Impediments to improvements in service quality in luxury hotels

Purpose – The purpose of this article is to identify the key factors that impede service quality delivery in the context of luxury hotels (four- and five-star properties) in Sydney, Australia. Design/methodology/approach – The empirical dataset for this qualitative study was collected through 22 individual semi-structured interviews with senior hotel managers of ten luxury hotels in Sydney, Australia. The technique used for analysing the data was progressive comparative analysis, after which constant comparative methodology was applied. The key themes emerging from these techniques have been categorised to form conclusions. Findings – Analysis of the data revealed a number of impediments to developing and maintaining distinguishable, superior service. These impediments fell into four broad areas: Budget constraints, Staff attitude, Lack of mentoring and High customer expectations. Research limitations/implications – The limitations with the current study are primarily related to the scope of the research in terms of the number of hotel properties participating, and the fact that it incorporates the views of managers only. Furthermore, the focus of this study was on the hotel sector, and thus the findings cannot be accepted as being necessarily relevant and applicable to services across the tourism/hospitality industry as a whole. Future research needs to be conducted to incorporate the views of all stakeholders in service quality, including non-management staff and customers. Originality/value – The findings of this research can inform hotel sector researchers and practitioners of identified impediments to service quality, whether current strategies are addressing these impediments and, if not, how strategies may be modified to address to achieve this

Balancing Yin and Yang: the development of a framework using Participatory Action Research for the Translation and Implementation (Part 1) of new practices

Context: Despite the demonstrable benefits of many healthcare innovations, embedding research findings into practice has been slow and sporadic. [1,2] Many implementation frameworks exist, however most havebeen criticised for not having a strong theoretical underpinning. This study addresses this gap by reviewing the current models to propose a new, theoretically driven framework for change management and translation. Methods: This study is reported in two parts. In part 1, a systematically-based literature review was undertaken. Following this, part 2 included conducting focus groups with academics to verify the model and provide feedback on the new framework. Findings: The gaps in current implementation frameworks identified include deficiencies in the areas of individual and social behaviour, participatory action, operationalisation and evaluation of the frameworks. The Quality Implementation Framework (QIF) [3] was used to provide the basis to develop a robust extended model, which addressed those areas that were identified as deficient in the current frameworks. By combining the best parts of extant models with a translation and implementation foci, we developed the PARTI model that is underpinned by commitment to change (Ying) and change fidelity (Yang) at each of its four stages, which included a behavioural questionnaire and implementation checklist. PARTI stands for Participatory Action Research, Translation and Implementation. Conclusions: The implementation of change in healthcare delivery is difficult and demanding, and healthcare managers look to change frameworks for guidance. The PARTI model has been developed to provide a systematic approach to implementing changed practices that is repeatable, reliable and scalable. Abbreviations: ISF – Interactive Systems Framework; PAR – Participatory Action Research; PARTI – Participatory Action Research for Translation and Implementation; QIF – Quality Implementation Framework; TDF – Theoretical Domains Framework

Prevalence and architecture of de novo mutations in developmental disorders.

The genomes of individuals with severe, undiagnosed developmental disorders are enriched in damaging de novo mutations (DNMs) in developmentally important genes. Here we have sequenced the exomes of 4,293 families containing individuals with developmental disorders, and meta-analysed these data with data from another 3,287 individuals with similar disorders. We show that the most important factors influencing the diagnostic yield of DNMs are the sex of the affected individual, the relatedness of their parents, whether close relatives are affected and the parental ages. We identified 94 genes enriched in damaging DNMs, including 14 that previously lacked compelling evidence of involvement in developmental disorders. We have also characterized the phenotypic diversity among these disorders. We estimate that 42% of our cohort carry pathogenic DNMs in coding sequences; approximately half of these DNMs disrupt gene function and the remainder result in altered protein function. We estimate that developmental disorders caused by DNMs have an average prevalence of 1 in 213 to 1 in 448 births, depending on parental age. Given current global demographics, this equates to almost 400,000 children born per year

Heterozygous Variants in KMT2E Cause a Spectrum of Neurodevelopmental Disorders and Epilepsy.

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities

Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia.

