Daniel Meehan, Ameera Balhareth, Madhumitha Gnanamoorthy, John Burke and Deborah A. McNamara
The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources…
Abstract
Purpose
The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital.
Design/methodology/approach
A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes.
Findings
In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases.
Practical implications
Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals.
Originality/value
While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.
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Hao Li, Jialin Sun and Guotang Zhao
With the help of multi-body dynamics software UM, the paper uses Kik–Piotrowski model to simulate wheel-rail contact and Archard wear model for rail wear.
Abstract
Purpose
With the help of multi-body dynamics software UM, the paper uses Kik–Piotrowski model to simulate wheel-rail contact and Archard wear model for rail wear.
Design/methodology/approach
The CRH5 vehicle-track coupling dynamics model is constructed for the wear study of rails of small radius curves, namely 200 and 350 m in Guangzhou East EMU Depot and those 250 and 300 m radius in Taiyuan South EMU Depot.
Findings
Results show that the rail wear at the straight-circle point, the curve center point and the circle-straight point follows the order of center point > the circle-straight point > the straight-circle point. The wear on rail of small radius curves intensifies with the rise of running speed, and the wearing trend tends to fasten as the curve radius declines. The maximum rail wear of the inner rail can reach 2.29 mm, while that of the outer rail, 10.11 mm.
Originality/value
With the increase of the train passing number, the wear range tends to expand. The rail wear decreases with the increase of the curve radius. The dynamic response of vehicle increases with the increase of rail wear, among which the derailment coefficient is affected the most. When the number of passing vehicles reaches 1 million, the derailment coefficient exceeds the limit value, which poses a risk of derailment.
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Xingwen Wu, Zhenxian Zhang, Wubin Cai, Ningrui Yang, Xuesong Jin, Ping Wang, Zefeng Wen, Maoru Chi, Shuling Liang and Yunhua Huang
This review aims to give a critical view of the wheel/rail high frequency vibration-induced vibration fatigue in railway bogie.
Abstract
Purpose
This review aims to give a critical view of the wheel/rail high frequency vibration-induced vibration fatigue in railway bogie.
Design/methodology/approach
Vibration fatigue of railway bogie arising from the wheel/rail high frequency vibration has become the main concern of railway operators. Previous reviews usually focused on the formation mechanism of wheel/rail high frequency vibration. This paper thus gives a critical review of the vibration fatigue of railway bogie owing to the short-pitch irregularities-induced high frequency vibration, including a brief introduction of short-pitch irregularities, associated high frequency vibration in railway bogie, typical vibration fatigue failure cases of railway bogie and methodologies used for the assessment of vibration fatigue and research gaps.
Findings
The results showed that the resulting excitation frequencies of short-pitch irregularity vary substantially due to different track types and formation mechanisms. The axle box-mounted components are much more vulnerable to vibration fatigue compared with other components. The wheel polygonal wear and rail corrugation-induced high frequency vibration is the main driving force of fatigue failure, and the fatigue crack usually initiates from the defect of the weld seam. Vibration spectrum for attachments of railway bogie defined in the standard underestimates the vibration level arising from the short-pitch irregularities. The current investigations on vibration fatigue mainly focus on the methods to improve the accuracy of fatigue damage assessment, and a systematical design method for vibration fatigue remains a huge gap to improve the survival probability when the rail vehicle is subjected to vibration fatigue.
Originality/value
The research can facilitate the development of a new methodology to improve the fatigue life of railway vehicles when subjected to wheel/rail high frequency vibration.
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Timmy Frawley, Annabel Meehan and Aoife De Brún
The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental…
Abstract
Purpose
The purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.
Design/methodology/approach
Data were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard’s framework.
Findings
Three overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders’ ability to focus on, and advance, the quality and safety agenda.
Research limitations/implications
Typical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.
Practical implications
There is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.
Originality/value
The study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.
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Kellie B. Keeling, Evelyn Brown and John F. Kros
This work investigates a regional hospital, which has an affiliated low-acuity emergency department (ED) facility that currently struggles to meet its service level goal (85% of…
Abstract
This work investigates a regional hospital, which has an affiliated low-acuity emergency department (ED) facility that currently struggles to meet its service level goal (85% of its patients should be in the room in 60 minutes or less). A capability analysis using data from existing processes at this facility revealed that with the current processes and current level of resources, the facility is not capable of meeting existing service level goal. A simulation was developed to examine multiple alternatives that could improve patient flow at the facility. A set of scenarios were created that modified one or more of the resources such as doctors, nurses, and rooms by changing their schedules or their quantities. The impact of the response variables related to the facility’s service level goal was recorded for each scenario. Based on the results of the simulation, recommendations to the facility for alternative ways to schedule and allocate its resources in order to meet its current service level goal were given.
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Diego A. de J. Pacheco and Daniel Møller Clausen
In response to multiple disruptions, the purchasing supply management (PSM) function in construction supply chain management (CSCM) has gained prominence due to stakeholder…
Abstract
Purpose
In response to multiple disruptions, the purchasing supply management (PSM) function in construction supply chain management (CSCM) has gained prominence due to stakeholder pressures, dynamic market conditions and the need to adhere to complex sustainability, safety and health regulations and standards. However, there is a noticeable absence of empirical research on measuring and mitigating PSM vulnerabilities, especially considering the distinct challenges faced by large engineer-to-order project-oriented manufacturers. To address these issues, the purpose of this study is to develop and test a novel method to assist companies in construction supply chains in assessing and managing risks associated with sustainable procuring and sourcing materials.
