Failure demand: a concept evaluation in UK primary care

Purpose The purpose of this paper is to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. The authors assess whether the concept’s limited use is a missed opportunity to help us understand improvement priorities, given that a UK Government requirement for public service managers to report failure demand has been removed. Design/methodology/approach The authors look at the literature across the public sector and then apply the failure demand concept to the UK’s primary healthcare system. The UK National Health Service (NHS) demand data are analysed and the impact on patient care is elicited from patient interviews. Findings The study highlighted the concept’s value, showing how primary care systems often generate failure demand partly owing to existing demand and capacity management practices. This demand is deflected to other systems, such as the accident and emergency department, with a considerable detrimental impact on patient experience. Research limitations/implications More research is needed to fully understand how best to exploit the failure demand concept within wider healthcare as there are many potential barriers to its appropriate and successful application. Practical implications The authors highlight three practical barriers to using failure demand: first, demand within the healthcare system is poorly understood; second, systems improvement understanding is limited; and third, need to apply the concept for improvement and not just for reporting purposes. Originality/value The authors provide an objective and independent insight into failure demand that has not previously been seen in the academic literature, specifically in relation to primary healthcare

Clinicopathological determinants of an elevated systemic inflammatory response following elective potentially curative resection for colorectal cancer

Introduction: The postoperative systemic inflammatory response (SIR) is related to both long- and short-term outcomes following surgery for colorectal cancer. However, it is not clear which clinicopathological factors are associated with the magnitude of the postoperative SIR. The present study was designed to determine the clinicopathological determinants of the postoperative systemic inflammatory response following colorectal cancer resection. Methods: Patients with a histologically proven diagnosis of colorectal cancer who underwent elective, potentially curative resection during a period from 1999 to 2013 were included in the study (n = 752). Clinicopathological data and the postoperative SIR, as evidenced by postoperative Glasgow Prognostic Score (poGPS), were recorded in a prospectively maintained database. Results: The majority of patients were aged 65 years or older, male, were overweight or obese, and had an open resection. After adjustment for year of operation, a high day 3 poGPS was independently associated with American Society of Anesthesiologists (ASA) grade (hazard ratio [HR] 1.96; confidence interval [CI] 1.25–3.09; p = 0.003), body mass index (BMI) (HR 1.60; CI 1.07–2.38; p = 0.001), mGPS (HR 2.03; CI 1.35–3.03; p = 0.001), and tumour site (HR 2.99; CI 1.56–5.71; p < 0.001). After adjustment for year of operation, a high day 4 poGPS was independently associated with ASA grade (HR 1.65; CI 1.06–2.57; p = 0.028), mGPS (HR 1.81; CI 1.22–2.68; p = 0.003), NLR (HR 0.50; CI 0.26–0.95; p = 0.034), and tumour site (HR 2.90; CI 1.49–5.65; p = 0.002). Conclusions: ASA grade, BMI, mGPS, and tumour site were consistently associated with the magnitude of the postoperative systemic inflammatory response, evidenced by a high poGPS on days 3 and 4, in patients undergoing elective potentially curative resection for colorectal cancer

Implementing failure demand reduction as part of a demand management strategy

Police forces, like much of the UK public sector, have struggled to meet the demand placed upon them because of real-term funding cuts and increases in some types of demand. Where increases in resource are not possible, attention has to be paid to the reduction of demand or the increase in effective capacity through efficiency gains. Within the literature, ‘failure demand’ is seen as unnecessary demand, caused by errors and repeated work that could be eliminated. This article reports on the analysis of failure demand at one police force as a method of sustainably reducing demand. The findings suggest 30% of non-urgent demand entering the system could be avoided. However, not all of this avoidable demand has been eliminated so far. The article explores the necessary system changes to reduce failure demand and the management challenges to achieve effective change

Digital Entrepreneurship in China: Insight into Online Business Start-up Among Chinese University Students Based On Entrepreneurial Intention

