Delivering and sustaining change through implementation of a lean management system : a journey towards health improvement : a thesis presented in partial fulfilment of the requirements for the degree of Master of Business Studies in Management at Massey University, Albany, New Zealand

In this ever-changing world organisations seek to be adaptive and innovative and in response they are adopting new ways of working. Approaches to managing change have been well documented and have progressed as a deeper understanding of change and the associated study of human behaviours has developed. One such methodology that emerged from the well-studied area of Lean Thinking is the Lean Management System, which aims to align direction and distribute decision-making in an organisation in order to have greater sustainability of change. This study was conducted in the pharmacy department of a large New Zealand public hospital that sought to engage their team in change from a supply-driven pharmacy model, to a model focused on medicines optimisation. To enable the change, the pharmacy department developed work practices based on a Lean Management System that had been adopted in other areas of the hospital. There is very little literature on studies that discuss the impact of Lean Management Systems in healthcare organisations, in particular a pharmacy department. The primary aim for this study is to explore the impact that a Lean Management System has on the sustainability of change in a hospital pharmacy department. Participatory Action Research was selected as the methodology to explore the two main themes of ‘Relevance’ and ‘Reactivity’ before, during and after the introduction of a Lean Management System. The data for the study was collected through a combination of focus groups, interviews and researcher reflections. Given that the researcher worked with the participants of the study to facilitate the introduction of the Lean Management System, processes were established to ensure the study was conducted in an ethical manner. The findings from the study indicate that the introduction of a Lean Management System has a positive impact on sustainability of change, as observed through an increase in the Relevance individuals had with the wider pharmacy department and a reduction in the day-to-day Reactivity team members experienced. This improvement was not consistent across all teams in the pharmacy department, in particular a difference observed in the level of Relevance between the Pharmacy Leadership Team and the ‘front line’ teams. The findings also highlight the strong connection between leadership behaviours and effectiveness of the Lean Management System. The findings can be explained by a range of literature relating to behavioural characteristics, identity theory, alignment to purpose and leadership. Implications for policy and practice are provided with the aim of guiding organisations introducing Lean Management Systems to be successful. The research identifies a number of gaps in literature and recommends that, in order to achieve greater sustainability of change, the introduction of a Lean Management System be conducted in conjunction with the development of leadership behaviours. Finally, future research is recommended focusing on the development of Lean Management Systems aligned to social networks and the impact of Organisational Identity on Lean Management Systems

Strain ageing in iron-niobium alloys

Imperial Users onl

The need to disentangle assessment and feedback in higher education

In contemporary higher education systems, the processes of assessment and feedback are often seen as coexisting activities. As a result, they have become entangled in both policy and practice, resulting in a conceptual and practical blurring of their unique purposes. In this paper, we present a critical examination of the issues created by the entanglement of assessment and feedback, arguing that it is important to ensure that the legitimate purposes of both feedback and assessment are not compromised by inappropriate conflation of the two. We situate our argument in the shifting conceptual landscape of feedback, where there is increasing emphasis on students being active players in feedback processes working with and applying information from others to future learning tasks, rather than regarding feedback as a mechanism of transmission of information by teachers. We surface and critically discuss six problems created by the entanglement of assessment and feedback: students’ focus on grades; comments justifying grades rather than support learning; feedback too late to be useful; feedback subordinated to all other processes in course design; overemphasis on documentation of feedback; and the downgrading of feedback created by requirements for anonymous marking. We then propose a series of strategies for preserving the learning function of feedback, through models that give primacy to feedback within learning cycles. We conclude by offering suggestions for research and practice that seek to engage with the challenges created by the entanglement of assessment and feedback, and that maintain the unique purposes of assessment and feedback

Exploring cultures of feedback practice: the adoption of learning-focused feedback practices in the UK and Australia

