Exploring poor outcomes from quality assurance programs – An analysis based around the concept of Mechanisms and The Theory of Constraints (TOC) Thinking Process (TP)

Quality programs have been used by organisations since their advent in the 1930s and continue to be implemented to achieve various goals. For example, according to the International Organization for Standardization (2015) and the CASRO Institute for Research Quality (2016), organisations aim to reduce costs, gain a competitive advantage, improve the quality of their processes and products, and enhance profitability through attaining such accreditations. ISO accreditations have also been used to ensure compliance with market requirements (Williams, 2004). However, a major challenge in implementing these programs, referred to in this thesis as ‘Quality Assurance Programs’ (QAPs), is the gap that continues to exist between the desired and the actual outcomes (Prajogo, 2011; Williams, 2004). The actual outcomes are often poor and disappointing, with many firms reporting dissatisfaction with the outcomes of such expensive QAPs (Heravitorbati, Coffey, & Trigunarsyah, 2011; Ormerod, 2006). Successful ISO accreditations are typically evident when the ISO standards are met, and profitability and organisational performance enhanced; however, failed accreditations are difficult to quantify because organisations may attain the accreditation but fail to achieve fundamental desired outcomes, such as increased productivity. These disappointing outcomes come at a high cost for both the organisation and the employees. This thesis sets out to explain this observed anomaly for three different case examples. The focus is on investigating “how” and “why” QAPs succeed or fail, and to provide an explanation for such outcomes. In other words, this thesis seeks to contribute to answering the research question “what works for whom in what circumstances?” (Pawson & Tilley, 1997). This requires defining the possible mechanisms in context that explain the observed outcomes. The investigation conducted in this thesis proposes particular mechanisms that explain the observed outcomes. For this purpose, a structured-case method was used. Structured-case refers to a formal process model involving three structural components: a conceptual framework, a predefined research cycle, and a literaturebased scrutiny of the research finding (Carroll & Swatman, 2000). This method has the advantage of constructing a theory from the data collected in the field. Three case studies were selected to explain anomalies in outcomes related to ISO accreditations and QAP. The core of the investigation is the proposal that implementing ISO accreditations can enable the organisation to lead the market in one or more of Treacy and Wiersema’s (1993) strategic choices: Customer Intimacy (CI), Operational Excellence (OE), and Product Differentiation (PD). For implementing this purpose, a relatively new feature within the Theory of Constraints (TOC) - the Strategy and Tactic (S&T) tree - was used. The thesis demonstrates how combining the S&T tree with Treacy and Wiersema’s (1993) strategic choices has important outcomes for QAP. The aim of this thesis is to explain the anomalous outcomes of the ISO accreditation. For this purpose, the research required a research philosophy that enables an explanation and proposal of generative mechanisms. Therefore, Critical Realism (CR) was adopted as the philosophy of the thesis and this provided the foundation for proposing mechanisms. It is argued that mechanisms proposed from the Theory of Constraints (TOC) have the capacity to explain the poor performance demonstrated in the three case organisations. The particular mechanisms proposed are Goal Alignment, Defining the Constraints, and Defining the Tactics. It is suggested that when these mechanisms exist and are activated, the desired outcomes are more likely to be achieved. On the other hand, it is proposed that the absence of these mechanisms can explain the anomalies and the disappointment in the outcomes of the three cases. Case study A is an ISO certified professional service provider. Their goal was to upgrade from local Australian standards to ISO accreditation in order to meet market requirements. Attaining this accreditation effectively addressed customer intimacy (CI in the strategic choices model); in addition, it helped the organisation to streamline their processes. The examination of this case showed that the outcomes were generally poor and that employees had varied understandings of the goal of the ISO accreditation. To explain such an anomaly, the TOC Thinking Process (TP) tools were used. Through this process, the causal mechanisms behind poor outcomes were proposed as being not targeting the system constraint, and a lack of goal alignment between the ISO accreditation goal and the organisational goal. In addition, it was suggested that for this organisation to continue its quality program successfully, their next ISO accreditation should aim to achieve another Treacy and Wiersema (1993) strategic choice, namely OE, and apply the S&T tree in its tactical implementation. Such significant findings needed to be checked and tested in a second case, which was the rationale for selecting organisation B. At the time of data collection, this organisation had recently attained an ISO accreditation, after two previous unsuccessful attempts. The accreditation helped to improve their internal operations (OE) which consequently reduced their operational and rework costs. However, several undesirable outcomes associated with the accreditation became evident such as the staff not realising the importance of following the ISO accreditation’s procedures and standards. The mechanisms suggested to explain this anomaly were again a lack of goal alignment and not targeting their constraint. The analysis also showed that the organisational goal was not defined in terms of the organisation’s throughput (the TOC defined necessary real goal). It was suggested that to continue their QAP successfully, this organisation needs to link the subsequent accreditation’s goal to achieving CI. This will encourage goal alignment and result in leading the market in this strategic choice. The third case study, organisation C, did not go through a QAP program and the role of their auditing, as a simplified form of a quality program was more holistic, and the S&T tree assisted in defining the pervasive role of quality, in the sense of “fitness for purpose”, throughout the organisation. This case is a professional not-forprofit research centre. After three years of operating, the management sought to restructure and reinforce their research focus. This decision was made because the observed research outcomes were not meeting their stated goals. In this case, it was felt that their goal was articulated well but their implementation was poor. In order to focus on their implementation issues, it was decided to develop models of S&T trees specifically for the critique of the stakeholders. This provided an opportunity for management to reflect on the goal of the organisation and their performance. The process of developing and validating the S&T trees models actually became an important QAP in its own right and led the centre to defining and addressing the conflicts within the system. The suggested explanation of the anomaly of poor outcomes in this case is that the tactics to achieve their strategies were not well defined; in other words, poor implementation leading to disappointing outcomes Besides defining TOC based mechanisms, a major contribution of this thesis is the development of a new approach for the S&T tree which expands its usage to include operationalising Treacy and Wiersema’s (1993) strategic choices. This new model is a platform that provides an opportunity for stakeholders to define and possibly address the assumptions underpinning the organisation’s decisions and actions. The stakeholder feedback generated is also important because it communicates the strategic choice in light of the actual needs of the organisation. Most importantly, the S&T tree can be used for more than just planning the execution of a goal; it actually can be used to plan the organisation’s sequential growth and lead the market in one or more of Treacy and Wiersema’s (1993) strategic choices. This thesis proposes a linkage between TOC and the concept of mechanisms and demonstrates how TOC can help explain the mechanisms behind poor QAP outcomes. By so doing, it also demonstrates the advantages of linking Critical Realism and TOC, and how the S&T tree models provide a promising platform for operationalising the achievement of Treacy and Wiersema’s (1993) strategic choices. Finally, from a practical perspective, it suggests that any QAP, including ISO accreditation, should only be considered if they target the constraint of the syste

