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The purpose of this paper is to discuss a novel life cycle approach to education for sustainable development (ESD) where the students become “design thinkers”.

A case study on the creation, development and utilisation of educational games by university students is presented. The paper discusses the case study in the context of Kolb’s experiential learning and dynamic matching model, Perry’s stages of intellectual development and Beech and Macintosh’s processual learning model. The data used were from questionnaire feedback from the pupils who played the games and students who designed the games. Further qualitative feedback was collected from local schools involved in playing the games created by the students.

Overall, the students responded positively to the assessment and would like to see more of this type of assessment. They enjoyed the creativity involved and the process of developing the games. For the majority of the skill sets measured, most students found that their skills improved slightly. Many students felt that they had learnt a lot about effectively communicating science. The school children involved in playing the student-created games found them accessible with variable degrees of effectiveness as engaging learning tools dependent on the game.

This paper contributes a new approach to ESD which incorporates learner-centred arrangements within a full life cycle of game creation, delivery, playing and back to creation. The games can be used as a tool for enhancing knowledge and influencing behaviours in school children whilst enhancing ESD capacity in schools. The assessment also helps forge important links between the academic and local communities to enhance sustainable development.

Zoe Robinson reports on recent and forthcoming developments within the National Social Inclusion Programme.

Zoe Robinson reports on recent and forthcoming developments within the National Social Inclusion Programme.

This paper aims to explore a single-institution case study of partnership working between students, the University and Students’ Union, through four student-led sustainability projects. The paper analyses the role and value of these partnerships and provides advice for other institutions on effective partnership working between these stakeholders.

A single case study of partnership working with multiple embedded units of analysis (four projects) is presented based on reflections of practitioners involved in the projects who have different roles within the University and Students’ Union.

The longevity and effectiveness of student-led projects, and disciplinary-breadth of students engaged, can be enhanced by greater collaboration with, and integration into, University and Students’ Union systems. Partnership working between different stakeholders is key to overcoming challenges and the success of student-led projects, helped by key staff “enablers”. These projects provide myriad learning opportunities for developing change agency skills, even where projects are relatively short-lived and could be seen as failures in terms of longevity.

This analysis is based solely on practitioner reflections, with limited direct quantification or qualitative data on the projects’ impacts on the students themselves.

This paper draws together the experiences and reflections of four practitioners with different roles within the University and Students’ Union across four different projects and provides advice to generate student-led sustainability projects which have longevity and impact for wider student populations and future generations of cohorts.

The new local government performance framework, in combination with the move towards greater personalisation in services, creates a radically new funding environment for housing with care and support. From the Public Service Agreement (PSA) on achieving settled accommodation for individuals at risk of exclusion, through to the impact of local joint strategic needs asessments and individual budgets, the principles and mechanisms of the new joint commissioning culture create more opportunities for providers to articulate the needs of the client group served, and to assert the case for more joined‐up and responsive services. This may require different skills and new styles of leadership at local level, and providers who have become adept at being competitors may need to re‐discover the skills of partnership. Meanwhile, new social exclusion policy frameworks are emerging for supported accommodation, which can support moves away from institutional care for those with mental health problems.

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature.

A comprehensive review of literature focussing on lean and lean healthcare was conducted.

Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings.

The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study.

The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed.

To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

As healthcare often is studied in relation to operational rather than socio-technical aspects of Lean such as teamwork, the purpose of this paper is to explore how a Swedish hospital Lean intervention was related to changes in teamwork over time.

Teamwork was measured with the Group Development Questionnaire (GDQ) employee survey during Lean implementation at three units, in 2010 (n=133) and 2011 (n=130). Qualitative data including interviews, observations and document analysis were used to characterize the Lean implementation and context. The expected teamwork change patterns were compared with GDQ data through linear regression analysis.

At Ward-I, Lean implementation was successful and teamwork improved. At Ward-II, Lean was partially implemented and teamwork improved slightly, while both Lean and teamwork deteriorated at the emergency department (ED). The regression analysis was significant at ED (p=0.02) and the Ward-II (p=0.04), but not at Ward-I (p=0.11).

Expected changes in teamwork informed by theory and qualitative data may make it possible to detect the results of a complex change.

Overall, Lean may have some impact on teamwork, if properly implemented. However, this impact may be more prominent in relation to structural and productivity issues of teamwork than group members’ relational issues. Practitioners should note that, with groups struggling with initial stages of group functioning, Lean may be very challenging.

This study focussed specifically on implications of Lean for nurse teamwork in a hospital setting using both qualitative and quantitative data. Importantly, the group functioning at the time when Lean is initiated may affect the implementation of Lean.

The purpose of this paper is to use a systems lens to assess the comparative performance of healthcare supply chains and provide guidance for their improvement.

A well-established and rigorous multi-method audit methodology, based on the uncertainty circle model, yields an objective assessment of value stream performance in eight Australasian public sector hospitals. Cause-effect analysis identifies the major barriers to achieving smooth, seamless flows. Potentially high-leverage remedial actions identified using systems thinking are examined with the aid of an exemplar case.

The majority of the healthcare value streams studied are underperforming compared with those in the European automotive industry. Every public hospital appears to be caught in the grip of vicious circles of system uncertainty, in large part being caused by problems of their own making. The single exception is making good progress towards seamless functional integration, which has been achieved by elevating supply chain management to a core competence; having a clearly articulated supply chain vision; adopting a systems approach; and, managing supplies with accurate information.

The small number of cases limits the generalisability of the findings at this time.

Hospital supply chain managers endeavouring to achieve smooth and seamless supply flows should attempt to elevate the status of supplies management within their organisation to that of a core competence, and should use accurate information to manage their value streams holistically as a set of interwoven processes. A four-level prism model is proposed as a useful framework for thus improving healthcare supply delivery systems.

Material flow concepts originally developed to provide objective assessments of value stream performance in commercial settings are adapted for use in a healthcare setting. The ability to identify exemplar organisations via a context-free uncertainty measure, and to use systems thinking to identify high-leverage solutions, supports the transfer of appropriate best practices even between organisations in dissimilar business and economic settings.

The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data.

A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services’ capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews.

The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity.

The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.