This paper investigates the entrepreneurial intention of Chinese university students to provide insight into digital entrepreneurship. An online survey of 305 university students in Beijing was the basis for the data used to test a logistic regression model of the variables underpinning entrepreneurial intention. Factors determining whether Chinese students intend to engage in digital entrepreneurship were “family business”, “perceived motivations” (especially “Self-achievement”), and “perceived barriers” (especially “Lack of experience”). These are a subset of the antecedent factors influencing entrepreneurship more broadly. The nature of digital entrepreneurship may negate some of the factors, especially culture, that serve as barriers to entrepreneurship in the Chinese context. Although this study is limited by its quantitative methodology and focus on Chinese students attending a single university in Beijing, it contributes to knowledge regarding student engagement with digital entrepreneurship

Reducing attendances and waits in emergency departments : a systematic review of present innovations

Reducing the waits in emergency departments is important for patients and is a government priority. In order to reduce waits the whole system must be considered. The flow of patients before arrival at the emergency department determines the workload of the department. The staffing, resources and systems within the emergency department are key to providing high quality timely care. The flow of patients after leaving the emergency department until their return home will determine whether they can be discharged from the department in a timely manner. Despite the present focus on emergency care in the NHS there have been no reviews of the literature to inform the present changes to reduce waits

Failure demand: a concept evaluation in UK primary care

Purpose: Our purpose was to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. We assess whether the concept’s limited use is a missed opportunity to help us understand improvement priorities, given that a UK Government requirement for public service managers to report failure demand has been removed. Design/methodology/approach: We look at the literature across the public sector and then apply the failure demand concept to the UK’s primary healthcare system. The UK National Health Service (NHS) demand data are analysed and the impact on patient care is elicited from patient interviews. Findings: The study highlighted the concept’s value, showing how primary care systems often generate failure demand partly owing to existing demand and capacity management practices. This demand is deflected to other systems, such as the accident and emergency department, with a considerable detrimental impact on patient experience. Research implications: More research is needed to fully understand how best to exploit the failure demand concept within wider healthcare as there are many potential barriers to its appropriate and successful application. Practical implications: We highlight three practical barriers to using failure demand: (i) demand within the healthcare system is poorly understood; (ii) systems improvement understanding is limited; and (iii) need to apply the concept for improvement and not just for reporting purposes. Originality/value: We provide an objective and independent insight into failure demand that has not previously been seen in the academic literature, specifically in relation to primary healthcare

Strengthening school leadership towards improving school resiliency

“Strengthening School Leadership Toward Improving School Resiliency” was a two-year interdisciplinary multi-country development research project exploring how the quality of school leadership could be strengthened as a means of improving education quality in under-resourced environments. The primary objective of the project was to understand whether use of a specific continuous improvement approach, Improvement Science (IS), supports sustainable change in the practices of school leaders. School leaders are acknowledged to have a critical role in improving the quality of teaching and learning within schools. Continuous improvement methods such as IS offer a set of ideas, tools and practices which empower practitioners such as school leaders to take an active role in improvement, crafting a narrative which explains the improvement initiative and helping to remove obstacles and blockages in the improvement initiative, and other actions which move the institution towards its goals

Strengthening school leadership towards improved school resiliency: final technical report

