Digital Transformation Models for the I4.0 Transition: Lessons from the Change Management Literature

The growing diffusion of digital technologies, especially in production systems, is leading to a new industrial paradigm, named Industry 4.0 (I4.0), which involves disruptive changes in the way companies organize production and create value. Organizations willing to seize the opportunities of I4.0 must thus innovate their processes and business models. The challenges that companies must face for the transition towards I4.0 paradigm are not trivial. Several digital transformation models and roadmaps have been lately proposed in the literature to support companies in such a transition. The literature on change management stresses that about 70% of change initiatives—independently of the aim—fail to achieve their goals due to the implementation of transformation programs that are affected by well-known mistakes or neglect some relevant aspects, such as lack of management support, lack of clearly defined and achievable objectives and poor communication. This paper investigates whether and to what extent the existing digital transformation models (DTMs) and roadmaps for I4.0 transition consider the lessons learnt in the field of change management. To this aim, a Systematic Literature Review to identify existing models and roadmaps is carried out. The results obtained by the review are discussed under the lens of the change-management literature. Based on that, the shortcomings and weaknesses of existing DTMs are pinpointed. Extant DTMs mainly focus on digital transformation initiatives carried out in manufacturing companies; they do not cover all the phases of the digital transformation process but rather focus on the definition of the I4.0 vision, strategy and roadmap. Little attention is devoted to the implementation and consolidation of digital change. Change management lessons are considered to a limited extent, based on which, some suggestions for better dealing with digital transformation initiatives are discussed. The paper contributes to advancing knowledge on models and approaches to support organizations in managing digital transformation. The identification of change management activities that a digital transformation initiative should involve as well as the suggestions on how to effectively deal with it can be used by managers to successfully lead the I4.0 transition journey in their organizations

Digital Transformation Models for the I4.0 Transition: Lessons from the Change Management Literature

The growing diffusion of digital technologies, especially in production systems, is leading to a new industrial paradigm, named Industry 4.0 (I4.0), which involves disruptive changes in the way companies organize production and create value. Organizations willing to seize the opportunities of I4.0 must thus innovate their processes and business models. The challenges that companies must face for the transition towards I4.0 paradigm are not trivial. Several digital transformation models and roadmaps have been lately proposed in the literature to support companies in such a transition. The literature on change management stresses that about 70% of change initiatives—independently of the aim—fail to achieve their goals due to the implementation of transformation programs that are affected by well-known mistakes or neglect some relevant aspects, such as lack of management support, lack of clearly defined and achievable objectives and poor communication. This paper investigates whether and to what extent the existing digital transformation models (DTMs) and roadmaps for I4.0 transition consider the lessons learnt in the field of change management. To this aim, a Systematic Literature Review to identify existing models and roadmaps is carried out. The results obtained by the review are discussed under the lens of the change-management literature. Based on that, the shortcomings and weaknesses of existing DTMs are pinpointed. Extant DTMs mainly focus on digital transformation initiatives carried out in manufacturing companies; they do not cover all the phases of the digital transformation process but rather focus on the definition of the I4.0 vision, strategy and roadmap. Little attention is devoted to the implementation and consolidation of digital change. Change management lessons are considered to a limited extent, based on which, some suggestions for better dealing with digital transformation initiatives are discussed. The paper contributes to advancing knowledge on models and approaches to support organizations in managing digital transformation. The identification of change management activities that a digital transformation initiative should involve as well as the suggestions on how to effectively deal with it can be used by managers to successfully lead the I4.0 transition journey in their organizations

Improving the mental health care process in response to Covid-19 pandemic: The case of a penitentiary mental health division.

