Due to the changing technological possibilities of services, the demands that society places on the level of service provided by the Dutch Central Government (DCG) are changing rapidly. To accommodate this, the Dutch government is improving its processes in such a way that they become more agile and are continuously improved. However, the DCG struggles with the implementation of improvement tools that can support this. The research described in this paper aims to deliver key factors that influence the adoption of tools that improve the agile way of working and continuous improvement at the DCG. Therefore, a literature review has been conducted, from which 24 factors have been derived. Subsequently, 9 semi structured interviews have been conducted to emphasize the perspective of employees at the DCG. In total, 7 key factors have been derived from the interviews. The interviewees consisted of both employees from departments who already worked with tools to improve agile working and continuous improvement as well as employees from departments who haven’t used such tools yet. An important insight based on this research is that the aims, way of working and scope of the improvement tools must be clear for all the involved co-workers
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Objectives: In the post-surgical setting, active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care. This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients. Methods: We used a quality improvement project following a multi-phase design. In Phase 1, an iterative method was used to combine evidence from a narrative review and professionals’ preferences. In Phase 2, the logic model underlying the program was developed guided by four steps: (1) confirm situation, intervention aim, and target population; (2) documented expected outcomes, and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review. In Phase 2, the logic model was developed and includes (1) the inputs (e.g. educational- and environmental support), (2) the ultimate outcomes (e.g. reduction of postoperative complications), (3) the intermediate outcomes (e.g. behavioural changes), and (4) immediate outcomes (e.g. improved knowledge, skills and attitude). Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards, and how we took different factors into account. The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.
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At a time when much attention is being paid to teachers’ effectiveness, there is little regard for the effectiveness of their professional support. Although professional development facilitators are frequently involved in school improvement projects, little is known about the interventions they should carry out and the effectiveness of these interventions. In this study, five facilitators’ interventions are operationalised. Multilevel regression analyses show, that the intervention “guiding the process” explains a significant part of variance in teachers’ knowledge, attitude and concerns with respect to an innovation and the degree of implementation. The interventions “team training and coaching”, “creating conditions for innovation at school level” and “individual coaching” explain a significant part of variance in teachers’ knowledge with respect to an innovation. In general, it appears that professional development facilitators have considerable influence on teachers’ knowledge and concerns and reasonable influence on teachers’ attitude and the degree of implementation.
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Purpose: To deal with an increasingly competitive environment, organizations are combining continuous improvement (CI) practices with digitalization to accrue their benefits on operational performance and achieve operational excellence. The purpose of this study was to identify the enablers and inhibitors of digitalization as part of CI projects. Design/methodology/approach: A mixed-methods sequential explanatory research design consisting of an online survey and semi-structured interviews was used to examine how digitalization technologies have been incorporated by organizations in their CI projects. Findings: Key enablers of digitalization were found to be leadership capabilities, strategic direction, stakeholder involvement, system compatibility, data quality and giving employees room to experiment. Knowledge of digitalization was found to affect all these enablers. Research limitations/implications: The empirical findings are based on a nonprobability sample of Dutch CI practitioners, limiting their generalizability. Practical implications: The empirical findings highlight the need for organizations to adopt a structured approach to implementing digitalization as part of their CI projects, starting by ensuring that the necessary knowledge and skills are either present or accessible to the organization. Originality/value: The empirical findings show that enablers of digitalization in the context of CI are strongly interlinked, and thus require a holistic approach.
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In pursuit of competitive advantage in an increasingly globalized and complex environment, organizations are turning to continuous improvement and digitalization to achieve operational excellence. Viewed through the lens of Dynamic Capabilities Theory, the similarities complementarities, and synergies of continuous improvement capability and data analytic capability are examined. Bridging the gap between theory and practice, continuous improvement routines and practices that can be harnessed to accelerate the implementation of data analytical capability are identified. These include Hoshin Kanri to link digitalization projects to organizational strategic, training to develop organizational knowledge of digitalization, problem solving teams to break knowledge silos, and the use of PDCA-type processes for adopting and monitoring the performance of digital technologies.
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Introduction: The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of “authentic” patients and caregivers in quality improvement of these predetermined pathways is in its infancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together. Methods and design: Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method. Discussion: This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving “experience experts” together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation.
