Article ID 932564

Abstract Quality in its contemporary incarnation is commonly referred to as organizational excellence, enterprise excellence, business excellence, or performance excellence. While technology may serve as a key enabler of enterprise excellence, enterprise excellence itself is in large enabled by the human dimension both in terms of ideation and effort. The human dimension manifests in many ways, with people-centered innovation representing a critical intersection of the market environment and the enterprise's human capital or the individual inventor. Innovation in all its faces and forms can be more effectively and strategically attained through collaboration that extends throughout the enterprise, to its supply chain, and ultimately to the marketplace itself, that is, cooperation between the enterprise and the culture(s) it serves via the process of co-creation. Understanding of, sensitivity to, and leverage of culture as broadly construed is an underdeveloped aspect enterprise excellence. As considered herein, innovation contributes to enterprise excellence through conscious and customer-centric collaboration between the enterprise and the culture. As such we explore intersections among cultural anthropology, innovation, and enterprise excellence by more thoughtfully elaborating the interface between the enterprise and the customer (user) culture, including society

Viral innovation: integration via sustainability and enterprise excellence

Abstract Enterprises face mounting challenges in three generic sustainability domains that form the basis of the so-called triple bottom line: economic sustainability, societal sustainability, and environmental sustainability. In most instances, it is the primacy of economic sustainability that is emphasized since an enterprise that is not economically secure does not survive. Despite the importance of sustainability's economic dimension, increasing regulatory requirements taken together with societal demands are forcing enterprises to address both their impact on the natural environment and their contribution to society. Indeed, taken together these considerations form a sort 'holy trinity' that are necessary as both singular and joint considerations for enterprises striving to be continuously relevant and responsible. Environmental impacts and societal contributions can take many forms and thus far the environmental and societal challenges facing enterprises have, when considered comprehensively, outpaced the capability of enterprises to successfully address them. Since enterprises must be economically sustainable, an enterprise excellence approach supported by various international quality award models and criteria is herein recommended. This is augmented with emphasis on strategic, high-speed integration and deployment of sustainable innovation and innovation for sustainability. The goal in taking this approach is to aid organizations in their quest for continuously relevant and responsible actions and results

Decisions to use surgical mesh in operations for pelvic organ prolapse : a question of geography?

Introduction and hypothesis: Surgical mesh can reinforce damaged biological structures in operations for genital organ prolapse. When a method is new, scientific information is often contradictory. Individual surgeons may accept different observations as useful, resulting in conflicting treatment strategies. Additional scientific information should lead to increasing convergence. Methods: Based on data from the Swedish National Quality Register of Gynecological Surgery, all patients who underwent their first recurrent anterior compartment prolapse operation between 2006 and 2017 were included (2758 patients). Surgical mesh was used in 56.5%. We analyzed inter-county disparities in and patterns of mesh use over 12 years. To minimize confounding, we selected a group of highly comparable patients where similar decision patterns could be expected. Results: The use of mesh differed between counties by a factor of 11 (8.6-95.3%). Counties with low use of mesh continued with low use and counties with high use continued with high use. Conclusions: Decisions regarding how to interpret existing scientific information about mesh implants in the early years of mesh use have led to "communities of practice" highly influenced by geographical factors. For 12 years, these groups have made disparate decisions and upheld them without measurable change toward consensus. The scientific learning process has stopped-despite the abundance of new publications and the steady supply of new types of mesh. Ongoing disparity in surgeons' choices in comparable patients has an adverse effect on clinical care. For the patient, this represents 12 years of a geographical lottery concerning whether mesh is used or not

Impact of surgeon experience on routine prolapse operations

Introduction and hypothesis: Surgical work encompasses important aspects of personal and manual skills. In major surgery, there is a positive correlation between surgical experience and results. For pelvic organ prolapse (POP), this relationship has to our knowledge never been examined. In any clinical practice, there is always a certain proportion of inexperienced surgeons. In Sweden, most prolapse surgeons have little experience in performing prolapse operations, 74% conducting the procedure once a month or less. Simultaneously, surgery for POP globally has failure rates of 25-30%. In other words, for most surgeons, the operation is a low-frequency procedure, and outcomes are unsatisfactory. The aim of this study was to clarify the acceptability of having a high proportion of low-volume surgeons in the management of POP. Methods: A group of 14,676 exclusively primary anterior or posterior repair patients was assessed. Data were analyzed by logistic regression and as a group analysis. Results: Experienced surgeons had shorter operation times and hospital stays. Surgical experience did not affect surgical or patient-reported complication rates, organ damage, reoperation, rehospitalization, or patient satisfaction, nor did it improve patient-reported failure rates 1 year after surgery. Assistant experience, similarly, had no effect on the outcome of the operation. Conclusions: A management model for isolated anterior or posterior POP surgery that includes a high proportion of low-volume surgeons does not have a negative impact on the quality or outcome of anterior or posterior colporrhaphy. Consequently, the high recurrence rate was not due to insufficient experience of the surgeons performing the operation.Errata: Nüssler, E., Eskildsen J. K., Nüssler, E. K., Bixo, M., Löfgren, M. Impact of surgeon experience on routine prolapse operations. International Urogynecology Journal 2018;29:2. DOI: 10.1007/s00192-017-3525-y</p