Investigating Employee Resistance to Lean Transformation: UK Case Study

Lean is a business process transformation approach that eliminates ‘wastes’ – activities that generate no value for the customer. Lean originated from the production line but is widely implemented in the service sector. This study investigates human and social factors in a Lean transformation in a ‘knowledge worker’ environment. We identify a paradox: a successful Lean programme in the service sector develops staff who are educated and empowered and thus potential opponents to future business change. We offer five recommendations for organizations undertaking Lean transformations: (1) Build an in-house organization-wide ‘Lean Team’ to drive the programme rather than hiring external consultants; (2) Ensure participation is recognized and rewarded; (3) Replace departmental parochialism with a genuinely corporate vision; (4) Align the Lean programme with corporate information strategies; (5) Incorporate Lean thinking into the organizational culture

Novel fire testing frameworks for Phase Change Materials and hemp-lime insulation

Modern buildings increasingly include the usage of innovative materials aimed at improving sustainability and reducing the carbon footprint of the built environment. Phase Change Materials (PCMs) are one such group of novel materials which reduce building energy consumption. These materials are typically flammable and contained within wall linings yet there has been no detailed assessment of their fire performance. Current standard fire test methods provide means to compare similar materials but do not deliver knowledge on how they would behave in the event of a real fire. Thus, the aim of this thesis is to develop a novel testing framework to assess the behaviour of these materials in realistic fire scenarios. For PCMs, a flammability study is conducted in the bench-scale cone calorimeter to evaluate the fire risk associated with these materials. Then, micro-scale Thermogravimetric Analysis (TGA) is used to identify the fundamental chemical reactions to be able to confidently interpret the flammability results. Finally, intermediate-scale standard fire tests are conducted to evaluate the applicability of the bench-scale results to realistic fire scenarios. These take the form of modified Lateral Ignition and Flame spread Test (LIFT) and Single Burning Item (SBI) tests to understand flame spread and compartment fires respectively. Finally, a simplified method to combine this knowledge for use in building design is proposed. This method allows the balancing of potential energy benefits with quantified fire performance to achieve the specified goals of the designer. Hemp-lime insulation is a material which has also becoming increasingly popular in the drive towards sustainability. The porous nature of the material means that smouldering combustions are the dominant reaction mode but there is currently no standardised test method for this type of behaviour. Thus, hemp-lime materials also represent an unquantified risk. The work in this thesis defines a simple, accessible and economically viable bench-scale method for quantifying the fire risk associated with rigid porous materials. This is applicable for both downward opposed flow and upward forward flow smoulder propagation conditions. The behaviour is then interpreted using micro-scale thermogravimetric analysis to understand the underlying pyrolysis and oxidation reactions. Designers can utilise this framework to quantify the smouldering risk associated with hemp-lime materials to enable their usage in the built environment. The holistic fire risk assessment performed in this thesis has quantified the behaviour of PCMs and hemp-lime insulation applicable to realistic fire scenarios. The simplified design method empowers designers to be able to realise innovative buildings through fundamental understanding of the fire behaviour of these materials. The outcomes of this thesis allow designers to mitigate the fire risk associated with these materials and achieve optimised engineering solutions. Furthermore, the novel fire testing frameworks provide the economically viable means to assess the fire performance of future PCMs and hemp-lime products which ensures lasting relevance of this research in the future

Visitor composition andevent-related spending

The purpose of this paper is to examine the spending patterns of non‐local participants and spectators at a medium‐sized international sport event, to segment their spending patterns and consider implications for the quality of each segment\u27s event experience

Historical data and modern methods reveal insights in measles epidemiology: a retrospective closed cohort study

OBJECTIVES Measles was endemic in England during the early 1800s; however, it did not arrive in Australia until 1850 whereas other infectious diseases were known to have arrived much earlier-many with the First Fleet in 1788-leading to the question of why there was a difference. DESIGN Ships surgeons' logbooks from historical archives, 1829-1882, were retrospectively reviewed for measles outbreak data. Infectious disease modelling techniques were applied to determine whether ships would reach Australia with infectious measles cases. SETTING Historical ship surgeon logbooks of measles outbreaks occurring on journeys from Britain to Australia were examined to provide new insights into measles epidemiology. PRIMARY AND SECONDARY OUTCOME MEASURES Serial intervals and basic reproduction numbers (R(0)), immunity, outbreak generations, age-distribution, within-family transmission and outbreak lengths for measles within these closed cohorts. RESULTS Five measles outbreaks were identified (163 cases). The mean serial interval (101 cases) was 12.3 days (95% CI 12.1 to 12.5). Measles R(0) (95 cases) ranged from 7.7-10.9. Immunity to measles was lowest among children ≤10 years old (range 37-42%), whereas 94-97% of adults appeared immune. Outbreaks ranged from 4-6 generations and, before 1850, were 41 and 38 days in duration. Two outbreaks after 1850 lasted longer than 70 days and one lasted 32 days. CONCLUSIONS Measles syndrome reporting in a ship surgeon's logs provided remarkable detail on prevaccination measles epidemiology in the closed environment of ship voyages. This study found lower measles R(0) and a shorter mean clinical serial interval than is generally reported. Archival ship surgeon log books indicate it was unlikely that measles was introduced into Australia before 1850, owing to high levels of pre-existing immunity in ship passengers, low numbers of travelling children and the journey's length from England to Australia.g BP was supported by a Master of Applied Epidemiology scholarship from the Australian Government and a Hunter Medical Research Institute Research Fellowshi

