The development and testing of a contextual model for healthcare quality improvement using Lean and the Model for Understanding Success in Quality (MUSIQ) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Quality Systems at Massey University, Palmerston North, New Zealand

This study developed a new theoretical model of quality improvement (QI) contextual factors, for QI activity undertaken at the healthcare microsystem level. The Model for Understanding Success in Quality (MUSIQ) (Kaplan, Provost, Froehle, & Margolis, 2012), was aligned with Lean improvement activity using the Toyota Way framework. The aim of the research was to improve the effectiveness of healthcare quality improvement initiatives by providing more understanding of the associations, relative importance and precise functioning of critical contextual factors. A new survey instrument, based on the literature, was developed to collect data and the hypothesised theoretical relationships were tested using the partial least squares path modelling (PLSPM) technique. QI practitioners at a large New Zealand District Health Board were surveyed on a range of contextual factors hypothesised to influence improvement outcomes. All survey participants had recently completed a small-scale improvement project using Lean, or were participants in training programmes that introduced them to Lean thinking and methods. Some participants worked autonomously on improvements of their own selection; others were part of a wider training programme derived from the National Health Service’s (UK) ‘productive ward’ programme. In the healthcare organisational context, the majority of these improvement initiatives were carried out at the microsystem level – initiated and delivered by the teams responsible for the work processes being modified. Survey responses were first analysed via principal components analysis (to examine the dimensionality of the scales) and then PLSPM. The defined contextual factors for ‘Teamwork’, ‘Respect for People’, ‘Lean Actions’ and the influence of negatively motivating factors all reached significance. Defined contextual factors for ‘Previous Experience’ and the influence of positive motivating factors did not reach significance at 5% level. The final model showed a statistically significant, moderate predictive strength, with an overall adjusted R2 of 0.58. This result was an encouraging validation of the microsystem-level layer of the MUSIQ model using Lean as the QI method (context). The relative influence of ‘Teamwork’, ‘Respect for People’, ‘Motivation’, and a mediating mechanism for making process changes (in this instance, Lean) were measured and found to be consistent with the MUSIQ model. Identifying more detailed causal mechanisms (the present model was intentionally parsimonious due to the time frame allowed and the resources available for the research), refining the operational definitions, and developing and testing predictive models for the defined contextual factors are the proposed next steps in the research

DIFFERENTIATION AND IMPLICIT PRICES IN EXPORT WHEAT MARKETS

This paper describes the extent and characteristics of differentiation in the international wheat market. Results indicate that the degree of differentiation has increased in the last 15 years. A hedonic price function is specified and estimated to examine implicit prices for characteristics and their changes through time.Crop Production/Industries, Demand and Price Analysis, International Relations/Trade,

Expanding the Domain of Policy-Relevant Scholarship in the Social Sciences

In this paper the author argues that social scientists need to do more to provide policy-relevant research. Rapid technological and economic change raise new issues about how policy should adjust that are not adequately addressed by older and narrower approaches. The author suggests two ways in which the domain of policy-relevant scholarship can be expanded. First, social scientists should be more flexible about the kinds of data they use and the ways they use them. Preliminary data can suggest new hypotheses, which can widen debate, and ethnographic and other qualitative methods can uncover patterns of behaviour invisible in quantitative sources. Second, social theories, concepts and ideas should play a greater role in the policy arena, shaping the way policy actors think about how the world works.social science, policy debates, research approaches

ESTIMATION OF MODAL DEMAND ELASTICITIES IN GRAIN TRANSPORTATION

Recent legislation in the transportation industry has stimulated a move toward more flexibility in railroad pricing and has consequently provided the impetus for the analysis of transportation demand. Modal demands for grain transportation are analyzed in this paper using a derived demand approach assuming dual relationships between production and cost functions of shippers' distribution activities. Hypotheses were introduced in the empirical specification about the effects of rail car shortages and the introduction of multiple-car rail rates. The model was estimated and hypotheses tested in the case of eastbound wheat and barley shipments form North Dakota.Demand and Price Analysis, Public Economics,

Spectrometer technology recommendations

A typical heterodyne remote sensing system contains three major elements: the antenna, the radiometer, and the spectrometer. The radiometer consists of the local oscillator, the mixer, and the intermediate frequency amplifiers. This subsystem performs the function of down converting the high frequency incident thermal emission signal to a lower intermediate frequency. The spectrometer measures the power spectrum of the down-converted signal simultaneously in many contiguous frequency channels. Typical spectrum analysis requirements involve measurement of signal bandwidths of 100 to 1000 MHz with a channel resolution of 0.5 to 10 MHz. Three general approaches are used for spectrometers: (1) filter banks, (2) Acousto-Optic Spectrometers (AOS's), and (3) digital autocorrelators. In contrast to the two frequency domain techniques, an autocorrelator works in the time domain. The autocorrelation function (ACF) of the incoming signal is computed and averaged over the integration time. The averaged ACF is then Fourier transformed to obtain the signal power spectrum. Significant progress was made in the development of sub mm antennas and radiometers. It is now time to begin research in the development of low power spaceborne spectrometers and to reduce their size and weight. The near-term research goal will be to develop a prototype digital autocorrelation spectrometer, using VLSI gate array technology, which will have a small size, low power requirements, and can be used in spacecraft mm and sub mm radiometer systems. The long-range objective of this technology development is to make extremely low power, less than 10 mW/channel, small and stable wideband spectrometers which can be used in future mm and sub mm wavelength space missions such as the Large Deployable Reflector

When Work Disappears: New Implications for Race and Urban Poverty in the Global Economy

This paper discusses the impact of growing joblessness and dwindling work opportunities on inner-city areas in America. The lack of low-skilled manual work in the inner city is linked to poverty, crime, family dissolution and the social life of neighbourhoods. The paper discusses this impact at a neighbourhood-wide, family and individual level, noting the interaction between these levels and the intergenerational repercussions that result. The paper goes on to look at race in this context, identifying a new form of cultural racism. It examines the way race becomes an issue as black people become disproportionately represented in neighbourhoods where there is a high ratio of joblessless and very few work opportunities. The paper shows how this segregation plus its interaction with other changes in society, escalates rates of neighbourhood joblessness and compounds existing problems in these neighbourhoods. Finally the paper examines the role of public policy, the way it has exacerbated inner-city joblessness and how it attempted to resolve the problem, but failed. The paper concludes by pointing to a way forward to improve work opportunities for all sectors of society that are struggling to make ends meet, including inner-city poor and the working- and middle- classes.joblessness, race, urban poverty

DEMAND FOR WHEAT CLASSES BY PACIFIC RIM COUNTRIES

The transcendental logarithmic function is used to derive demand functions which are estimated for wheat classes imported by Pacific Rim countries. Results indicate substantial differences exist in underlying demand parameters for wheat of different classes as well as across countries. In addition, the expenditure level has important impacts on the distribution of imported wheat classes, and preferences have shifted significantly through time, generally toward higher protein wheats.Demand and Price Analysis,

HEDONIC PRICES IN THE MALTING BARLEY MARKET

An important characteristic in the malting barley market is the multitude of quality variables which affect the value of particular samples. The purpose of this study was to estimate implicit (or hedonic) prices for selected quality factors. An econometric model was used to analyze factors affecting the variability in malting barley prices, and to estimate implicit prices for plumpness and protein. The results indicate that a change may be evolving in the price determination process for malting barley. In particular, the feed grains sector has had increasingly less effect on malting barley prices in recent years.Crop Production/Industries, Marketing,