An evaluation of the practices of, and barriers to, continuous improvement through learning on NHS LIFT projects

The Department of Health (DoH), which is responsible for maintaining the overall health of people living in England through the National Health Service (NHS), introduced the Local Improvement Finance Trust (LIFT) initiative in 2000 to reverse the declining state of primary care infrastructure. The initiative involves partnerships between diverse public and private sector organisations to deliver improvements in facilities that will be suitable for modern primary and social care services over a 20 – 25 year period. The initiative contractually demands for continuous performance improvement from the demand and supply sides, but the attainment still remains elusive. This paper is aimed at describing the investigation into the practices of, and barriers to, the achievement of continuous improvement through learning on NHS LIFT schemes. The investigation is part of a study aimed at developing a continuous improvement framework that will ensure that current and relevant knowledge is captured and reused during the execution of long-term partnering (LTP) relationships. The methodology adopted for the investigation involved semi-structured interviews with ten senior officers of six organisation working across three LIFT schemes following the review of relevant literature. The study revealed that ad hoc procedures were mostly used for capturing lessons learned during the planning and implementation of the various LIFT projects. Although a variety of techniques and few technologies were being employed in capturing relevant project knowledge, the study revealed that the reuse of the captured knowledge have been largely ineffective. The key barriers to the achievement of continuous improvement on NHS LIFT projects identified include distrust and lack of mutual understanding, difference in modus operandi and timeframes of the key participants, lack of clarity and communication, lack of appropriate skills and competencies; and adversarial contexts

Is the Local Improvement Finance Trust (LIFT) procurement initiative delivering the expected economies of scale? Results from three case studies

The UK Department of Health (DoH) introduced the Local Improvement Finance Trust (LIFT) initiative in 2000 to reverse the declining state of primary healthcare facilities. The initiative involves partnerships between diverse organisations from public and private sectors working together to deliver improvements in facilities that will be suitable for modern primary and social care services. However, recent evaluations of the performance of some schemes under the initiative show mixed results. This paper examines three LIFT case studies to investigate whether the LIFT procurement strategy supports the delivery of facilities for improved primary and social care services that meet local needs whilst providing value for money. The investigations, which involved senior managers, revealed significant differences in the maturity levels of the schemes evaluated in terms of appropriate systems, processes and structures in the planning and implementation of the schemes. Although there is potential for more improvements, the pattern of progress made generally confirmed an evolving system, with considerable evidence of performance improvement from project-to-project. Whilst suggesting some potential ways for securing long-term improvements and sustained value for money, this paper concludes that there is considerable evidence that the LIFT initiative is delivering the expected economies of scale in providing modern facilities for the provision of integrated primary and social care services

The development of a continuous improvement framework for long-term partnering relationships

The sub-optimal performance of the global construction sector in the last two decades has led to its scrutiny. Accordingly, improvements in the efficiency and competitiveness of the industry through reforms in contracting, tendering, design process, and other areas had been advocated. This consequently led to steady flow of research, reports and analyses on the nature of the industry, its various components, systems and structures. One of the key findings is the effective use and management of inter-organisational project teams in enhancing project success, thereby resulting in enormous interest in collaborative approaches such as partnering. However, when new initiatives and techniques are introduced, the challenges of quantifying their impact on performance improvement arise. The difficulty of the evaluation increases with complexity, duration and multitude of parties involved in the procurement process. This paper aims at describing the methodology proposed for a PhD research underway to develop a continuous improvement framework for long-term partnering relationships. The methodology adopted for the research is a hypothetico-deductive approach that comprises of two main stages. First, the framework is conceptualised from the synthesis of literature and preliminary interviews while the second stage involves the empirical testing of the framework using triangulated methods for collecting and analysing data. The framework will consider the complete whole life cycle of a construction project; planning and design, construction and operational stages

El entorno para el cuidado de personas con demencia

Populations in many countries are ageing at a rapid pace which is expected to rise over the coming years. Health and social care provision and infrastructure need to respond to the ageing population and its related conditions such as dementia. The healthcare built environment can impact on people with dementia and the care pathway is highly relevant to quality of life, patients, residents, family, staff and carers. Evidence-based design solutions and best practice can help to improve the quality of life and deliver value for money during a period of rapid change where long term solutions relating to the healthcare environment are requrired. Research and pilot studies can help to demonstrate the benefits of evidence-based design and best practice for integrated care delivery. This paper explores the current trend and future oportunities to deliver dementia-friendly environments and integrated care through gathering of evidence, development of best practice guidance and integration of care delivery

Isospin-violating dark matter at liquid noble detectors: new constraints, future projections, and an exploration of target complementarity

There is no known reason that dark matter interactions with the Standard Model should couple to neutrons and protons in the same way. This isospin violation can have large consequences, modifying the sensitivity of existing and future direct detection experimental constraints by orders of magnitude. Previous works in the literature have focused on the zero-momentum limit which has its limitations when extending the analysis to the Non-Relativistic Effective Field Theory basis (NREFT). In this paper, we study isospin violation in a detailed manner, paying specific attention to the experimental setups of liquid noble detectors. We analyse two effective Standard Model gauge invariant models as interesting case studies as well as the more model-independent NREFT operators. This work demonstrates the high degree of complementarity between the target nuclei xenon and argon. Most notably, we show that the Standard Model gauge-invariant formulation of the standard spin-dependent interaction often generates a sizeable response from argon, a target nuclei with zero spin. This work is meant as an update and a useful reference to model builders and experimentalists.Comment: 22 pages in total, 13 figures, 1 table, 3 appendices. Data from the main results of this paper is available at https://doi.org/10.1140/epjc/s10052-023-11826-

