A call for conceptual clarity: a soft systems view of performance measurement in public service delivery

Performance measurement systems and the publication of performance data are fundamental to the New Public Management, with its emphasis on decentralised service provision through a variety of agencies. There seem to be four reasons for this performance measurement: to see what works, to identify competences, to support public accountability and to allow control of decentralised service provision. Each of these is examined, using the root definitions that form part of soft systems methodology, which highlights the importance of different worldviews that provide justifications for different approaches to this measurement. If performance measurement systems are to be beneficial, their design should be based on a conceptualisations that recognises these different worldviews and purposes

Emergency and on-demand health care: modelling a large complex system

This paper describes how system dynamics was used as a central part of a whole-system review of emergency and on-demand health care in Nottingham, England. Based on interviews with 30 key individuals across health and social care, a 'conceptual map' of the system was developed, showing potential patient pathways through the system. This was used to construct a stock-flow model, populated with current activity data, in order to simulate patient flows and to identify system bottle-necks. Without intervention, assuming current trends continue, Nottingham hospitals are unlikely to reach elective admission targets or achieve the government target of 82% bed occupancy. Admissions from general practice had the greatest influence on occupancy rates. Preventing a small number of emergency admissions in elderly patients showed a substantial effect, reducing bed occupancy by 1% per annum over 5 years. Modelling indicated a range of undesirable outcomes associated with continued growth in demand for emergency care, but also considerable potential to intervene to alleviate these problems, in particular by increasing the care options available in the community

The born-digital in future digital scholarly editing and publishing

Editorial scholarship is once again in a state of upheaval. Digital scholarly editing, for all it has achieved, has not accommodated the increasingly digital nature of cultural production and consumption. The theories and practices of digital scholarly editing need to better account for born-digital cultural materials like social media content, digital fiction, and video games. This paper discusses the state-of-the-art in digital scholarly editing, and advocates for future forms of digital scholarly editing and publishing suited to the born-digital

Success and Failure in the Simulation of an Accident and Emergency Department

Healthcare simulation has the potential to offer many benefits but the implementation is often problematic. This paper describes the development of a simulation of an Accident and Emergency Department in an NHS hospital. The early experience of the client provoked great enthusiasm but ultimately the simulation failed to meet all expectations. The simulation delivered a number of benefits, notably in terms of stimulating constructive debate and helping the stakeholders appreciate the complete Accident and Emergency system. The project produced a technically proficient tool that was delivered too late to have the desired impact. This mixed record of success appears typical of many simulations. Important lessons were learned, both technically and in the management of client expectations, which have contributed to subsequent successful implementation in other departments of the hospital. The experience suggests that both potential clients and analysts need to establish realistic expectations and appreciate the particular challenges of simulation in a healthcare environment

Quid pro quo:reflections on the value of problem structuring workshops

Attracting clients who are willing to invest in using a problem structuring method (PSM) can be particularly difficult for the emerging generation of modellers. There are many reasons for this, not least that the benefits of a problem structuring intervention are vague and evidence of benefits are often anecdotal for example, claims of constructing a deeper understanding of the problem or building the commitment of a group to implementing an outcome. This paper contributes to the evaluation of problem structuring methods by reflecting on the quid pro quo that a client and problem structuring modeller can enjoy from collaboration. The paper reflects on 21 cases, where Journey Making (a problem structuring method) was used with 16 organizations to help managers agree a suite of actions to tackle a complex strategic issue. The reflections are clustered around those benefits that pertain to: PSMs in general; PSMs that use computer-supported workshops; the Journey Making methodology

Applications of simulation within the healthcare context

This is a pre-print of an article published in Journal of the Operation Research Society. The definitive publisher-authenticated version Katsaliaki, K., Mustafee, N.,(2010). Applications of simulation within the healthcare context. Journal of the Operation Research Society. 62, 1431-1451 is available online at: http://www.palgrave-journals.com/jors/journal/v62/n8/full/jors201020a.htmlA large number of studies have applied simulation to a multitude of issues related to healthcare. These studies have been published over a number of unrelated publishing outlets, and this may hamper the widespread reference and use of such resources. In this paper we analyse existing research in healthcare simulation in order to categorise and synthesise it in a meaningful manner. Hence, the aim of this paper is to conduct a review of the literature pertaining to simulation research within healthcare in order to ascertain its current development. A review of approximately 250 high quality journal papers published between 1970 and 2007 on healthcare-related simulation research was conducted. The results present: a classification of the healthcare publications according to the simulation techniques they employ; the impact of published literature in healthcare simulation; a report on demonstration and implementation of the studies’ results; the sources of funding; and the software used. Healthcare planners and researchers will benefit from this study by having ready access to an indicative article collection of simulation techniques applied in healthcare problems that are clustered under meaningful headings. This study facilitates the understanding of the potential of different simulation techniques for solving diverse healthcare problems

Application of the quick scan audit methodology in an industrial filter production process

The quick scan audit methodology (QSAM) is an established investigative tool to assess the health of business processes and supply chains within short schedules. This study extends the standard QSAM procedure to include the simulation step. It also extends the QSAM to a wider industry platform by applying it into the precision mechanical engineering industry, where managers have been under competitive pressure to reduce an industrial filter production lead time. Following a review of the relevant literature, this paper presents the research design adopted in the study. The QSAM has been conducted using various data collection techniques (such as observations, process activity mapping, interviews, questionnaires, brainstorming and access to company documents) and data analysis methods (including cause and effect analysis, Pareto analysis and time series plot). This is followed by the development of a set of improvement strategies, namely, direct information sharing, priority planning, and additional data recording and analysis. In addition to testing the potential benefits of changing scheduling approaches for the paint plant, simulation has been utilized in this study as a communication means to increase employee participation in the QSAM process and enhance the audit accuracy. It has also provided the case company with a better understanding of the behaviour and characteristics of the system under study, thus facilitating more thoughtful decisions to improve the system. The paper concludes with further research opportunities derived from this study

Knowledge based improvement:simulation and artificial intelligence for identifying and improving human decision-making in an operations systems

The performance of most operations systems is significantly affected by the interaction of human decision-makers. A methodology, based on the use of visual interactive simulation (VIS) and artificial intelligence (AI), is described that aims to identify and improve human decision-making in operations systems. The methodology, known as 'knowledge-based improvement' (KBI), elicits knowledge from a decision-maker via a VIS and then uses AI methods to represent decision-making. By linking the VIS and AI representation, it is possible to predict the performance of the operations system under different decision-making strategies and to search for improved strategies. The KBI methodology is applied to the decision-making surrounding unplanned maintenance operations at a Ford Motor Company engine assembly plant