Covid-19 outbreak led all organizations to reorganize their processes to prevent infection and contagion risk. All healthcare facilities, included penitentiary mental health services, had to redesign their processes to safely deliver care services. In this paper, the case of a Penitentiary Mental Health Division located in southern Italy is presented. Soft System Methodology and Business process management principles and techniques are adopted to analyse and redesign the detainees' mental health care process. The process, characterized by direct, close and prolonged contact with patients, exposes detainees and healthcare staff to a high Covid-19 infection risk. Through document analysis, interviews with the actors involved in the process and direct observation, the process's inefficiencies and criticalities are identified. The process is redesigned to make it compliant with Covid-19 prevention provisions and national penitentiary regulations and address the other criticalities. The proposed methodological approach-which innovatively combines Soft System Methodology and Business Process Management-constitutes a human-centered process-based redesign approach that can be used both in healthcare and other organizational settings

Digital Transformation Models for the I4.0 Transition: Lessons from the Change Management Literature

The growing diffusion of digital technologies, especially in production systems, is leading to a new industrial paradigm, named Industry 4.0 (I4.0), which involves disruptive changes in the way companies organize production and create value. Organizations willing to seize the opportunities of I4.0 must thus innovate their processes and business models. The challenges that companies must face for the transition towards I4.0 paradigm are not trivial. Several digital transformation models and roadmaps have been lately proposed in the literature to support companies in such a transition. The literature on change management stresses that about 70% of change initiatives—independently of the aim—fail to achieve their goals due to the implementation of transformation programs that are affected by well-known mistakes or neglect some relevant aspects, such as lack of management support, lack of clearly defined and achievable objectives and poor communication. This paper investigates whether and to what extent the existing digital transformation models (DTMs) and roadmaps for I4.0 transition consider the lessons learnt in the field of change management. To this aim, a Systematic Literature Review to identify existing models and roadmaps is carried out. The results obtained by the review are discussed under the lens of the change-management literature. Based on that, the shortcomings and weaknesses of existing DTMs are pinpointed. Extant DTMs mainly focus on digital transformation initiatives carried out in manufacturing companies; they do not cover all the phases of the digital transformation process but rather focus on the definition of the I4.0 vision, strategy and roadmap. Little attention is devoted to the implementation and consolidation of digital change. Change management lessons are considered to a limited extent, based on which, some suggestions for better dealing with digital transformation initiatives are discussed. The paper contributes to advancing knowledge on models and approaches to support organizations in managing digital transformation. The identification of change management activities that a digital transformation initiative should involve as well as the suggestions on how to effectively deal with it can be used by managers to successfully lead the I4.0 transition journey in their organizations

Dysphagia in Huntington's disease: Correlation with clinical features

Huntington's disease (HD) is an inherited neurodegenerative disorder characterised by motor impairment, cognitive decline and psychiatric disorders. Dysphagia is a pathologic condition that increases morbidity and mortality of the affected people. Our aim was to evaluate dysphagia in a group of HD patients in view of motor, cognitive and functional decline. Thirty-seven genetically confirmed HD patients were submitted to clinical evaluations of swallowing. Bedside Swallowing Assessment Scale (BSAS) was used. Dysphagia Outcome and Severity Scale (DOSS) was applied for a preliminary classification of swallowing difficulties. All patients were also evaluated by the Unified Huntington's Disease Rating Scale (UHDRS). A group of 39 controls comparable for sex and age were recruited for BSAS scores normalisation. The BSAS scores indicated that in our HD cohort, 32.4% presented relevant or severe dysphagia. The DOSS levels were significantly correlated with main clinical features, such as age, disease duration and motor impairment, with special regard to lingual protrusion ability, dysarthria and bradykinesia. The total functional capacity (TFC) and cognitive scales did not show significant correlation with DOSS levels. The results of clinical examination of swallowing indicated that dysphagia is a prevalent motor symptom of HD

What we don\u27t need to prove but need to do in multidisciplinary treatment and care in Huntington\u27s disease: A position paper

