Improving supply chain management in construction: what can be learned from the aerospace industry?

In order to provide for controllable delivery, reliable lead times and efficient customer response, lean manufacturing and platform assembly practices play an important role in supply chains in the aerospace industry. The adoption of lean manufacturing practices ensures an efficient delivery of products to the market. Benefits from the development of platform strategies are a more reliable materials supply and an improved logistics control. The aerospace industry is characterized by a small number of major global players and many small ones. A major part of the design and production has been contracted out to suppliers. In this paper the basic similarities and differences between the construction and aerospace industry and supply chains are analysed. A comparative study of aerospace and construction supply chains is presented to indicate and discuss the applicability of supply chain management concepts to construction, and the improvement potential of these concepts regarding supply chain management in construction. It is concluded that in particular the practice of platform assembly is a fruitful concept to be applied in the construction industry

Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments\ud

Objective  To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care.\ud \ud Background  Health care is becoming more user-centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care.\ud \ud Methods  Instruments were identified by means of a systematic literature review. Appropriateness of instruments was analysed on seven criteria. The two most promising instruments were translated into Dutch, if necessary, and administered to a convenience sample of 109 people with a chronic illness. Data derived from respondents were analysed statistically. Focus-group interviews were conducted to assess the semantic and technical equivalence as well as opinions of people about the applicability and relevance of the translated instruments.\ud \ud Results  From 37 instruments identified, the Patients’ Assessment of Care for chronIc Conditions (PACIC) and the short form of the Patient Satisfaction Questionnaire III (PSQ-18) were selected as most promising instruments. Both instruments produced similar median scores across people with different chronic conditions. The overall PACIC and its subscales and the overall PSQ-18 were highly internally consistent, but not the PSQ-18 subscales. Overall, the PACIC demonstrated better psychometric characteristics. PACIC and PSQ-18 scores were found to be moderately correlated. Whereas more respondents preferred the PSQ-18, focus-group participants regarded the PACIC to be more applicable and relevant. The technical and semantic equivalence of both instruments were sufficient.\ud \ud Conclusions  Because of its psychometric characteristics, perceived applicability and relevance, the PACIC is the most appropriate instrument to measure the experience of people receiving integrated chronic care\u

Integrated chronic care management for patients with atrial fibrillation : a rationale for redesigning atrial fibrillation care

Atrial Fibrillation (AF) is a highly prevalent heart rhythm disturbance, often associated with underlying (cardio)vascular disease. Due to this the management of AF is often complex and current practice calls for a more comprehensive, multifactorial and patient-centred approach. Therefore an Integrated Chronic Care approach in AF was developed and implemented in terms of a nurse-led specialized outpatient clinic for patients with AF. A randomised controlled trial comparing the nurse-led approach with usual care demonstrated superiority in terms of cardiovascular hospitalization and death as well as cost-effectiveness in terms of Quality Adjusted Life Years (QALYs) and life years, in favour of the nurse-led approach. Implementing such approach can be difficult since daily practice can be persistent. To highlight the importance of integrated care wherein the nurse fulfils a significant role, and to provide a guide in developing and continuing such approach, this paper presents the theoretical framework of the AF-Clinic based on the principles of the Taxonomy for Integrated Chronic Atrial Fibrillation Management.Jeroen M L Hendriks, Harry J G M Crijns, Hubertus J M Vrijhoe

Identifying potentially cost effective chronic care programs for people with COPD

Objective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified. Methods: Systematic search of Medline and Cochrane databases for evaluations of multicomponent disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized. Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money. Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of 'perfect data', support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision uncertainty

A Fourth Party Energy Provider for the Construction Value Chain: Identifying Needs and Establishing Requirements

Today’s building and energy management market is heterogeneous and complex. Most of the players in the construction market are not in possession of the managerial capability to fully control the dynamics that affect their energy costs in terms of energy sourcing and energy management. Moreover, construction industry needs to rely on a stronger technical and commercial expertise. On one hand, there is a need of an in-depth and extensive level of technical know-how that most of facility managers, property developers and building owners at private and public level scarcely hold. On the other hand, this industry is characterized by a fragmentation within the single tiers of the value chain. In this context, the paper aims at proposing a new vision of the building value chain towards a collaborative network led by a new player, namely the Fourth Party Energy Provider, acting as the “one-stop contracting and managing” operator, integrating resources, capabilities, best available technologies and practices for providing energy-efficient building solutions

