-of-information analysis, and enjoy one-step Bayes-optimality