The importance of key supplier relationship management in supply chains

Purpose: This paper investigates the impact of key supplier relationship management (KSRM) – understood as an aggregated supply chain management (SCM) process in the upstream direction – on the overall level of the execution of SCM within organizations. Methodology: A conceptual model is developed from a theoretical framework and proposes the capability to do KSRM as a mediator between internal and external SCM resources and SCM execution. A survey of 174 managers representing different supply chain stages is used to test the model through variance-based structural equation modelling. Findings: The findings reveal that external SCM resources directly affect the capability to do KSRM. Nevertheless, internal resources show a considerable indirect impact through external resources and can thus be considered an indirect determinant. The capability to do KSRM in turn impacts upon the level of SCM execution, measured in terms of the integration of business processes, directly and substantially, as well as mediating the effect between SCM resources and the level of SCM execution. Value: The main contribution of this paper is to empirically demonstrate the potential of KSRM for enhancing the level of SCM execution within organizations and consequently the level of integration in supply chains, leading to higher customer and shareholder value

Lean in healthcare: The unfilled promise?

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean ‘tools’, such as ‘kaizen blitz’ and ‘rapid improvement events’, which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the ‘tool level’. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining ‘customer value’ that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily ‘professional’ in origin but actually more ‘organisational’ and ‘managerial’ and, if not addressed could severely constrain Lean’s impact on healthcare productivity at the systems level

On the tension between standardized and customized policies in healthcare: The case of length-of-stay reduction

Hospitals increasingly adopt standardized policies as a way to improve the efficiency of healthcare delivery. One key policy has been to reduce a patient's length of stay, which is commonly perceived as an effective means of improving patient outcome, as well as reducing the cost per procedure. We put this notion to the empirical test by using a database of 183,712,784 medical records of patients in the English NHS between 1998 and 2012, studying the effects of the NHS's policy of decreasing length of stay for hernia patients. While we found it to be an effective way of reducing the cost per procedure, on aggregate, we also found that it increases the risk of readmission and of death for vulnerable and elderly patients, unduly increasing the long-term failure costs of the operation for these patient groups. Based on our findings we propose a differentiated policy to selectively decrease length of stay, which we estimate could save up to US$565 per non-emergency hernia procedure (a 19.97% reduction in the cost per procedure). We outline the implications of our findings for medical practice, and discuss the wider theoretical contributions to the wider standardization-customization debate in healthcare operations management

The influence of frontal alignment in the advanced reciprocating gait orthosis on energy cost and crutch force requirements during paraplegic gait

Reduction of energy cost and upper body load during paraplegic walking is considered to be an important criterion in future developments of walking systems. A high energy cost limits the maximum walking distance in the current devices, whereas wrist and shoulder pathology can deteriorate because of the high upper body load. A change in alignment of the mechanical brace in the frontal plane, i.e. abduction, can contribute to a more efficient gait pattern with sufficient foot clearance with less pelvic lateral sway. A decrease in pelvic lateral sway after aligning in abduction results in a shift of the centre of mass to the swing leg crutch which may result in a decrease in required crutch force on stance side to maintain foot clearance. Five paraplegic subjects were provided with a standard Advanced Reciprocating Gait Orthosis (ARGO) and an ARGO aligned in 4 different degrees of abduction (0°, 3°, 6° and 9°). After determining an optimal abduction angle for each of the subjects, a cross over design was used to compare the ARGO with the individually optimised abducted orthosis. An abduction angle between 0° and 3° was chosen as optimal abduction angle. Subjects were not able to walk satisfactory with abduction angles 6° and 9°. A significant reduction in crutch peak force on stance side was found (approx. 12% , p < 0.01) in the abducted orthosis. Reduction in crutch force time integral (15%) as well as crutch peak force on swing side (5%) was not significant. No differences in oxygen uptake as well as oxygen cost was found. We concluded that an abduction angle between 0° and 3° is beneficial with respect to upper boHy load, whereas energy requirements did not change

Lean in healthcare: the unfilled promise?