Landbouwpraktijk en waterkwaliteit op landbouwbedrijven aangemeld voor derogatie in 2015

Dutch manure policy tries to limit the harmful environmental impact of agriculture. This is in line with international agreements on fertilizer use. The European Nitrates Directive prescribes Member States to limit the use of animal manure to 170 kg nitrogen per hectare. Farms with at least 80 percent of grassland may, under certain conditions, use more manure from grazing animals such as cows and sheep (derogation). Over the last 10 years, nitrate leaching from the manure to the upper groundwater has decreased or remained the same for these farms. By 2015, on average, the concentration is in all regions below the EU standard of 50 milligrams of nitrate per liter. This is according to the annual report by RIVM and Wageningen Economic Research. They follow agricultural practices and the effects on water quality at 300 derogation farms and report their results to the EU annually. This report describes the situation in 2015 and the development between 2006 and 2016 (trend). Management. The permissible amount of nitrogen from grazing manure is, depending on the soil and region, 250 kilograms per hectare (in the Clay region. Peat region and northern part of the Sand region) or 230 kg/ha (in the Loess region and the rest of the Sand region). On average, derogation companies have used 238 kilograms of nitrogen from animal manure per hectare in 2015. The amount of nitrogen that can leached as nitrate to groundwater is determined, among others, by the so-called nitrogen soil surplus. This is the difference between the input of nitrogen (such as fertilizers) and their output (including through grass and maize). The average nitrogen surplus over the regions has decreased over the period considered. Groundwater quality. By 2015, the average nitrate concentration in the groundwater in Sand 250 was 26 milligrams per liter (mg/l). The highest concentration is measured in the Loess region (42 mg/l) and in Sand 230 (45 mg/l). On the average, farms in the Clay region and the Peat region had lower nitrate concentrations in leaching water (22 and 13 mg/l respectively). The difference between the regions can be explained by the proportion of soils prone to nitrate leaching. Especially in Sand 230 and in the Loess region there are grounds for which nitrate is reduced in a lesser extent, and therefore can leach more to groundwater.Het Nederlandse mestbeleid probeert de schadelijke milieueffecten van de landbouw te beperken. Dit sluit aan bij internationale afspraken over het mestgebruik, die onder meer zijn vastgelegd in de Europese Nitraatrichtlijn. Die schrijft lidstaten voor om het gebruik van dierlijke mest te beperken tot 170 kg stikstof per hectare. Bedrijven met ten minste 80 procent grasland mogen onder bepaalde voorwaarden meer mest gebruiken, afkomstig van graasdieren zoals koeien en schapen (derogatie). Op deze bedrijven is in de periode 2006 tot en met 2016 de uitspoeling van nitraat uit de mest naar het grondwater gedaald of gelijk gebleven. In 2015 ligt op derogatiebedrijven de concentratie gemiddeld in alle regio's onder de EU-norm van 50 milligram nitraat per liter. Dit blijkt uit de jaarlijkse rapportage van het RIVM en Wageningen Economic Research. Zij volgen op 300 derogatiebedrijven de bedrijfsvoering en de effecten op de waterkwaliteit en zij rapporteren de resultaten hiervan jaarlijks aan de EU. In deze rapportage is de situatie in 2015 beschreven en de ontwikkeling tussen 2006 en 2016 (trend). Bedrijfsvoering. De toegestane hoeveelheid stikstof uit graasdiermest is, afhankelijk van de bodemsoort en regio, 250 kilogram per hectare (in de Kleiregio, Veenregio en het noordelijke deel van de Zandregio) of 230 kg/ha (in de Lössregio en het overige deel van de Zandregio). Gemiddeld hebben derogatiebedrijven in 2015 238 kilogram stikstof uit dierlijke mest per hectare gebruikt. De hoeveelheid stikstof die als nitraat kan uitspoelen naar het grondwater wordt onder andere bepaald door het zogenoemde stikstofbodemoverschot. Dit is het verschil tussen de aanvoer van stikstof (zoals meststoffen) en de afvoer ervan (waaronder via gras en maïs). Het stikstofbodemoverschot is gemiddeld over de regio's tijdens de onderzochte periode gedaald met 16%. Grondwaterkwaliteit. In 2015 was de gemiddelde nitraatconcentratie in het grondwater 26 milligram per liter (mg/l) in Zand 250. De hoogste concentratie wordt gemeten in de Lössregio (42 mg/l) en in Zand 230 (45 mg/l). Bedrijven in de Kleiregio en de Veenregio hadden gemiddeld een lagere nitraatconcentratie (respectievelijk 22 en 13 mg/l). Het verschil tussen de regio's kan verklaard worden door het aandeel uitspoelingsgevoelige gronden. Vooral in Zand 230 en in de Lössregio komen gronden voor waar nitraat in mindere mate in de bodem wordt afgebroken en daardoor meer kan uitspoelen naar het grondwater.Ministerie van Economische Zake

