Modelling the reliability of search operations within the UK through Bayesian belief networks

This paper uses a Bayesian belief networks (BBN) methodology to assess the reliability of search and rescue (SAR) operations within the UK coastguard (maritime rescue) coordination centers. This is an extension of earlier work, which investigated the rationale of the government's decision to close a number of coordination centers. The previous study made use of secondary data sources and employed a binary logistic regression methodology to support the analysis. This study focused on the collection of primary data through a structured elicitation process, which resulted in the construction of a BBN. The main findings of the study are that approaches such as logistic regression are complementary to BBN's. The former provided a more objective assessment of associations between variables but was restricted in the level of detail that could be explicitly expressed within the model due to lack of available data. The latter method provided a much more detailed model but the validity of the numeric assessments was more questionable. Each method can be used to inform and defend the development of the other. The paper describes in detail the elicitation process employed to construct the BBN and reflects on the potential for bias

Sustaining excellence in practice : a longitudinal study of a clothing manufacturing plant

This paper discusses the relevant academic literature on organisational excellence, presents a longitudinal case study of a clothing manufacturing plant, and discusses the case study findings in the light of the literature. Based on this, four observations are made. First, the nature of organisational excellence is multi-faceted, and cannot be simply equated with TQM or any other specific management approach. Second, although developing a Total Quality culture may yield significant benefits, improving operations does not, on its own, lead to sustainable organisational excellence. Instead, the organisation has to build its own, unique strategic position. Third, sustainable organisational excellence depends on building dynamic capabilities for organisational innovation. Fourth, top management performs two vital roles in sustaining organisational excellence: an administrative role of maintaining and exploiting existing organisational competences, and an entrepreneurial role of both continually developing and transforming existing organisational competences and searching for new competences in order to keep pace with changes in the environment

Fracture clinic redesign reduces the cost of outpatient orthopaedic trauma care

Objectives: “Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. Methods: National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign. Results: The total staffing costs rose by 4% over the time period (from £1 744 933 to £1 811 301) compared with a national increase of 16%. The total outpatient department rate of attendance fell by 15% compared with a national fall of 5%. Had our local costs increased in line with the national average, an excess expenditure of £212 705 would have been required for staffing costs. Conclusions: The virtual fracture clinic system was associated with less overall use of staff resources in comparison to national cost data. Adoption of this system nationally may have the potential to achieve significant cost savings

Service operations, the question of productivity and quality

This paper discusses service operations, the question of productivity and quality. It was presented at the 1st joint conference of the production and operation management society and the European operations management association, in 2003

The disciplined healthcare professional: a qualitative interview study on the impact of the disciplinary process and imposed measures in the Netherlands

Objective It is known that doctors who receive complaints may have feelings of anger, guilt, shame and depression, both in the short and in the long term. This might lead to functional impairment. Less is known about the impact of the disciplinary process and imposed measures. Previous studies of disciplinary proceedings have mainly focused on identifying characteristics of disciplined doctors and on sentencing policies. Therefore, the aim of this study is to explore what impact the disciplinary process and imposed measures have on healthcare professionals. Design Semistructured interview study, with purposive sampling and inductive qualitative content analysis. Participants 16 healthcare professionals (9 medical specialists, 3 general practitioners, 2 physiotherapists and 2 psychologists) that were sanctioned by the disciplinary tribunal. Setting The Netherlands. Results Professionals described feelings of misery and insecurity both during the process as in its aftermath. Furthermore, they reported to fear receiving new complaints and provide care more cautiously after the imposed measure. Factors that may enhance psychological and professional impact are the publication of measures online and in newspapers, media coverage, the feeling of treated as guilty before any verdict has been reached, and the long duration of the process. Conclusions This study shows that the disciplinary process and imposed measures can have a profound psychological and professional impact on healthcare professionals. Although a disciplinary measure is meant to have a corrective effect, our results suggest that the impact that is experienced by professionals might hamper optimal rehabilitation afterwards. Therefore, organising emotional support should be considered during the disciplinary process and in the period after the verdict. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, pro

Study protocol: adjuvant holmium-166 radioembolization after radiofrequency ablation in early-stage hepatocellular carcinoma patients-a dose-finding study (HORA EST HCC Trial)

Purpose To investigate the biodistribution of holmium-166 microspheres (Ho-166-MS) when administered after radiofrequency ablation (RFA) of early-stage hepatocellular carcinoma (HCC). The aim is to establish a perfused liver administration dose that results in a tumoricidal dose of holmium-166 on the hyperaemic zone around the ablation necrosis (i.e. target volume). Materials and Methods This is a multicentre, prospective, dose-escalation study in HCC patients with a solitary lesion 2-5 cm, or a maximum of 3 lesions of = 120 Gy has been reached on the target volume in 9/10 patients of a cohort. Secondary endpoints include toxicity, local recurrence, disease-free and overall survival. Discussion This study aims to find the optimal administration dose of adjuvant radioembolization with Ho-166-MS after RFA. Ultimately, the goal is to bring the efficacy of thermal ablation up to par with surgical resection for early-stage HCC patients.Cellular mechanisms in basic and clinical gastroenterology and hepatolog