In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level. © 2011 Elsevier Ltd

Einfluss des Connective Tissue Growth Factor (CCN2) auf das posttraumatische Überleben humaner Chondrozyten im Kompressionstrauma-Modell

Arthrose (OA) ist eine bis heute nicht vollständig verstandene degenerative Gelenkerkrankung, die das gesamte Gelenk, also den Gelenkknorpel und die umgebenden Strukturen und Gewebe betrifft und für die aufgrund des fehlenden Verständnisses nur unzureichende therapeutische Optionen zur Verfügung stehen. Insbesondere biologische Therapien zur Prävention sowie zur kausalen Therapie stehen momentan noch nicht zur Verfügung. Nach (Kompressions-)Trauma kommt es im Knorpelgewebe zu einem signifikanten Zelltod durch Apoptose und Nekrose, wobei direkt nach dem Trauma Nekrose dominiert und im Verlauf die Apoptose überwiegt. Außerdem kommt es zum Verlust an Matrixbestandteilen, insbesondere sulfatierten Glykosaminoglykanen, Aggrecan sowie Kollagen Typ II. Dieser Verlust der Makromoleküle geht mit der Apoptose einher. Zelltod scheint ein relevanter Faktor der OA- Entstehung sowie der OA-Progression zu sein. FGF-2 (auch basic FGF genannt) wird endogen im Knorpelgewebe hergestellt und bindet an Perlecan, ein PG und Bestandteil der ECM, das das gebundene FGF-2 bei Belastung freisetzt. Neben der Regulation der Apoptose durch FGF-2 kommt es durch die Bindung und Aktivierung von FGF-2 an den FGFR1 über den Ras- und den PKCδ-Signalweg zu katabolen Prozessen im humanen Gelenkknorpel, wie vermehrte Produktion Matrix-abbauender Enzyme, Hemmung der Ansammlung von Matrixproteinen sowie der Proteoglykansynthese sowie Clusterbildung der Chondrozyten. CCN2 ist über die Bindung des CT-Module von CCN2 an FGF-2 in der Lage, die Aktivierung von FGFR-1 zu hemmen, was zu einer verminderten Phosphorylierung und Aktivierung des Ras-Raf-MAPK-Signalweg mit den MAPK ERK, JNK und p38 führt und in der Folge zu einer verminderten Phosphorylierung und Aktivierung von MMP-13. Zusätzlich wird die Proliferation der Chondrozyten durch Hemmung des FGFR-1 gehemmt. Folglich scheint das CT-module ein Regulator der FGF-2- und damit der Knorpelhomöostase zu sein. Demzufolge sollte es durch die Hemmung der Aktivierung des FGFR-1 über die Hemmung der MAP-Kinasen sowie des PKCδ-Signalweges zu einer Reduktion der Apoptose, verminderten Clusterbildung der Chondrozyten sowie über die Hemmung von MMP-13, ADAMTS-5 und vermehrten Expression von Aggrecan zu einer verminderten Degradierung des Knorpelgewebes kommen. In der vorliegenden Arbeit konnte ein statistisch signifikanter Zusammenhang zwischen der posttraumatischen Inkubation mit CCN2 und der Reduktion des Anteils toter Zellen nachgewiesen werden. Inkubiert man Knorpel-Discs der Superficial Zone (SZ) nach einem Kompressionstrauma mit CCN2, führt dies in den untersuchten Zeiträumen zu einer signifikanten Reduktion des Anteils toter Zellen. Die Ergebnisse legen einen direkten Zusammenhang zwischen dem Einfluss des CCN2 auf die oben beschriebenen Signalwege und der Reduktion des Anteils toter Zellen nahe. Weitere Untersuchungen bezüglich der Art des Zelltodes (Nekrose versus Apoptose) sowie RT-PCR- und Western-Blot- Untersuchungen sind notwendig, um den Einfluss auf die Signalwege durch CCN2 zu beweisen. Beim posttraumatischen Verlust an Matrixproteinen konnte nur eine Tendenz, aber kein signifikanter Zusammenhang nachgewiesen werden. Hier sind weitere Experimente, eventuell mit höherer Kompressionsbelastung, notwendig, um diesen Sachverhalt weiter zu untersuchen. Mit der vorliegenden Arbeit konnten wir einen Beitrag zum besseren Verständnis der Pathophysiologie der OA und der resultierenden Gewebezerstörung leisten und einen Grundstein für weiterführende Forschung und möglicher Therapieansätze legen. Wir konzentrierten uns in der vorliegenden Arbeit auf humanen Kniegelenksknorpel, genauer auf die weiche SZ möglichst gesunden Knorpels der distalen Femurkondylen nach Kniegelenks-Totalendoprothesen, da diese Schicht vulnerabel für Kompressionstrauma und früh im Krankheitsverlauf der OA betroffen ist