Lean: Changing the organizational discourse for facilities management?

Purpose: NHS Trusts have begun to use Lean Management thinking to engage staff in redesigning organisational processes to reduce waste, improve quality and increase efficiency ensuring patients receive effective treatment. Lean is starting to be utilised within FM but despite evidence of process redesign and waste reduction there is no research on the impact on the people involved, or the support required for successful implementation. Theory: The study sought to understand the engagement with, and views of, lean approaches by facilities staff utilising these techniques in reorganisation projects. The understanding was applied to a case study of process redesign of the laundry service. Findings: The study found that FM staff saw lean providing an opportunity to develop a better understanding between FM staff and their customers. This contributed to FM staff and customers engaging in joint process redesign, where the co-creative approach enabled the development of efficient and effective patient focused FM services. It was observed that for many FM staff the lean journey can be frustrating, traumatic and in some cases life changing. Staff of all levels need the support of effective leaders as they experience changing approaches to decision making and process design. Originality/Value: The study provides further evidence to support the proposition that translational leadership and awareness of both ‘horizontal’ and ‘vertical’ discourses is a key enabler of effective facilitie

Leveraging the holistic benefits of biosimilars in Europe - part 2:how payers can safeguard the future of a healthy biosimilar market environment

IntroductionBiosimilars have improved access to biologic medicines; however, historical thinking may jeopardize the viability of future markets.Areas coveredAn expert panel of eight diverse European stakeholders provided insights about rethinking biosimilars and cost-savings, reducing patient access inequalities, increasing inter-market equity, and improving education. The insights reported here (Part 2) follow a study that provides perspectives on leveraging the holistic benefits of biosimilars for market sustainability based on independent survey results and telephone interviews of stakeholders from diverse biosimilar markets (Part 1). Directional recommendations are provided for payers.Expert OpinionThe panel's market maturity framework for biosimilars has three stages: 'Invest,' 'Expand' and 'Harvest.' Across market stages, re-thinking the benefits of biosimilars beyond cost-savings, considering earlier or expanded access/new indications, product innovations, and re-investment of biosimilar-generated cost-savings should be communicated to stakeholders to promote further engagement. During 'Expand' and 'Harvest' stages, development of efficient, forward-looking procurement systems and mechanisms that drive uptake and stabilize competition between manufacturers are key. Future biosimilars will target various therapy areas beyond those targeted by existing biosimilars. To ensure a healthy, accessible future market, stakeholders must align their objectives, communicate, collaborate, and coordinate via education, incentivization, and procurement, to maximize the totality of benefits

Commensal microbiota modulate gene expression in the skin

Abstract Background The skin harbors complex communities of resident microorganisms, yet little is known of their physiological roles and the molecular mechanisms that mediate cutaneous host-microbe interactions. Here, we profiled skin transcriptomes of mice reared in the presence and absence of microbiota to elucidate the range of pathways and functions modulated in the skin by the microbiota. Results A total of 2820 genes were differentially regulated in response to microbial colonization and were enriched in gene ontology (GO) terms related to the host-immune response and epidermal differentiation. Innate immune response genes and genes involved in cytokine activity were generally upregulated in response to microbiota and included genes encoding toll-like receptors, antimicrobial peptides, the complement cascade, and genes involved in IL-1 family cytokine signaling and homing of T cells. Our results also reveal a role for the microbiota in modulating epidermal differentiation and development, with differential expression of genes in the epidermal differentiation complex (EDC). Genes with correlated co-expression patterns were enriched in binding sites for the transcription factors Klf4, AP-1, and SP-1, all implicated as regulators of epidermal differentiation. Finally, we identified transcriptional signatures of microbial regulation common to both the skin and the gastrointestinal tract. Conclusions With this foundational approach, we establish a critical resource for understanding the genome-wide implications of microbially mediated gene expression in the skin and emphasize prospective ways in which the microbiome contributes to skin health and disease

Leveraging the holistic benefits of biosimilars in Europe – part 2: how payers can safeguard the future of a healthy biosimilar market environment

Biosimilars have improved access to biologic medicines; however, historical thinking may jeopardize the viability of future markets. An expert panel of eight diverse European stakeholders provided insights about rethinking biosimilars and cost-savings, reducing patient access inequalities, increasing inter-market equity, and improving education. The insights reported here (Part 2) follow a study that provides perspectives on leveraging the holistic benefits of biosimilars for market sustainability based on independent survey results and telephone interviews of stakeholders from diverse biosimilar markets (Part 1). Directional recommendations are provided for payers. The panel’s market maturity framework for biosimilars has three stages: ‘Invest,’ ‘Expand’ and ‘Harvest.’ Across market stages, re-thinking the benefits of biosimilars beyond cost-savings, considering earlier or expanded access/new indications, product innovations, and re-investment of biosimilar-generated cost-savings should be communicated to stakeholders to promote further engagement. During ‘Expand’ and ‘Harvest’ stages, development of efficient, forward-looking procurement systems and mechanisms that drive uptake and stabilize competition between manufacturers are key. Future biosimilars will target various therapy areas beyond those targeted by existing biosimilars. To ensure a healthy, accessible future market, stakeholders must align their objectives, communicate, collaborate, and coordinate via education, incentivization, and procurement, to maximize the totality of benefits.</p