In recent years, there have been calls in the literature for the dominant model of feedback to shift away from the transmission of comments from marker to student, towards a more dialogic focus on student engagement and the impact of feedback on student learning. In the present study, we sought to gain insight into the extent to which such a shift is evident in practice, and how practice is shaped by national and disciplinary cultures. A total of 688 higher education staff from the UK and Australia completed a survey, in which we collected data pertaining to key influences on the design of feedback, and the extent to which emphasis is placed on student action following feedback. Our respondents reported that formal learning and development opportunities have less influence on feedback practice than informal learning and development, and prior experience. Australian respondents placed greater emphasis on student action following feedback than their counterparts in the UK, and were also more likely than UK respondents to judge the effectiveness of feedback by seeking evidence of its impact on student learning. We contextualise these findings within the context of disciplinary and career stage differences in our data. By demonstrating international differences in the adoption of learning-focused feedback practices, the findings indicate directions for the advancement of feedback research and practice in contemporary higher educatio

Towards tactile sensing active capsule endoscopy

Examination of the gastrointestinal(GI) tract has traditionally been performed using tethered endoscopy tools with limited reach and more recently with passive untethered capsule endoscopy with limited capability. Inspection of small intestines is only possible using the latter capsule endoscopy with on board camera system. Limited to visual means it cannot detect features beneath the lumen wall if they have not affected the lumen structure or colour. This work presents an improved capsule endoscopy system with locomotion for active exploration of the small intestines and tactile sensing to detect deformation of the capsule outer surface when it follows the intestinal wall. In laboratory conditions this system is capable of identifying sub-lumen features such as submucosal tumours.Through an extensive literary review the current state of GI tract inspection in particular using remote operated miniature robotics, was investigated, concluding no solution currently exists that utilises tactile sensing with a capsule endoscopy. In order to achieve such a platform, further investigation was made in to tactile sensing technologies, methods of locomotion through the gut, and methods to support an increased power requirement for additional electronics and actuation. A set of detailed criteria were compiled for a soft formed sensor and flexible bodied locomotion system. The sensing system is built on the biomimetic tactile sensing device, Tactip, \cite{Chorley2008, Chorley2010, Winstone2012, Winstone2013} which has been redesigned to fit the form of a capsule endoscopy. These modifications have required a $360^{o}$ cylindrical sensing surface with $360^{o}$ panoramic optical system. Multi-material 3D printing has been used to build an almost complete sensor assembly with a combination of hard and soft materials, presenting a soft compliant tactile sensing system that mimics the tactile sensing methods of the human finger. The cylindrical Tactip has been validated using artificial submucosal tumours in laboratory conditions. The first experiment has explored the new form factor and measured the device's ability to detect surface deformation when travelling through a pipe like structure with varying lump obstructions. Sensor data was analysed and used to reconstruct the test environment as a 3D rendered structure. A second tactile sensing experiment has explored the use of classifier algorithms to successfully discriminate between three tumour characteristics; shape, size and material hardness. Locomotion of the capsule endoscopy has explored further bio-inspiration from earthworm's peristaltic locomotion, which share operating environment similarities. A soft bodied peristaltic worm robot has been developed that uses a tuned planetary gearbox mechanism to displace tendons that contract each worm segment. Methods have been identified to optimise the gearbox parameter to a pipe like structure of a given diameter. The locomotion system has been tested within a laboratory constructed pipe environment, showing that using only one actuator, three independent worm segments can be controlled. This configuration achieves comparable locomotion capabilities to that of an identical robot with an actuator dedicated to each individual worm segment. This system can be miniaturised more easily due to reduced parts and number of actuators, and so is more suitable for capsule endoscopy. Finally, these two developments have been integrated to demonstrate successful simultaneous locomotion and sensing to detect an artificial submucosal tumour embedded within the test environment. The addition of both tactile sensing and locomotion have created a need for additional power beyond what is available from current battery technology. Early stage work has reviewed wireless power transfer (WPT) as a potential solution to this problem. Methods for optimisation and miniaturisation to implement WPT on a capsule endoscopy have been identified with a laboratory built system that validates the methods found. Future work would see this combined with a miniaturised development of the robot presented. This thesis has developed a novel method for sub-lumen examination. With further efforts to miniaturise the robot it could provide a comfortable and non-invasive procedure to GI tract inspection reducing the need for surgical procedures and accessibility for earlier stage of examination. Furthermore, these developments have applicability in other domains such as veterinary medicine, industrial pipe inspection and exploration of hazardous environments