Design/methodology/approach
Grounded in the literature gaps on construction PSM and a real case supply chain, the research uses the design science research (DSR) approach to develop an integrated method for assessing PSM strategies in this sector. The method integrates three essential purchasing dimensions: supply risks, profit impact and sustainability risks of materials, supported by nine subdimensions. Empirical validation took place within a multinational European construction company based in Denmark.
Findings
Findings from the supplier–buyer relationships confirmed that the developed method allows for the identification of the key components that significantly impact supplier–buyer relationships, profitability and sustainability. The research further suggests that construction supply chain managers and purchasing practitioners can use the proposed method to evaluate PSM, thus enabling them to make more informed decisions.
Practical implications
Through the utilization of the proposed artifact, construction companies can take a more proactive approach to address PSM uncertainties, thereby enhancing their competitiveness in dynamic construction supply chains.
Originality/value
The research contributes to bridging the theory and practice, providing valuable assistance for construction companies assessing and managing the PSM and supply risks within global construction value chains. This paper provides original insights for the CSCM, aiding in adopting competitive PSM strategies to improve overall supply chain performance.
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The paper aims to describe the career and contributions of Joseph Scanlon in gaining labor‐management cooperation through employee participation and sharing the gains from cost…
Abstract
Purpose
The paper aims to describe the career and contributions of Joseph Scanlon in gaining labor‐management cooperation through employee participation and sharing the gains from cost savings.
Design/methodology/approach
The paper makes use of archives and unpublished sources; correspondence with Scanlon's daughter and a previous colleague; Scanlon's writings; and secondary sources as needed.
Findings
Joseph Scanlon used his experiences to develop a plan that encouraged union‐management cooperation and workers and managers sharing gains from improved productivity. Scanlon's background is examined and how his colleagues at Massachusetts Institute of Technology, especially Douglas McGregor, provided the venue for his ideas to flourish and gain widespread acceptance. An analysis of 117 studies over a period of six decades is used to identify the conditions that appear to promote or to interfere with the Scanlon Plan.
Practical implications
The Scanlon Plan illustrates a means to promote labor‐management cooperation and a means to involve employees through sharing cost savings.
Originality/value
This is the first biographical study to use archival and unpublished sources to provide new insights into Scanlon and how his plan for cooperation and Gainsharing developed.
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Gender segregation remains a remarkably persistent feature of the workforce in all member states of the European Union (EU), regardless of variations in rates of female economic…
Abstract
Gender segregation remains a remarkably persistent feature of the workforce in all member states of the European Union (EU), regardless of variations in rates of female economic activity, the growth of equality legislation and changing values prompted by notions of social justice. However, the argument that such patterns of segregation, in particular the clustering of women in low skilled, low paid work, represents a waste of human resources has a more powerful resonance in the context of converging economic and social factors. The creation of a Single Market, chronic skill shortages and an ageing workforce have combined with a more acute awareness of social justice and climate of political correctness to put women's skill and training needs higher on the political agenda than ever before. As a consequence, the Commission of the European Communities (CEC), which arguably has a good track record in acting as a catalyst in the promotion of equal opportunities (EO) more generally, is now in a unique position to challenge the rigidities of segregation through its funding programmes for training.
Brandsford Kwame Gidigah, Kofi Agyekum and Bernard K. Baiden
Though the Public Procurement Act of Ghana makes room for specific socio-economic policies (environmental, social, economic and other policies which are intended to promote social…
Abstract
Purpose
Though the Public Procurement Act of Ghana makes room for specific socio-economic policies (environmental, social, economic and other policies which are intended to promote social and economic impact), there is no explicit definition and provision for social value as an evaluation criterion, culminating in the absence of a definition in the Act. This paper elicits the conception and understanding of social value from stakeholders in the Ghanaian construction industry.
Design/methodology/approach
The study adopted a qualitative method that relied on a semi-structured interview of 30 participants purposively drawn from Western, Western North and Central regions of Ghana. An inductive thematic analysis approach, which involved identifying repetitions, exploring similarities and differences, noting linguistic connectors, and a framework were employed to analyse the data.
Findings
The study established no single definition or explanation for social value in the construction industry in Ghana. However, it was revealed from the study that the concept of social value could be defined from the functional perspective of the definer, particularly from the perspective of a Procurement Officer, Works Engineer, and a Quantity Surveyor. A new insight from the study that differs from the body of literature is that participants equated benefits derived from physically constructed projects as social value.
Social implications
The study has implication for public administration and practice regarding the decision-making process in the construction industry in Ghana. It provides a vital awakening on social value as a criterion in evaluating construction works procurement in Ghana. The ability of participants to equate the benefits derived from executed construction projects as social value creates a new perspective on understanding the meaning of social value in the procurement of works construction.
Originality/value
The study contributes to the state-of-the-art and ongoing discourse on the concept of social value globally. The findings create an important catalyst for social value research in the Ghanaian construction industry.