Critics and Crusaders 30 years on: Is Workplace Spirituality inherently ‘good’?

This paper presents a systematic review of the workplace spirituality literature as characterised by two factions which we have called the Crusaders and the Critics. The Crusaders are seen as authors whose work is clearly aimed at promoting the notion of workplace spirituality academically and in practice. The Critics are those who are, at the least, more reticent and calling for caution. The literature suggests very clear lines of demarcation between these two factions over about a 30 year period beginning in the 1990’s and identifies three themes in the bulk of the ‘crusader’ contributions which we have labelled as follows: functional and managerial, dualistic and reified. By way of comparison, these three themes were then compared with the results of an ethnographic study of self-sustaining spirituality communities (Buddhist and Benedictine) (Brown, 2009), and it was noted how these three themes are the antithesis of organisations with a spiritual raison d’etre to aspire too. The paper concludes by arguing that the field known as workplace spirituality is unlikely to develop and/or contribute to management discourse in the absence of a clear attempt to address the issues noted in the three themes

Attitudinal predictors of older peoples' and caregivers' desire to deprescribe in hospital

Background Deprescribing is a partnership between practitioners, patients and caregivers. External characteristics including age, comorbidities and polypharmacy are poor predictors of attitude towards deprescribing. This hospital-based study aimed to describe the desire of patients and caregivers to be involved in medicine decision-making, and identify attitudinal predictors of desire to try stopping a medicine. Methods Patients and caregivers recruited from seven Older People’s Medicine wards across two UK hospitals completed the revised Patients’Attitudes Towards Deprescribing (rPATD) questionnaire. Patients prescribed polypharmacy and caregivers involved in medication decision-making of such patients were eligible. A target of 150 patients and caregivers provided a 95% confidence interval of ±11.0% or smaller around rPATD item agreement. Descriptive statistics characterised participants and rPATD responses. Responses to items regarding desire to be involved in medication decision-making and desire to try stopping a medicine were used to address the aims. Binary logistic regression provided the adjusted odds ratios (OR) for predictors of desire to try stopping a medicine. Results Patient participants (N=75) were a median (IQ) 87.0 (83.0, 90.0) years old and the median (IQ) number of pre-admission medication was 8.0 (6.0, 10.0). Caregiver participants (N=76) were a median (IQ) 70.0 (57.0, 83.0) years old and the majority were a spouse (63.2%). For patients and caregivers respectively, the following were reported: 58.7% and 65.8% wanted to be involved in medication decision-making; 29.3% and 43.5% reported a desire to try stopping a medicine. Attitudinal predictors of low desire to try stopping a medicine for patients and caregivers are a perception that there are no unnecessary prescribed medicines [OR=0.179 (patients) and 0.044 (caregivers)] and no desire for dose reduction [OR=0.199 (patients) and 0.024 (caregivers)]. A perception of not being prescribed too many medicines also predicted low patient desire to try stopping a medicine [OR=0.195]. Conclusion A substantial proportion of patients and caregivers did not want to be involved medication decision-making, however this should not result in practitioners dismissing deprescribing opportunities. The three diagnostic indicators for establishing desire to try stopping a medicine are perceived necessity of the medicine, appropriateness of the number prescribed medications and a desire for dose reduction

Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity

Background: Deprescribing medication may be in response to an adverse clinical trigger (reactive) or if future gains are unlikely to outweigh future harms (proactive). A hospital admission may present an opportunity for deprescribing, however current practice is poorly understood. Objective: To quantify and describe the nature of deprescribing in a UK teaching hospital. Method: Prescribing and discontinuation data for admission medication from a hospital’s electronic prescribing system were extracted over 4 weeks. The rationale for discontinuation of a random sample of 200 was determined using medical records. This informed categorisation of deprescribing activity by clinicians into ‘proactive’ or ‘reactive’. Data were extrapolated to estimate the proportion of admission medications deprescribed and the proportion which were reactive and proactive. Results: From 24,552 admission medicines, 977 discontinuations were recorded. Of the 200 discontinuations sampled for review, only 44 (22.0%) were confirmed deprescribing activities; categorised into 7 (15.9%) proactive and 37 (84.1%) reactive. Extrapolation yielded 0.6% (95% CI 0.5–0.7%) of all admission medications deprescribed. Conclusion: Limited deprescribing activity, dominated by reactive behaviour was identified, suggesting prescribers require a clinical trigger to prompt deprescribing. There may be scope for increasing proactive deprescribing in hospital, however the extent to which this is feasible is unknown

