Background: A quality improvement collaborative is an intensive project involving a combination of implementation strategies applied in a limited “breakthrough” time window. After an implementation project, it is generally difficult to sustain its success. In the current study, sustainability was described as maintaining an implemented innovation and its benefits over a longer period of time after the implementation project has ended. The aim of the study was to explore potentially promising strategies for sustaining the Enhanced Recovery After Surgery (ERAS) programme in colonic surgery as perceived by professionals, three to six years after the hospital had successfully finished a quality improvement collaborative. Methods: A qualitative case study was performed to identify promising strategies to sustain key outcome variables related to the ERAS programme in terms of adherence, time needed for functional recovery and hospital length of stay (LOS), as achieved immediately after implementation. Ten hospitals were selected which had successfully implemented the ERAS programme in colonic surgery (2006–2009), with success defined as a median LOS of 6 days or less and protocol adherence rates above 70%. Fourteen semi-structured interviews were held with eighteen key participants of the care process three to six years after implementation, starting with the project leader in every hospital. The interviews started by confronting them with the level of sustained implementation results. A direct content analysis with an inductive coding approach was used to identify promising strategies. The mean duration of the interviews was 37 minutes (min 26 minutes – max 51 minutes). Results: The current study revealed strategies targeting professionals and the organisation. They comprised internal audit and feedback on outcomes, small-scale educational booster meetings, reminders, changing the physical structure of the organisation, changing the care process, making work agreements and delegating responsibility, and involving a coordinator. A multifaceted self-driven promising strategy was applied in most hospitals, and in most hospitals promising strategies were suggested to sustain the ERAS programme. Conclusions: Joining a quality improvement collaborative may not be enough to achieve long-term normalisation of transformed care, and additional investments may be needed. The findings suggest that certain post-implementation strategies are valuable in sustaining implementation successes achieved after joining a quality improvement collaborative.
This paper describes some explorations on the concept of disassemblability as an important circularity indicator for products because of its severe impact on reuse value. Although usefulness of the concept for determining disassembly strategies and for improving circular product design clearly shows in earlier studies, the link with Industry 4.0 (I4.0)-related process innovation is still underexposed. For further technical development of the field of remanufacturing, research is needed on tools & training for operators, diagnostics, disassembly/repair instructions and forms of operator support. This includes the use of IoT and cobots in remanufacturing lines for automatic disassembly, sorting and recognition methods; providing guidance for operators and reduction of change-over times. A prototype for a disassembly work cell for a mobile phone has been developed together with researchers and students. This includes the removal of screws by means of a cobot using both vision & the available info in the product’s Bill-Of-Materials, the removal of covers, opening of snap fits and replacement of modules. This prototyping demonstrates that it is relatively easy to automate disassembly operations for an undamaged product, that has been designed with repairability in mind and for which product data and models are available. Process innovations like robotisation influence the disassemblability in a positive way, but current indicators like a Disassembly Index (DI) can’t reflect this properly. This study therefore concludes with suggestions for an evaluation of disassemblability by looking at the interaction between product, process and resources in a coherent way.
MULTIFILE
This paper discusses two studies - the one in a business context, the other in a university context - carried out with expert educational designers. The studies aimed to determine the priorities experts claim to employ when designing competence-based learning environments. Designers in both contexts agree almost completely on principles they feel are important. Both groups emphasized that one should start a design enterprise from the needs of the learners, instead of the content structure of the learning domain. However, unlike business designers, university designers find it extremely important to consider alternative solutions during the whole design process. University designers also say that they focus more on project plan and desired characteristics of the instructional blueprint whereas business designers report being more client-oriented, stressing the importance of "buying in" the client early in the process.
expressiveness, performance, musicians, skills, educationUsing the genre of Improvisational theatre as a basis, my research aims to design and develop instructional strategies that would help students enhance their expressive skills and achieve the flexibility to adapt their motor behavior to the musical piece. Embodying diverse characters and physicalities, as well as affective states or fictional realities through improv theatre exercises should enable them to expand their expressive range and, therefore, better convey their interpretation to their audience. Through this process, this study also seeks to gain an understanding of the effect this type of training may have on musicians' performance experience, as well as its implications in other areas of their development.