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Objectives There is a broad call for change towards € new era' quality systems in healthcare, in which the focus lies on learning and improving. A promising way to establish this in general practice care is to combine audit and feedback with peer group discussion. However, it is not known what different stakeholders think of this type of quality improvement. The aim of this research was to explore the opinions of different stakeholders in general practice on peer discussion of audit and feedback and on its opportunities and risks. Second, their thoughts on transparency versus accountability, regarding this system, were studied. Design An exploratory qualitative study within a constructivist paradigm. Semistructured interviews and focus group discussions were held and coded using thematic analysis. Included stakeholders were general practitioners (GP), patients, professional organisations and insurance companies. Setting General practice in the Netherlands. Participants 22 participants were purposively sampled for eight interviews and two focus group discussions. Results Three main opportunities of peer discussion of audit and feedback were identified: deeper levels of reflection on data, adding context to numbers and more ownership; and three main risks: handling of unwilling colleagues, lacking a safe group and the necessity of patient involvement. An additional theme concerned disagreement on the amount of transparency to be offered: insurance companies and patients advocated for complete transparency on data and improvement of outcomes, while GPs and professional organisations urged to restrict transparency to giving insight into the process. Conclusions Peer discussion of audit and feedback could be part of a change movement, towards a quality system based on learning and trust, that is initiated by the profession. Creating a safe learning environment and involving patients is key herein. Caution is needed when complete transparency is asked, since it could jeopardise practitioners' reflection and learning in safety.
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Waste from raw materials has a direct influence on the final price of a product. However, since waste has no added value to products, customers are unwilling to pay for it. Reducing waste along the production process and supply chain allows companies to decrease costs and remain competitive in product prices. This research is conducted in a medical device manufacturing company located in Tijuana (Mexico). The company found a negative variation in part number 9540, a metallic foil used for hot stamping. During inventory cycle counts, the company found that they were purchasing rawer material than necessary due to a 50% of waste generated along the production process. We implemented two process improvement methodologies, namely Practical Process Improvement (PPI) and the Plan-Do-Check-Act model, to eliminate 100% of the raw material waste, specifically regarding the foil's waste. The improvement project comprised two phases: a) adjusting the parameters of the hot foil stamping machine and b) replacing the hot foil stamping machine with a pad printing machine. In our research, the PPI methodology is presented in 8 detailed stages as a simple problem-solving method, in contrast with five stages reported in other documented cases. This case study presents how a company can apply continuous improvement programs and its managerial implications, even without having a structured and defined systems for quality, such as Six Sigma or Lean Manufacturing implemented. After the two implementation phases, the improvement project led to economic savings of $\$ $ 165,000 in a year.
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Continuing professional development approaches such as professional learning communities (PLCs) could help schools to sustainably work on school improvement to meet the rapid changes in the world around us. Sustainability is achieved when the core components of the approach become a self-evident and functional part of the school (or: organizational routine), which is flexible and adaptive to ongoing work, and aimed at regular improvement. Achieving sustainability has been found to be a challenge for a lot of schools, however. Leadership is assumed to be crucial for sustainability. We studied leadership through a distributed leadership lens: all activities tied to the core work of the school that are designed by the school’s staff members to influence the motivation, knowledge, or practices of other members of the school organization were considered. As research into sustainability of professional development and leadership was scarce, this dissertation focused on the following question: What is the role of school leadership in schools that work sustainably on school improvement with PLCs? A case study design was used to gain in-depth insight into what leadership and sustainably working on school improvement with PLCs looks like in five Dutch secondary schools. The schools were intensively observed (approximately 160 hours per school), school (policy) documents were collected, social network questionnaires were administered, and the school leadership was interviewed. Based on four studies, that focused on leaders’ practices, knowledge brokerage, and beliefs, the role of school leadership appears to be threefold. They 1) adequately designed the organization for working with the PLC, 2) managed the teaching and learning program while considering the PLC, and 3) helped and supported the staff members’ development for working with the PLC. The way in which leaders carried out the triple role of leadership seemed to be related to different factors. These factors are situated at the personal, interpersonal, and school contextual levels. The dissertation shows what leadership practices were carried out in what way and provides practical implications resulting from that. The insights could inspire schools and school leadership to work sustainably on school improvement with PLCs too.
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