Förändringsarbete på Södersjukhusets ögonmottagning

Background: The Eye Clinic at Södersjukhuset used to be a healthcare facility with hospitalized patients, who stayed overnight. But with the construction of S:t Eriks eye hospital the healthcare facility was turned into a daytime clinic. The clinic stayed in the premises, which was oversized and not suited for clinical work. Over time the amount of patients and personnel increased until all rooms at the clinic were utilised. A couple of years ago a new pharmaceutical, Lucentis, was introduced as treatnebt if one of the most common eye diseases, Age-related Macular degeneration (AMD). This treatment has grown significantly and today it makes up for over 20 % of the patients coming to the clinic. The rapid increase of this kind of treatment in combination with the clinics resources already fully utilized resulted in a growing waiting list for patients with chronic diseases. The clinic is now looking for changes that will increase efficiency and productivity in order to deal with the long waiting list. Purpose: The main purpose of this project is to reduce the waiting list by increasing the efficiency and productivity of the clinics processes. still maintaining or improving the quality of the healthcare and working conditions. Goal: Develop a method for managing change for project groups that are not trained or educated in the businesses profession. Furthermore the project will apply this method to create suggestions for change, investigate the suggestions compatibility and effect and finally make an implementation of the respective suggestions. Method: The project utilises an actors approach because the researchers and the personnel must interact to implement suggestions for changes. The researchers method, “Flexibelt Förändringsarbete” for managing change is a combination between a leading business process improvement model and action research. This combination creates a method that supports the change process from start to finish and has the flexibility to allow the researchers to go back and revise earlier steps due to an increased understanding. vii Business development process: The process was initiated by analysing the organisation of the clinic, processes and the frequency of different diseases. Then the processes, which handled most of the patients and had good potential for improvement, were identified. From these initial analyses three different processes were selected. In streamlining the Lucentisprocess both detailed and organizational changes were made. The information gathered from internal interviews and observations with and external benchmarking was used during a presentation and workshop with the personnel. This meeting resulted in the new process. Two weeks after the meeting the implementation started. At the end of the project the production had increased by 38,5 % without adding extra resources. Teamwork and a dedicated clinic; changes that aim to stimulate teamwork and reduce the variation between patient visits, in order to increase productivity and improve working conditions. To implement this, in the entire clinic, is an extensive task. Due to time limitations the implementation the project focused on one specific process. When introducing this implementation to the clinic it became clear that this specific implementation would have a negative effect on the quality of the healthcare. Although this change initiative did not result in any actual implementation, it introduced the concept of teamwork and a dedicated clinic. By standardizing the initial examination the initial tasks of a patients visit are divided between doctors and nurses. This will create a more efficient process by allowing a better division of labour and flow of patients. The researchers believe that the final implementation will include 55,8 % of all patient visits. This standardization was conducted in three iterations, which convinced the staff of its benefits and created good conditions for starting an implementation. An initial implementation was introduced and the doctor’s productivity increased by 37,5 %. In conclusion this project not only resulted in an identification of improvements but also initial implementations. The method developed here, together with the initial studies, has created a good foundation for a successful handover and completion of the implementations in the future

Windbreaks in North American Agricultural Systems

Windbreaks are a major component of successful agricultural systems throughout the world. The focus of this chapter is on temperate-zone, commercial, agricultural systems in North America, where windbreaks contribute to both producer profitability and environmental quality by increasing crop production while simultaneously reducing the level of off-farm inputs. They help control erosion and blowing snow, improve animal health and survival under winter conditions, reduce energy consumption of the farmstead unit, and enhance habitat diversity, providing refuges for predatory birds and insects. On a larger landscape scale windbreaks provide habitat for various types of wildlife and have the potential to contribute significant benefits to the carbon balance equation, easing the economic burdens associated with climate change. For a windbreak to function properly, it must be designed with the needs of the landowner in mind. The ability of a windbreak to meet a specific need is determined by its structure: both external structure, width, height, shape, and orientation as well as the internal structure; the amount and arrangement of the branches, leaves, and stems of the trees or shrubs in the windbreak. In response to windbreak structure, wind flow in the vicinity of a windbreak is altered and the microclimate in sheltered areas is changed; temperatures tend to be slightly higher and evaporation is reduced. These types of changes in microclimate can be utilized to enhance agricultural sustainability and profitability. While specific mechanisms of the shelter response remain unclear and are topics for further research, the two biggest challenges we face are: developing a better understanding of why producers are reluctant to adopt windbreak technology and defining the role of woody plants in the agricultural landscape

Waermeenergiehaushalt und Bestandsklima eines Buchenwaldes Bericht ueber das Forschungsvorhaben

TIB: D.Dt.F./AC 1000 (21,52) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Ergebnisse von Strahlungsmessungen ueber und in einem Buchenwald bei Goettingen 1982-1984

TIB: AC 9108 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Ergebnisse von Strahlungsmessungen ueber und in einem Kiefernwald bei Fuhrberg 1984

TIB: AC 9104 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman