Lean and green – a systematic review of the state of the art literature

The move towards greener operations and products has forced companies to seek alternatives to balance efficiency gains and environmental friendliness in their operations and products. The exploration of the sequential or simultaneous deployment of lean and green initiatives is the results of this balancing action. However, the lean-green topic is relatively new, and it lacks of a clear and structured research definition. Thus, this paper’s main contribution is the offering of a systematic review of the existing literature on lean and green, aimed at providing guidance on the topic, uncovering gaps and inconsistencies in the literature, and finding new paths for research. The paper identifies and structures, through a concept map, six main research streams that comprise both conceptual and empirical research conducted within the context of various organisational functions and industrial sectors. Important issues for future research are then suggested in the form of research questions. The paper’s aim is to also contribute by stimulating scholars to further study this area in depth, which will lead to a better understanding of the compatibility and impact on organisational performance of lean and green initiatives. It also holds important implications for industrialists, who can develop a deeper and richer knowledge on lean and green to help them formulate more effective strategies for their deployment

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Background: The REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap. Methods: The programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses. Results: Most NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study. Conclusions: People who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery. Main limitation: Our programme included only NHS, non-secure, inpatient mental health rehabilitation services. Trial registration: Current Controlled Trials ISRCTN25898179. Funding: The NIHR Programme Grants for Applied Research programme

Addressing the nutritional needs of older people in residential care homes

Background: In the United Kingdom and Europe, malnutrition in older people is a significant problem as it predisposes to disease, impedes recovery from illness, increases mortality and is costly to society. Despite the high number of older people potentially at risk, malnutrition in care homes has been under explored. There is concern that national guidelines regarding the nutritional care of older people in residential care homes are not always implemented. Aim: This qualitative study informed by ethnography explored the factors which influence the nutritional care provided to residents in two different types of Local Authority residential care homes (providing personal care) in Wales. One home had communal dining rooms, the other had eight bedded units with their own kitchen and dining facilities. Methods: The total sample was 45 participants, comprised of 19 staff (managers, care workers and catering staff), 16 residents and 10 residents’ relatives. Mixed methods were employed including observation, individual qualitative interviews, focus groups and documentary review. The ways in which staff assessed and addressed residents’ nutritional needs is the focus of this paper.Findings and Conclusion: In both care homes, staff strove to be responsive to residents’ dietary preferences, provided person centred care and worked in partnership with residents and their families to provide nutritious food in a homely environment. However, nutritional screening to identify those at risk of malnutrition was not conducted in either home, contrary to national guidelines, but reliance was placed on ad hoc observation and monitoring. A need for further training for care home staff regarding the importance of nutrition in maintaining health in older people, use of nutritional screening and special dietary needs was identified. Shared nutrition training between health and social care staff needs to be furthered and policy implications in terms of an enhanced regulatory focus on maintaining nutritional needs in care homes are recommende

Integrating individual, work group and organizational factors: testing a multidimensional model of bullying in the nursing workplace

Aim The aim of the present study was to test a multidimensional model of bullying in the nursing workplace. Background This paper is part of a larger study of bullying in the Australian nursing workforce. While a number of studies have documented the frequency and consequences of bullying among nurses, there have been few attempts to develop integrated theoretical models that identify individual, work group and organizational factors. Method In the third stage of this sequential mixed methods study, data were collected from a randomized survey of Australian nurses. Structural equation modelling and confirmatory factor analysis on 370 completed surveys was used to test a multidimensional model of bullying. Results Organizational characteristics were confirmed to be critical antecedents of bullying, influencing both the occurrence of bullying and the resultant consequences. Conclusions The findings have important implications for the management and prevention of bullying, suggesting that, if they are to be effective, strategies to address the problem need to focus upon work group and organizational factors. Implications for nursing management The findings draw in question the usefulness of current approaches to managing bullying and will be of use to nurse managers, particularly those tasked with providing safer and more productive workplaces