Integration of resilience and sustainability: from theory to application

Purpose – This study aims to explore the challenges associated with the integration of resilience and sustainability, and propose a workable solution that ensures resilient and sustainable buildings. Recent research outcomes suggest that the number of natural hazards, both environmental and geophysical, will increase due to the effect of global warming. Various approaches have been investigated to reduce environmental degradation and to improve the physical resilience to natural hazards. However, most of these approaches are fragmented and when combined with cultural barriers, they often result into less-efficient assessment tools. Design/methodology/approach – The primary source of information used to develop this paper has been research publications, policy papers, reports and tool guidelines. A set of questions were developed to guide the review which was complemented with information distilled from the HFA 2005-2015 to develop an integration process to evaluate 10 international sustainability appraisal tools. Findings – The major finding of this research is that, from a technical point of view, resilience and sustainability could be integrated. However, it requires a long and thorough process with a multidisciplinary stakeholder team including technical, strategic, social and political parties. A combination of incentives and policies would support this process and help people work towards the integration. The Japanese model demonstrates a successful case in engaging stakeholders in the process which led to the development of a comprehensive appraisal tool, CASBEE®, where resilience and sustainability are integrated. Practical implications – Although data have been sought through literature review (i.e. secondary data), the research is expected to have significant impact, as it provides a clear theoretical foundation and methods for those wishing to integrate resilience within current sustainability appraisal tools or develop new tools. Social implications – This paper provides original concepts that are required to reduce fragmentation in the way resilience and sustainability are addressed. It sets up a new research agenda which has the potential to have a strong impact due the fact that sustainability and resilience are getting higher on the political priority scale. Originality/value – This paper provides findings of an original idea to reduce fragmentation in the way resilience and sustainability are addressed. It sets up a new research agenda which has the potential to have a strong impact due the fact that sustainability and resilience are getting higher on the political priority scale

The introduction and management of innovative construction processes and products

To gain competitive advantage, companies have to innovate and improve continuously. Exploiting innovative products and processes requires effective management. Construction organizations should exhibit specific characteristics to stimulate new technology and to overcome the expected barriers to innovation. This paper draws together several aspects of the management and introduction of innovative processes and products within a quality management framework. The implementation of innovation requires rational decision making when considering a company’s projects and the uncertainties inherent in innovation. This may be aided by a decision system which simulates the benefits of short-term flexibility and efficiency for project based work to verify long-term performance and to achieve the desired step changes

Implementing construction innovations

The need to gain a competitive advantage stimulates many construction organizations to exploit innovative products and processes. The high level of uncertainty associated with innovative construction leads many construction organizations to focus on the application of traditional construction processes and products. Implementing construction innovation often involves experimentation, iteration and refinement of activities that are reliant on volatile information. Although several decision support models have been developed to assess new technologies, innovation as an implementation process has received less attention. This paper presents several tools to assess the value of technological innovation. It also presents a conceptual model, which is currently being developed, that deals with the effectiveness of innovation implementation phase. The proposed model is a decision support tool that models different implementation scenarios. The model uses influence information, managerial and technological benefits to control the implementation phase

Phylogenetic trees, augmented perfect matchings, and a Thron-type continued fraction (T-fraction) for the Ward polynomials

We find a Thron-type continued fraction (T-fraction) for the ordinary generating function of the Ward polynomials, as well as for some generalizations employing a large (indeed infinite) family of independent indeterminates. Our proof is based on a bijection between super-augmented perfect matchings and labeled Schr\"oder paths, which generalizes Flajolet's bijection between perfect matchings and labeled Dyck paths.Comment: LaTeX2e, 36 pages (includes 4 figures). Version 2 corrects a small error in the definition of crossing number (p. 6) and includes a proof of the previously conjectured (1.25)/(1.26

Long-Range Periodic Patterns in Microbial Genomes Indicate Significant Multi-Scale Chromosomal Organization

Genome organization can be studied through analysis of chromosome position-dependent patterns in sequence-derived parameters. A comprehensive analysis of such patterns in prokaryotic sequences and genome-scale functional data has yet to be performed. We detected spatial patterns in sequence-derived parameters for 163 chromosomes occurring in 135 bacterial and 16 archaeal organisms using wavelet analysis. Pattern strength was found to correlate with organism-specific features such as genome size, overall GC content, and the occurrence of known motility and chromosomal binding proteins. Given additional functional data for Escherichia coli, we found significant correlations among chromosome position dependent patterns in numerous properties, some of which are consistent with previously experimentally identified chromosome macrodomains. These results demonstrate that the large-scale organization of most sequenced genomes is significantly nonrandom, and, moreover, that this organization is likely linked to genome size, nucleotide composition, and information transfer processes. Constraints on genome evolution and design are thus not solely dependent upon information content, but also upon an intricate multi-parameter, multi-length-scale organization of the chromosome