Background: Huntington’s disease is a complex neurodegenerative hereditary disease with symptoms in all domains of a person’s functioning. It begins after a healthy start in life and leads through the relentless progression over many years to complete care dependency and finally death. To date, the disease is incurable. The long progressive complex nature of the disease demands multiple disciplines for treatment and care of patient and family. These health care providers need inter- and multidisciplinary collaboration to persevere and be efficacious in this devastating disease trajectory. Discussion: The position paper outlines current knowledge and experience alongside the experience and consensus of a recognised group of HD multidisciplinary experts. Additionally the patient’s voice is clear and calls for health care providers with a holistic view on patient and family. Building long-term trust is a cornerstone of the network around the patient. This paper describes a managed care network comprising all the needed professionals and services. In the health care system, the role of a central coordinator or case manager is of key importance but lacks an appropriate guideline. Other disciplines currently without guidelines are general practitioners, nurses, psychologists, and social workers. Guidelines for neurologists, psychiatrists, geneticists, occupational therapists, speech and language therapists, physiotherapists, dieticians, and dentists are being discussed. Apart from all these profession-specific guidelines, distinctive inter- and multidisciplinary collaboration requirements must be met. Conclusions and recommendations: The complex nature of Huntington\u27s disease demands multidisciplinary treatment and care endorsed by international regulations and the lay association. Available guidelines as reviewed in this paper should be used, made available by a central body, and updated every 3 – 5 years. Time needs to be invested in developing missing guidelines but the lack of this ‘proof’ should not prevent the ‘doing’ of good care

Cytogenetic and Array-CGH Characterization of a Simple Case of Reciprocal t(3;10) Translocation Reveals a Hidden Deletion at 5q12

Chromosome deletions, including band 5q12, have rarely been reported and have been associated with a wide range of clinical manifestations, such as postnatal growth retardation, intellectual disability, hyperactivity, nonspecific ocular defects, facial dysmorphism, and epilepsy. In this study, we describe for the first time a child with growth retardation in which we identified a balanced t(3;10) translocation by conventional cytogenetic analysis in addition to an 8.6 Mb 5q12 deletion through array-CGH. Our results show that the phenotypic abnormalities of a case that had been interpreted as “balanced” by conventional cytogenetics are mainly due to a cryptic deletion, highlighting the need for molecular investigation in subjects with an abnormal phenotype before assuming the cause is an apparently simple cytogenetic rearrangement. Finally, we identify PDE4D and PIK3R1 genes as the two major candidates responsible for the clinical features expressed in our patient

High dose esomeprazole as an anti-inflammatory agent in sepsis: Protocol for a randomized controlled trial

Background: Sepsis is caused by dysregulated immune responses due to infection and still presents high mortality rate and limited efficacious therapies, apart from antibiotics. Recent evidence suggests that very high dose proton pump inhibitors might regulate major sepsis mediators' secretion by monocytes, which might attenuate excessive host reactions and improve clinical outcomes. This effect is obtained with doses which are approximately 50 times higher than prophylactic esomeprazole single daily administration and 17 times higher than the cumulative dose of a three day prophylaxis. We aim to perform a randomized trial to investigate if high dose esomeprazole reduces organ dysfunction in patients with sepsis or septic shock. Methods: This study, called PPI-SEPSIS, is a multicenter, randomized, double blind, placebo-controlled clinical trial on critically ill septic patients admitted to the emergency department or intensive care unit. A total of 300 patients will be randomized to receive high dose esomeprazole (80 mg bolus followed by 12 mg/h for 72 h and a second 80 mg bolus 12 h after the first one) or equivolume placebo (sodium chloride 0.9%), with 1:1 allocation. The primary endpoint of the study will be mean daily Sequential Organ Failure Assessment (SOFA) score over 10 days. Secondary outcomes will include antibiotic-free days, single organ failure severity, intensive care unit-free days at day 28, and mortality. Discussion: This trial aims to test the efficacy of high dose esomeprazole to reduce acute organ dysfunction in patients with septic shock. Trial registration: This trial was registered on ClinicalTrials.gov with the trial identification NCT03452865 in March 2018