''Strengthening School Leadership Towards Improving School Resiliency” was a two-year interdisciplinary multi- country development research project exploring how the quality of school leadership could be strengthened as a means of improving education quality in under-resourced environments. The primary objective of the project was to understand whether use of a specific continuous improvement approach, Improvement Science (IS), supports sustainable change in the practices of school leaders. School leaders are acknowledged to have a critical role in improving the quality of teaching and learning within schools. Continuous improvement methods such as IS offer a set of ideas, tools, and practices which empower practitioners such as school leaders to take an active role in improvement, crafting a narrative which explains the improvement initiative and helping to remove obstacles and blockages in the improvement initiative, and other actions which move the institution towards its goals. This exploratory multi-country research adopted a realistic evaluation (RE) framework to explore the use of IS with groups of school leaders in three contrasting contexts. The multidisciplinary research team collaborated with in-country partners across three continents: Chile – SUMMA (Laboratory of Education Research and Innovation for Latin America and the Caribbean); Kenya – Worldreader; the Philippines – FIT-ED (Foundation for Information Technology Education and Development). Despite the constraints of the COVID-19 pandemic in each setting, school leaders were recruited and improvement communities were established and guided to engage with the IS methodology through carrying out “Plan-Do-Study-Act” (PDSA) cycles on local challenges. Data was gathered on the experiences of the school leaders through their improvement science journeys using a range of qualitative research instruments including records of the PDSA activities. The project offers a contribution to knowledge by offering emerging findings on how an amended IS methodology might be effectively utilized by school leaders working in under-resourced contexts. To date, there has been little utilization of the Improvement Science approach in low- or medium-income contexts; relevant prior research has all been undertaken in high-income contexts. Our analysis revealed that there can be clear benefits for schools when school leaders engage with the IS approach: changes in institutional practices, attitudes, and relationships are noted when conditions are favorable. The findings draw attention to the importance of the school leader improvement communities. They enable school leaders to develop a broader vision on their work and strengthen potential for further collaborations towards common goals. These are values and behaviors which support implementation of a continuous improvement approach. Our recommendations identify a number of issues for consideration in further research and implementation of the IS approach. Specifically, it is important to encourage school leaders to embrace continuous improvement as a core part of their leadership role. This may require changes in how school leaders enact their role. Practices such as team working, more consideration of different forms of data, and active experimentation are required for successful use of the IS approach. In addition, the IS approach will only be useful with particular kinds of problems. It needs to be used for small-scale change and improvements; it is not appropriate for tackling large or complex problems. From a development perspective, the use of IS methodology in education appears to offer the potential to shift towards more equitable dialogue between education partners when problem solving. It supports movement away from implementation of external “what works” solutions in schools and towards a legitimizing of the use of locally-driven small changes or adaptations that respond to highly specific local conditions and capabilities. It moves discussion from “this isn’t being implemented properly or with sufficient intensity” to “is this the most appropriate change for my institution?” The sharing of these local improvements with peers and other actors starts to point towards ways in which school leader collaboration could be harnessed for improvements in the quality of local education provision, in particular pedagogic change. This research was undertaken in the highly fluid and dynamic environments of the pandemic; when rules and expectations were constantly shifting, and project partners (development practitioners, school leaders, and researchers) were experiencing the impact of COVID-19 in different ways. This led to a number of challenges and consequent changes in ways of working. For example, local authority stakeholders had reduced capacity to engage with the project, organizing meetings with the school leaders was difficult at times, and the IS approach required multiple team members to move outside their usual roles to become more enabling and less solution-focused

Failure demand: An evaluation of concept in UK Primary Care

Purpose: Our purpose was to assess failure demand as a lean concept that assists in waste analysis during quality improvement activity. We assess whether the concept's limited use is a missed opportunity to help understand improvement priorities, given that a UK Government requirement for public service managers to report failure demand has been removed. Design/methodology/approach: We look at the literature across the public sector and then apply the failure demand concept to the UK's primary healthcare system. The UK National Health Service (NHS) demand data are analysed and the impact on patient care is elicited from patient interviews. Findings: The study highlighted the concept's value, showing how primary care systems often generate failure demand partly owing to existing demand and capacity management practices. This demand is deflected to other systems, such as the accident and emergency department, with a considerable detrimental impact on patient experience. Research implications: More research is needed to fully understand how best to exploit the failure demand concept within wider healthcare as there are many potential barriers to its appropriate and successful application. Practical implications: We highlight three practical barriers to using failure demand: (i) poor general understanding of demand within the healthcare system; (ii) limited understanding of systems improvement; and (iii) need to apply the concept for improvement and not just for reporting purposes. Originality/value: We provide an objective and independent insight into failure demand that has not previously been seen in the academic literature, specifically in relation to primary healthcare