Support to the public services mutation through continuous improvement in a french metropolis

Public Services have their own principles and codes in order to address needs of general interest through the procurement of physical objects, information or services to various kinds of users. Characterized by a political context and a dedicated legal framework, public services have specific constraints and objectives. This communication shows how continuous improvement methods born in an industrial context could be adapted for addressing the specificity of public service, especially in the new context of "Smart Cities"

A Discrete Event Simulation model to evaluate the treatment pathways of patients with Cataract in the United Kingdom

Background The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. Methods We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. Results Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Conclusions Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.Peer reviewedFinal Published versio

A critical analysis of the efficacy of law as a tool to achieve gender equality and to address the problem of domestic violence : The case of Trinidad and Tobago

Law is often perceived as an instrument that can effect social change. National law in Trinidad and Tobago, prima facie providing for gender equality, does not fully contemplate issues of particular concern to women, such as domestic violence. Gender equality and domestic violence are unwitting partners as women cannot achieve the former without first addressing the latter. Additionally, problems such as male dominance in politico-legal structures and lack of political will create practical obstacles to the realisation of gender equality and/or the full potential of the law. A case study of Trinidad and Tobago shows that the achievement of legal advances for women is particularly difficult where practical measures are not implemented domestically. Honouring international commitments subsequently becomes problematic as they do not guarantee change nationally and they, too, are sidelined. Gender equality and domestic violence are not given priority domestically and laws aimed towards protecting women and women’s rights are ineffective, scant and/or not enforced. The only way to achieve gender equality is through a multilevel approach from above (the UN) and, perhaps, more importantly, from below, as women have the potential to effect real national and international legal and institutional change to ensure gender equality at both levels.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

An approach for identifying value in business processes.

The article of record as published may be found at http://dx.doi.org/10.1108/13673270310492949Many organizations are embarking upon knowledge management initiatives to enhance their competitiveness. While there has been a significant amount of multidisciplinary research in this area, the evidence from surveys of practitioners indicate that a large proportion of company projects focus on the implementation of technology-based solutions without consideration for the structural and contextual issues. Many academic authors have presented a variety of different models for knowledge management but have often failed to relate these to the requirements of practitioners. This paper presents a model of knowledge management derived from a synthesis of current literature. The model emphasizes the need for knowledge evaluation within a knowledge management approach and describes, using a case study, how this might be achieved