Meeting the governance challenges of integrated health and social care

Background Many countries are experimenting with novel ways of organising and delivering more integrated health and social care. Governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration. Methods Cross-country case analysis involving document review and semi-structured interviews with 27 local, regional and national level stakeholders in Italy, the Netherlands and Scotland. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to structure our analytical enquiry to explore factors that influence the governance arrangements in each system. Results Governance arrangements ranged from informal agreements in the Netherlands to mandated integration in Scotland. Novel service models were generally participative involving a wide range of stakeholders, including the public, although integration was seen to be driven, largely, from a health perspective. In Italy and Scotland some reversion to ‘command & control’ was reported in response to the imperatives of the Covid-19 pandemic. Policies, budgets, auditing and reporting systems that are clearly aligned at all levels were seen to help with implementing innovations in service organisation. Where alignment was lacking, cooperation and integration was suboptimal, regardless of whether governance arrangements were statutory or not. There was wide recognition of the importance of buy-in. Enablers of greater engagement included visible leadership, time and long-standing working relationships. Lack of suitable indicators and openness to data sharing to measure integration hindered working relationships and thus the successful delivery of integrated services. Conclusions Our study provides important insights into how to more effectively and efficiently govern service delivery structures within care systems. We will discuss approaches to governance that help support more resilient integrated care systems. Key messages • Different governance arrangements face common challenges to greater integration of care. Enablers include strong leadership, inclusivity and openness to work across traditional boundaries. • Meeting the governance challenges of integrated health and social care requires clear lines of accountability, aligned policies, budgets and reporting systems

Self-reported adverse reactions in 4337 healthcare workers immunizations against novel H1N1 influenza

Purpose: The use of the 2009 H1N1 vaccine has generated much debate concerning safety issues among the general population and physicians. Therefore, we investigated the safety of an inactivated monovalent H1N1 pandemic influenza vaccine Methods: We focused on the H1N1 pandemic influenza vaccine Pandemrix(R) and applied a self reporting questionnaire in a population of healthcare workers (HCWs) and medical students at a major university hospital. Results: In total, 4337 individuals were vaccinated, consisting of 3808 HCWs and 529 medical students. The vaccination rate of the employees was higher than 40%.The majority of individuals were vaccinated in November 2009. In total, 291 of the 4337 vaccinations were reported to lead to one or more adverse reactions (6.7%). Local reactions were reported in 3.8%, myalgia and arthralgia in 3.7%, fatigue in 3.7%, headache in 3.1%. Conclusions: Our data together with available data from several national and international institutions points to a safe pandemic influenza vaccine

Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study

Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Results Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients’ insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Conclusions Dutch integrated diabetes care is still a work in progress, in the academic and the practice setting. This makes it difficult to establish whether overall quality of care has improved. Future efforts should focus on areas that this study found to be problematic or to not have received enough attention yet. Increased efforts are needed to improve the interoperability of the patient databases and to keep the negative consequences of the bundled payment system in check. Moreover, patient and community involvement should be incorporated