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This study investigates how a hospital can increase the flow of patients through its emergency department by using benchmarking and process improvement techniques borrowed from the manufacturing sector.

An in-depth case study of an Australasian public hospital utilises rigorous, multi-method data collection procedures with systems thinking to benchmark an emergency department (ED) value stream and identify the performance inhibitors.

High levels of value stream uncertainty result from inefficient processes and weak controls. Reduced patient flow arises from senior management’s commitment to simplistic government targets, clinical staff that lack basic operations management skills, and fragmented information systems. High junior/senior staff ratios aggravate the lack of inter-functional integration and poor use of time and material resources, increasing the risk of a critical patient incident.

This research is limited to a single case; hence, further research should assess value stream maturity and associated performance enablers and inhibitors in other emergency departments experiencing patient flow delays.

This study illustrates how hospital managers can use systems thinking and a context-free performance benchmarking measure to identify needed interventions and transferable best practices for achieving seamless patient flow.

This study is the first to operationalise the theoretical concept of the seamless healthcare system to acute care as defined by Parnaby and Towill (2008). It is also the first to use the uncertainty circle model in an Australasian public healthcare setting to objectively benchmark an emergency department's value stream maturity.

Company pressure for manufacturers is mounting from two angles: increasing pressure of global competition, and rapid advancements in technology such as additive manufacturing (AM) that are altering the way that goods are manufactured. The purpose of this paper is to explore the adoption process of AM within a manufacturing system and its business impact.

Research was conducted to collect empirical data at two manufacturing case companies in the North West England. Both cases are located in areas of industrial recovery using AM engineering innovation for value creation.

Early findings showed that the implementation of AM caused a shift in value propositions and the creation of additional value streams (VSs) for the case study companies. AM was shown to compliment and strengthen traditional manufacturing VSs rather than replacing them.

Limitations include the generalizability due to the number and location of case companies included in this research.

It is worthwhile to explore the opportunities that AM brings with the existing customer base as it has the potential to add unexplored and untapped value. However, managers need to be mindful of the capability and resources required to put the VS into practice.

Both cases resulted in skill retainment and development due to the implementation of AM. Hence, the innovation contributed to regional economic recovery and business survival.

This empirical research is one of the early field explorations focussing on the impact of AM on VS structures. Hence, this paper contributes to the area of technology enhanced manufacturing systems.

THE Reference Department of Paisley Central Library today occupies the room which was the original Public Library built in 1870 and opened to the public in April 1871. Since that date two extensions to the building have taken place. The first, in 1882, provided a separate room for both Reference and Lending libraries; the second, opened in 1938, provided a new Children's Department. Together with the original cost of the building, these extensions were entirely financed by Sir Peter Coats, James Coats of Auchendrane and Daniel Coats respectively. The people of Paisley indeed owe much to this one family, whose generosity was great. They not only provided the capital required but continued to donate many useful and often extremely valuable works of reference over the many years that followed. In 1975 Paisley Library was incorporated in the new Renfrew District library service.

THIS is the month when the public librarian again faces his annual estimates. Things are rarely exactly easy for him. This year may be no exception, as there will be in some places an effort to lop off the non‐essential works of local authorities. It is at this time that some librarians wish the service ceased to be local, because town councillors as a whole believe so much in the local character of government and do not realize that if they reduce on such things as libraries they are placing their own people at a disadvantage in relation to other towns. That is the soundest reason, and one that cannot too often be stressed, for some sort of imposed standard of service, which cannot be varied too greatly because of some temporary condition of local or national finance. We do not anticipate crippling reductions anywhere, but the signs for advance are not more propitious than in the bad old days. We shall be interested to hear of special cases this year, but hope that they will be few. We know that salaries cannot, at present, be greatly affected, but even librarians do not live for pay‐cheques alone; they want books, light, heat and many more things to revive, if not to improve, their service.