Private finance for the delivery of school projects in England

This paper analyses the use of the private finance initiative (PFI) approach to deliver school projects in England. The findings are based on case-study research in the Building Schools for the Future scheme (BSF), the largest single capital investment in SO years to rebuild and renew all of England's secondary schools. Up to half of the school infrastructure is to be procured by PFI contracts. A major concern has been the high cost associated with PFI procurement and any subsequent changes to scope. Furthermore, in some cases PFI-funded schools have been closed soon after completion; at great cost to the public sector. The aim of this research was therefore to understand the underlying reasons for these problems. The main conclusion is that the difficulties in BSF arise from not sorting out strategic issues and instituting appropriate organisational frameworks before engaging the private sector. The result of this is a lack of clarity about the long-term needs and end user aspirations. A brief outline of current programme management methods is given and it is suggested that this might be integral to the successful delivery of schools using private finance. A clear strategic vision that cascades into projects via programmes will ensure that the school infrastructure is appropriate for the anticipated strategic benefits and is aligned to the overall service delivery ambitions

Intraoperative patient experience and postoperative visual quality after SMILE and LASIK in a randomized, paired-eye, controlled study

PURPOSE: To compare intraoperative and postoperative subjective patient experience after small incision lenticule extraction (SMILE) and femtosecond laser–assisted LASIK. METHODS: In a prospective, randomized, paired-eye, single-masked clinical trial at Singapore National Eye Centre, 70 patients were randomly treated with SMILE and LASIK in each eye. The intraoperative questionnaire was completed immediately after surgery and included light perception and levels of anxiety, fear, and discomfort. The postoperative 1- and 3-month questionnaires evaluated severity of light sensitivity, eye discomfort, eye dryness, excessive tearing, gritty sensation, glare, halos, blurring, and fluctuations in vision. RESULTS: Average discomfort scores were higher during tissue manipulation in SMILE (1.9 ± 0.9) than flap lifting in LASIK (1.59 ± 0.8) (P = .020) but comparable during docking and laser application (P > .249). Fear scores were lower in SMILE than LASIK during docking (2.6 ± 1.6 vs 3.4 ± 1.9, P = .024) but similar during occasional blackout, laser application, and lenticule/flap manipulation (P > .364). Fear scores were generally higher in patients with intraoperative suction loss (n = 3). For SMILE, light sensitivity, eye discomfort, blurring, and fluctuations in vision improved from 1 to 3 months (P < .039). For LASIK, improvements were reported for light sensitivity, eye discomfort, eye dryness, gritty sensation, and fluctuations in vision from 1 to 3 months (P < .046). At 1 month, patients experienced more blurring after SMILE than LASIK (2.1 ± 0.8 vs 1.8 ± 0.7, P = .025), but with no differences in any of the visual symptoms at 3 months. CONCLUSIONS: Tissue manipulation may be more uncomfortable during SMILE than LASIK, but not more frightening. Subjective visual symptoms were comparable after 3 months

Successful programs wanted: exploring the impact of alignment.

Alignment between formulation and implementation of business strategy can be important for achieving successful programmes. The authors have explored developing a programme management alignment theory. Statistical testing suggests that interaction between the study model variables was found to be multidimensional, complex and subtle in influence. They conclude that programmes have both deliberate and emergent strategies requiring design and management to be organised as complex adaptive systems. Programme lifecycle phases of design and transition were often illustrated by an unclear and confusing strategic picture at the outset which makes it difficult to control. Learning was established as an underlying challenge. The study model demonstrated continuous alignment as an essential attribute contributing towards successful delivery. This requires programme design and structure to adopt an adaptive posture