Testing a model of antecedents and consequences of defensive pessimism and self-handicapping in school physical education

There has been very limited research on the use of self-worth protection strategies in the achievement context of school physical education (PE). Thus, this study aimed to examine some antecedents and consequences of defensive pessimism and self-handicapping. The sample comprised 534 (females n = 275; males n = 259) British pupils recruited from two schools who responded to established questionnaires. Results of structural equation modelling analysis indicated that self-handicapping and defensive pessimism were positively predicted by fear of failure and negatively predicted by competence valuation. In addition, defensive pessimism was negatively predicted by physical self-concept. In turn, defensive pessimism negatively predicted enjoyment in PE and intentions to participate in future optional PE programs. Self-handicapping did not predict enjoyment or intentions. Results from multi-sample structural equation modelling showed the specified model to be largely invariant across males and females. The findings indicate that although both strategies aim to protect one’s self-worth, some of their antecedents and consequences in PE may differ

Development of a hospital Deprescribing Implementation Framework : a focus group study with geriatricians and pharmacists

Background: over 50% of older people in hospital are prescribed a pre-admission medicine that is potentially inappropriate; however, deprescribing by geriatricians and pharmacists is limited. This study aimed to characterise geriatricians’ and pharmacists’ barriers and enablers to deprescribing in hospital. It also intended to develop a framework of intervention components to facilitate implementation of hospital deprescribing. Methods: fifty-four geriatricians and pharmacists representing four UK hospitals attended eight focus groups. We designed a topic guide to invite discussions about barriers and enablers to deprescribing. After thematic analysis, themes were mapped to the theoretical domains framework (TDF), enabling prioritisation of domains for behaviour change. We then identified evidence-based intervention components for changing behaviour within prioritised TDF domains. Results: geriatricians and pharmacists described several deprescribing enablers in the hospital setting including alignment with their role and generalist knowledge, and routine patient monitoring. Five prioritised TDF domains represent the key barriers and enabler: patient and caregiver attachment to medication (social influence); perceptions that deprescribing is riskier than continuing to prescribe (beliefs about consequences); pharmacists’ working patterns limiting capacity to support deprescribing (environmental context and resources); deprescribing being a low hospital priority (goals) and incentives to deprescribe (reinforcement). Prioritised TDF domains aligned with 44 evidence-based intervention components to address the barriers and enabler to hospital deprescribing. Conclusion: the behavioural determinants and their associated intervention components provide a hospital deprescribing implementation framework (hDIF). Intervention components should be selected from the hDIF to provide a theory and evidence-based intervention tailored to hospital contexts

Impact of yttrium-90 microsphere density, flow dynamics, and administration technique on spatial distribution: analysis using an in vitro model

Purpose: To investigate material density, flow, and viscosity effects on microsphere distribution within an in vitro model designed to simulate hepatic arteries.Materials and Methods: A vascular flow model was used to compare distribution of glass and resin surrogates in a clinically derived flow range (60–120 mL/min). Blood-mimicking fluid (BMF) composed of glycerol and water (20%–50% vol/vol) was used to simulate a range of blood viscosities. Microsphere distribution was quantified gravimetrically, and injectate solution was dyed to enable quantification by UV spectrophotometry. Microsphere injection rate (5–30 mL/min) and the influence of contrast agent dilution of injection solution (0%–60% vol/vol) were also investigated.Results: No significant differences in behavior were observed between the glass and resin surrogate materials under any tested flow conditions (P = .182; n = 144 injections). Microspheres tend to align more consistently with the saline injection solution (r2 = 0.5712; n = 144) compared with total BMF flow distribution (r2 = 0.0104; n = 144). The most predictable injectate distribution (ie, greatest alignment with BMF flow, &lt; 5% variation) was demonstrated with &gt; 10-mL/min injection rates of pure saline solution, although &lt; 20% variation with glass microsphere distribution was observed with injection solution containing as much as 30% contrast medium when injected at &gt; 20 mL/min.Conclusions: Glass and resin yttrium-90 surrogates demonstrated similar distribution in a range of clinically relevant flow conditions, suggesting that microsphere density does not have a significant influence on microsphere distribution. Injection parameters that enhanced the mixing of the spheres with the BMF resulted in the most predictable distribution.<br/