The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Cav2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca2+ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Cav2.2 in normal human neurodevelopment.MAK is funded by an NIHR Research Professorship and receives funding from the Wellcome Trust, Great Ormond Street Children's Hospital Charity, and Rosetrees Trust. E.M. received funding from the Rosetrees Trust (CD-A53) and Great Ormond Street Hospital Children's Charity. K.G. received funding from Temple Street Foundation. A.M. is funded by Great Ormond Street Hospital, the National Institute for Health Research (NIHR), and Biomedical Research Centre. F.L.R. and D.G. are funded by Cambridge Biomedical Research Centre. K.C. and A.S.J. are funded by NIHR Bioresource for Rare Diseases. The DDD Study presents independent research commissioned by the Health Innovation Challenge Fund (grant number HICF-1009-003), a parallel funding partnership between the Wellcome Trust and the Department of Health, and the Wellcome Trust Sanger Institute (grant number WT098051). We acknowledge support from the UK Department of Health via the NIHR comprehensive Biomedical Research Centre award to Guy's and St. Thomas' National Health Service (NHS) Foundation Trust in partnership with King's College London. This research was also supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre. J.H.C. is in receipt of an NIHR Senior Investigator Award. The research team acknowledges the support of the NIHR through the Comprehensive Clinical Research Network. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, Department of Health, or Wellcome Trust. E.R.M. acknowledges support from NIHR Cambridge Biomedical Research Centre, an NIHR Senior Investigator Award, and the University of Cambridge has received salary support in respect of E.R.M. from the NHS in the East of England through the Clinical Academic Reserve. I.E.S. is supported by the National Health and Medical Research Council of Australia (Program Grant and Practitioner Fellowship)

Doctors and nurses working together : a mixed method study into the construction and changing of professional identities

This research investigates the relevance of professional subcultures in a climate of change at a large hospital in South-Western Sydney and addresses the question : 'How do changes associated with health reform impact upon cultural interdependence between professional identities?'. As a corollary, cultural interdependence between professional identities may have profound consequences for health reform and for hospital management. By exploring the two main ideas, Professional Sub-group culture and change, this research draws from existing theory in areas such as organisational culture and cultural change, professional identities and health reform. The thesis addresses three anthropological perspectives of cultural change. It addresses the integration perspective as a homogenous unity by analysing the organisation-wide key ideas (or myths) that make action possible, often espoused by senior management. It addresses the fragmentation perspective as a gathering of transient concerns, by acknowledging the ambiguity and anxiety associated with a state of constant flux. It analyses the differentiation perspective as a collection of subcultures and its commonalities and differences. The change discussed in the thesis was not of an archetypal nature. There was no transformation of the organisational business model at government level. However, at lower levels, actors in the organisation experienced jolts through decreed change from a small district level hospital to a large tertiary level trauma centre. This research re-evaluates the theory on professional identity by establishing to what extent environmental changes and organisational changes impact upon professional identity from three cultural perspectives. This research does this by first assessing the health care organisation for existence of occupational subcultures through survey. The research continues by investigating the relationships between occupational groups through focus group discussion and in-depth interviews. Participant observation is used to illustrate and reflect commonality and diversity. This combination of methods facilitates the analysis of change and professional identit

To boldly go where no-one has gone before : multi-campus teaching bringing academics together

Although much is written on teaching models, teaching methodology and learning processes, these writings traditionally assume the delivery of content and facilitation of process of learning to take place between lecturer and students. The literature is sparse on delivering content in a process of teaching and learning where the pedagogical model for one unit, subject or module includes up to 15 other lecturers. The authors have experienced transitional change through amalgamation of universities and consolidation and harmonaation of units taught. We are now dealing with cross campus coordination of large units (exceeding 700 students), where the campus locations are scattered across an area of over 800 km2. This paper explores the advantages and disadvantages associated with co-ordination of such units, including the necessity of a closer working relationship with colleagues at different locations and a large number of adjunct staff. Issues discussed are the assurance of delivering the same content, control of quality of delivery of content, faciliitation of learning process, communication and personality differences. This paper concludes by offering practical solutions to the issues discussed, largely drawing upon the experience of the authors and their colleagues during this time of transition in universities, and reflecting upon how this new practice impacts upon established theory of teaching and learning

What makes students tick? : the Instinctive Drive System as a means to improve study group performance

The purpose of this paper is to introduce the notion of Instinctive Drive™ (ID). It discusses the I.D.™ System, where it came from, how it is employed and what value is attached to knowing the outcome of Instinctive Drive measurements and future work and/or study opportunities. This paper presents results from an open-ended questionnaire applied to a group of students undertaking a Master of Business and Commerce. This is an exploratory part of a much larger study to validate the I.D.™ System that will add to current thinking in the field of Organisational Behaviour. Results from this survey suggest that students found the Instinctive Drives™ questionnaire a useful tool to better understand their behavioural stimuli, and that it could be utilised to improve study group and team performance