Refugees’ dreams of the past, projected into the future

This article is about refugees’ and migrants’ dreams of home and family and stems from an Australian Research Council Linkage Grant, “A Hand Up: Disrupting the Communication of Intergenerational Welfare Dependency” (LP140100935), with Partner Organisation St Vincent de Paul Society (WA) Inc. (Vinnies). A Vinnies-supported refugee and migrant support centre was chosen as one of the hubs for interviewee recruitment, given that many refugee families experience persistent and chronic economic disadvantage. The de-identified name for the drop-in language-teaching and learning social facility is the Migrant and Refugee Homebase (MARH). At the time of the research, in 2018, refugee and forced migrant families from Syria, Iraq, and Afghanistan constituted MARH’s primary membership base. MARH provided English language classes alongside other educational and financial support. It could also organise provision of emergency food and was a conduit for furniture donated by Australian families. Crucially, MARH operated as a space in which members could come together to build shared community

Modulating Heat Shock Proteins 70 and 90 Expression by Low Power Laser Irradiation (635nm and 780nm) in Jurkat E6.1 T-lymphocyte Leukemia Cell Line

Introduction: Heat shock proteins (HSPs) are molecular chaperones involved in protein folding, stability and turnover, and due to their role in cancer progression, the effect of low power laser irradiation (LPLI) on the expression of HSP70 and HSP90 in Jurkat E6.1 T-lymphocyte leukemia (JELT) cell line was investigated in vitro.Methods: JETL cells were irradiated with LPLI at 635nm and 780m wavelengths (energy density 9.174 J/cm2), and assessed for the expression of HSP70 and HSP90 by flow cytometry after 24, 48 and 72 incubation time periods (ITPs).Results: At 24 hours ITP post-irradiation, control cultures showed that 10.7% of cells expressed HSP70, while LPLI cultures at 635nm and 780nm manifested a higher expression (32.1and 21.3%, respectively), and the difference was significant (P ≤ 0.05). However, at 48 hours ITP, the three means were decreased but approximated (5.6, 4.9 and 6.2%, respectively), while at 72 hours ITP, they were markedly increased (45.2, 76.5 and 66.7%, respectively). In contrast, HSP90 responded differently to LPLI. At 24 hours ITP, control cultures and 780nm cultures showed a similar expression (55.9 and 55.9%, respectively), but both means were significantly higher than that of 635nm cultures (24.0%). No such difference was observed at 48 hours ITP, and at 72 hours ITP, control cultures and 635nm cultures shared approximated means (31.7 and 35.6%, respectively); but both means were significantly higher than the observed mean in 780nm cultures (15.2%).Conclusion: The results highlighted that HSP70 and HSP90 expression responded differently to LPLI in JETL cells; an observation that may pave the way for further investigations in malignant cells

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Strategy and Tactic (S&T) tree for achieving the Treacy and Wiersema (1993) strategic choices

The paper proposes that the use of the relatively new tool from the Theory of Constraints - the Strategy and Tactic (S&T) tree can help to provide the linkage between the aim of the improvement and attaining the organization strategic goal. The integration of the S&T Tree and Treacy and Wiersema (1993)’s Value Discipline model is used to focus the original goal setting and subsequent implementation. Two case examples are presented to illustrate the application of the model. The case examples applied the ISO accreditations, and some of the outcomes of such quality program are undesirable and disappointing. This paper proposes that this dissatisfaction is often a consequence of a lack of clarity as to the goal of the implementation and the lack of a clear link age to the organizational goal over the implementation

A Framework for Clarifying the Goal and Implementation of ISO

Many organizations are dissatisfied with the outcomes of ISO implementations. This paper proposes that this dissatisfaction is often a consequence of a lack of clarity as to the goal of the implementation and the lack of a clear linkage to the organizational goal over the implementation. The paper proposes that the use of the relatively new tool from the Theory of Constraints – the Strategy and Tactic (S&T) tree can help to provide this linkage and to guide the subsequent implementation. The integration of the S&T Tree and Treacy and Wiersema’s Value Discipline model (1993) is used to focus the original goal setting and subsequent implementation. A case example is then presented to illustrate the application of the model